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1.
Medicine (Baltimore) ; 99(2): e18504, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914021

RESUMO

We aimed to evaluate the clinical significance of bacterial coexistence and the coinfection dynamics between bacteria and respiratory viruses among young children. We retrospectively analyzed clinical data from children aged < 5 years hospitalized with a community-acquired single respiratory viral infection of influenza, adenovirus, or RSV during 2 recent consecutive influenza seasons. Remnant respiratory specimens were used for bacterial PCR targeting Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.A total of 102 children were included; median age was 0.8 years and 44.1% had underlying comorbidities. Overall, 6.8% (7/102) of cases were classified as severe diseases requiring intensive care unit admission and/or mechanical ventilation and ranged from 8.8% for a patient with RSV and 7.6% for those with adenovirus to 0% for those with influenza viruses. The overall viral-bacterial codetection rate was 59.8% (61/102); M catarrhalis was the most frequent (33.3%), followed by H influenzae (31.4%). Influenza cases showed higher bacterial codetection rates (80.0%; 8/10) compared with those with adenoviruses (69.2%; 9/13) and RSV (55.7%; 44/79). S pneumoniae and H influenzae codetections were associated with reduced severity (aOR, 0.24; 95% CI, 0.07-0.89), and reduced risk of wheezing (aOR, 0.36; 95% CI, 0.13-0.98), respectively.We observed the interactions between respiratory viruses and bacteria and the clinical significance of viral-bacterial coexistence in upper airway on disease severity. Future study will be necessary to elucidate the active interactions between different viruses and bacteria and give clues to risk stratified strategy in the management of respiratory infections among young children.


Assuntos
Adenoviridae/isolamento & purificação , Haemophilus influenzae/isolamento & purificação , Infecções Respiratórias/microbiologia , Infecções Respiratórias/virologia , Infecções por Adenoviridae/diagnóstico , Infecções por Adenoviridae/virologia , Bactérias/genética , Pré-Escolar , Coinfecção/microbiologia , Coinfecção/virologia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/virologia , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Influenza Humana/diagnóstico , Influenza Humana/virologia , Masculino , Prevalência , Sons Respiratórios/diagnóstico , Sons Respiratórios/etiologia , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/virologia , Vírus Sinciciais Respiratórios/genética , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Staphylococcus aureus/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificação , Vírus/genética
2.
BMC Infect Dis ; 19(1): 973, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31730464

RESUMO

BACKGROUND: Diabetes is one of the underlying risk factors for developing community-acquired pneumonia (CAP). The high prevalence of diabetes among population and the rising incidence of this illness, converts it as an important disease to better control and manage, to prevent its secondary consequences as CAP. The objective of this research is to describe the characteristics of the patients with diabetes and the differences with the no diabetes who have had an episode of CAP in the context of the primary care field. METHODS: A retrospective, observational study in adult patients (> 18 years-old) who suffer from CAP and attended at primary care in Spain between 2009 and 2013 was developed using the Computerized Database for Pharmacoepidemiological Studies in Primary Care (BIFAP). We carried out a descriptive analysis of the first episodes of CAP, in patients with or without diabetes as comorbidity. Other morbidity (CVA, Anaemia, Arthritis, Asthma, Heart disease, Dementia, Depression, Dysphagia, Multiple sclerosis, Epilepsy, COPD, Liver disease, Arthrosis, Parkinson's disease, Kidney disease, HIV) and life-style factors were also included in the study. RESULTS: A total of 51,185 patients were included in the study as they suffer from the first episode of CAP. Of these, 8012 had diabetes as comorbidity. There were differences between sex and age in patients with diabetes. Patients without diabetes were younger, and had less comorbidities including those related to lifestyles such as smoking, alcoholism, social and dental problems than patients with diabetes. CONCLUSIONS: Patients who developed an episode of CAP with diabetes have more risk factors which could be reduced with an appropriate intervention, including vaccination to prevent successive CAP episodes and hospitalization. The burden of associated factors in these patients can produce an accumulation of risk. Health care professional should know this for treating and control these patients in order to avoid complications. Diabetes and those other risk factors associated could be reduced with an appropriate intervention, including vaccination to prevent the first and successive CAP episodes and the subsequent hospitalization in severe cases.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Complicações do Diabetes/diagnóstico , Pneumonia/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/complicações , Comorbidade , Complicações do Diabetes/complicações , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Atenção Primária à Saúde , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Espanha
3.
BMC Infect Dis ; 19(1): 835, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601192

RESUMO

BACKGROUND: Increasing number of hospitalized children with community acquired pneumonia (CAP) is co-detected with Mycoplasma pneumoniae (Mp). The clinical characteristics and impact of Mp co-detected with other bacterial and/or viral pathogens remain poorly understood. The purpose of this study was to evaluate the demographic and clinical features of CAP children with Mp mono-detection and Mp co-detection. METHODS: A total of 4148 hospitalized children with CAP were recruited from January to December 2017 at the Children's Hospital of Hebei Province, affiliated to Hebei Medical University. A variety of respiratory viruses, bacteria and Mp were detected using multiple modalities. The demographic and clinical features of CAP children with Mp mono-detection and Mp co-detection were recorded and analyzed. RESULTS: Among the 110 CAP children with Mp positive, 42 (38.18%) of them were co-detected with at least one other pathogen. Co-detection was more common among children aged ≤3 years. No significant differences were found in most clinical symptoms, complications, underlying conditions and disease severity parameters among various etiological groups, with the following exceptions. First, prolonged duration of fever, lack of appetite and runny nose were more prevalent among CAP children with Mp-virus co-detection. Second, Mp-virus (excluding HRV) co-detected patients were more likely to present with prolonged duration of fever. Third, patients co-detected with Mp-bacteria were more likely to have abnormal blood gases. Additionally, CAP children with Mp-HRV co-detection were significantly more likely to report severe runny nose compared to those with Mp mono-detection. CONCLUSION: Mp co-detection with viral and/or bacterial pathogens is common in clinical practice. However, there are no apparent differences between Mp mono-detection and Mp co-detections in terms of clinical features and disease severity.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/diagnóstico , Bactérias/isolamento & purificação , Líquido da Lavagem Broncoalveolar/microbiologia , Criança , Criança Hospitalizada , Pré-Escolar , Infecções Comunitárias Adquiridas/microbiologia , DNA Bacteriano/metabolismo , Feminino , Humanos , Lactente , Masculino , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/microbiologia , Prevalência , Estudos Prospectivos , Vírus/isolamento & purificação
4.
Pneumologie ; 73(10): 605-616, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31622999

RESUMO

Pneumonia belongs to the most frequent and most deadly infectious diseases worldwide. It represents an increasing problem for the aging population. The incidence and mortality rises with every decade. The clinical presentation of pneumonia differs between elderly and younger patients. Multiple factors including functional status (self-dependency and immobilization), comorbidities, immunosenescence, nutritional status, swallowing disorders have to be accounted for. Pneumonia in the elderly has to be differentiated from nursing home acquired pneumonia. Diagnosis of pneumonia of the elderly demands special attention as the diagnostic value of common biomarkers and prognostic scores is different.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Pneumonia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/diagnóstico , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Estado Nutricional , Pneumonia/diagnóstico
5.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(9): 868-875, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31506144

RESUMO

OBJECTIVE: To study the significance of plasma neutrophil extracellular trap (NET) and its markers in the diagnosis of community-acquired pneumonia (CAP) in children. METHODS: A total of 160 children with CAP were enrolled as the CAP group, and 50 healthy children were enrolled the control group. According to disease severity, the CAP group was further divided into a mild CAP subgroup with 137 children and a severe CAP subgroup with 23 children. According to the pathogen, the CAP group was further divided into a bacterial pneumonia subgroup with 78 children, a Mycoplasma pneumonia subgroup with 35 children, and a viral pneumonia subgroup with 47 children. The levels of plasma NET and its markers [antibacterial peptide (LL-37), extracellular free DNA (cfDNA), and deoxyribonuclease I (DNase I)] were measured. Receiver operating characteristic (ROC) curve was used to analyze the value of each index in diagnosing CAP and assessing its severity. RESULTS: Compared with the control group, the CAP group had significant increases in the levels of NET, LL-37, and cfDNA and a significant reduction in the activity of DNase I (P<0.05). Compared with the mild CAP subgroup, the severe CAP subgroup had significantly higher levels of NET, LL-37 and cfDNA and a significantly lower activity of DNase I (P<0.05). There were no significant differences in the levels of NET, LL-37, and cfDNA and the activity of DNase I among the bacterial pneumonia, Mycoplasma pneumonia, and viral pneumonia subgroups (P>0.05). In the CAP group, plasma NET levels were positively correlated with white blood cell count (WBC), percentage of neutrophils, and serum levels of C-reactive protein (CRP), procalcitonin and tumor necrosis factor-α (r=0.166, 0.168, 0.275, 0.181 and 0.173 respectively, P<0.05); LL-37 and cfDNA levels were positively correlated with WBC (r=0.186 and 0.338 respectively, P<0.05) and CRP levels (r=0.309 and 0.274 respectively, P<0.05); the activity of DNase I was negatively correlated with CRP levels (r=-0.482, P<0.05). The ROC curve analysis showed that NET, LL-37, cfDNA, and DNase I had an area under the ROC curve (AUC) of 0.844, 0.648, 0.727, and 0.913 respectively in the diagnosis of CAP, with optimal cut-off values of 182.89, 46.26 ng/mL, 233.13 ng/mL, and 0.39 U/mL respectively, sensitivities of 88.12%, 35.63%, 54.37%, and 91.25% respectively, and specificities of 74.00%, 92.00%, 86.00%, and 76.00% respectively. In the assessment of the severity of CAP, NET, LL-37, cfDNA, and DNase I had an AUC of 0.873, 0.924, 0.820, and 0.778 respectively, with optimal cut-off values of 257.7, 49.11 ng/mL, 252.54 ng/mL, and 0.29 U/mL respectively, sensitivities of 83.21%, 86.96%, 78.26%, and 95.65% respectively, and specificities of 78.26%, 83.94%, 76.64%, and 56.93% respectively. CONCLUSIONS: Plasma NET and its related markers have a certain value in diagnosing CAP and assessing its severity in children.


Assuntos
Infecções Comunitárias Adquiridas , Armadilhas Extracelulares , Pneumonia , Biomarcadores , Proteína C-Reativa , Criança , Infecções Comunitárias Adquiridas/diagnóstico , Diagnóstico Precoce , Humanos , Curva ROC
6.
BMC Infect Dis ; 19(1): 761, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477059

RESUMO

BACKGROUND: Aspiration pneumonia is a serious problem among elderly patients; it is caused by many risk factors including dysphagia, poor oral hygiene, malnutrition, and sedative medications. The aim of this study was to define a convenient procedure to objectively evaluate the risk of aspiration pneumonia in the clinical setting. METHODS: This prospective study included an aspiration pneumonia (AP) group, a community-acquired pneumonia (CAP) group, and a control (Con) group (patients hospitalized for lung cancer chemotherapy). We used the Oral Health Assessment Tool (OHAT), which assesses oral hygiene, and evaluated performance status, body mass index, serum albumin levels, substance P values in plasma, and oral bacterial counts. RESULTS: The oral health as assessed by the OHAT of the aspiration pneumonia group was significantly impaired compared with that of the CAP group and the control (5.13 ± 0.18, 4.40 ± 0.26, 3.90 ± 0.22, respectively; p < 0.05). The oral bacterial count in the aspiration pneumonia group (7.20 ± 0.11) was significantly higher than that in the CAP group (6.89 ± 0.12), consistent with the OHAT scores. Oral bacterial count was significantly reduced by oral care. CONCLUSIONS: OHAT and oral bacterial counts can be a tool to assess the requirement of taking oral care and other preventive procedures in patients at high risk of aspiration pneumonia.


Assuntos
Bactérias/isolamento & purificação , Biomarcadores/sangue , Avaliação Geriátrica/métodos , Mucosa Bucal/microbiologia , Pneumonia Aspirativa/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Estudos de Casos e Controles , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Masculino , Microbiota/fisiologia , Pessoa de Meia-Idade , Higiene Bucal , Projetos Piloto , Pneumonia Aspirativa/sangue , Pneumonia Aspirativa/microbiologia , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco
7.
BMC Infect Dis ; 19(1): 713, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409318

RESUMO

BACKGROUND: Management of partially-treated, community-acquired bacterial meningitis (PCBM) is commonly compromised by lack of microbiological diagnosis. We aimed to analyze the impact of FilmArray Meningitis-Encephalitis (FA-ME) PCR on the management of PCBM. METHODS: Comparison of treatment variables of PCBM cases between two periods, before (6.5 years, control group) and after (2 years, study group) the application of FA-ME PCR assay. RESULTS: The total duration of antimicrobial treatment in the study group (n = 8) was significantly shorter than the control group (n = 23) (9.5 ± 3.7 days vs. 15.2 ± 5 days, p = 0.007). The percentage of narrow-spectrum regimens was significantly higher in the study group (78 ± 11% vs. 40 ± 9%, p = 0.03). There was a significant difference in implementation of antimicrobial chemoprophylaxis for close contacts (4/8 (50%) vs. 1/23 (4%), p = 0.01). CONCLUSIONS: The use of FA-ME PCR provides significant benefits in the management of PCBM by shortening duration of antibiotic treatment, increasing the use of narrow-spectrum regimens, and allowing proper administration of antimicrobial chemoprophylaxis. TRIAL REGISTRATION: The study was approved and retrospectively registered by the Tel-Aviv Sourasky Medical Center ( 0378-17-TLV , 10/17/2017) and Rabin Medical Center ( 0270-18-RMC , 11/11/2018) Ethics committees and conforms to recognized standards.


Assuntos
Encefalite/diagnóstico , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Reação em Cadeia da Polimerase/métodos , Adulto , Antibacterianos/uso terapêutico , Quimioprevenção , Estudos de Coortes , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/prevenção & controle , Encefalite/genética , Feminino , Humanos , Israel , Masculino , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/prevenção & controle , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
8.
J Korean Med Sci ; 34(34): e228, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31456383

RESUMO

The susceptibility of Escherichia coli from community onset urinary tract infection (UTI) was evaluated by dividing community onset UTI into the simple community acquired-UTI (CA-UTI) and healthcare associated UTI (HCA-UTI) groups for a period of 10 years. The susceptibility of E. coli to most antibiotics, except amikacin and imipenem, continued to decrease. In the CA-UTI group, the susceptibility to cefotaxime was 88% in 2015, but rapidly decreased to 79.3% in 2017. The susceptibility to cefepime and piperacillin-tazobactam were 88.8% and 90.5% in 2017, respectively. In the HCA-UTI group, the susceptibility to most antibiotics markedly decreased to less than 60% by 2017. The incidence of ESBL-producing E. coli increased to 23.3% in the CA-UTI group in 2017.


Assuntos
Antibacterianos/farmacologia , Infecções Comunitárias Adquiridas/microbiologia , Escherichia coli/efeitos dos fármacos , Infecções Urinárias/microbiologia , Cefepima/farmacologia , Infecções Comunitárias Adquiridas/diagnóstico , Escherichia coli/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Combinação Piperacilina e Tazobactam/farmacologia , República da Coreia , Centros de Atenção Terciária , Infecções Urinárias/diagnóstico
9.
Artigo em Chinês | MEDLINE | ID: mdl-31446714

RESUMO

Summary A 29-year-old negro woman was admitted with external nasal pain and swelling for 5 weeks. The incision and drainage was done and a few of pus were drained out. CT scan showed the possibility of infectious lesions with nasal soft tissue swelling and increased density. The diagnosis was external nasal cellulitis, and the causative bacteria were enterobacter cloacae.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Nariz/microbiologia , Adulto , Celulite (Flegmão)/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos
12.
Rev Esp Quimioter ; 32(4): 400-409, 2019 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-31345006

RESUMO

The consensus paper for the implementation and development of the sepsis code, finished in April 2017 is presented here. It was adopted by the Regional Office of Health as a working document for the implementation of the sepsis code in the Community of Madrid, both in the hospital setting (acute, middle and long-stay hospitals) and in Primary Care and Out-of-Hospital Emergency Services. It is now published without changes with respect to the original version, having only added the most significant bibliographical references. The document is divided into four parts: introduction, initial detection and assessment, early therapy and organizational recommendations. In the second to fourth sections, 25 statements or proposals have been included, agreed upon by the authors after several face-to-face meetings and an extensive "online" discussion. The annex includes nine tables that are intended as a practical guide to the activation of the sepsis code. Both the content of the recommendations and their formal writing have been made taking into account their applicability in all areas to which they are directed, which may have very different structural and functional characteristics and features, so that we have deliberately avoided a greater degree of concretion: the objective is not that the sepsis code is organized and applied identically in all of them, but that the health resources work in a coordinated manner aligned in the same direction.


Assuntos
Consenso , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/terapia , Tratamento de Emergência , Escores de Disfunção Orgânica , Sepse/diagnóstico , Sepse/terapia , Antibacterianos/uso terapêutico , Biomarcadores/análise , Lista de Checagem , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/terapia , Tomada de Decisões Gerenciais , Diagnóstico Precoce , Serviços Médicos de Emergência/métodos , Medicina Baseada em Evidências , Humanos , Norepinefrina/uso terapêutico , Equipe de Assistência ao Paciente/organização & administração , Espanha , Vasoconstritores/uso terapêutico
13.
Medicine (Baltimore) ; 98(26): e16248, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261589

RESUMO

INTRODUCTION: Community-acquired (CA) carbapenem-susceptible Acinetobacter baumannii (CSAB) enterogenic sepsis is very rare but has a high mortality. Although CA A. baumannii bloodstream infections have been known to develop from respiratory tract, urinary tract, and intravenous device-related infections, CA A. baumannii bloodstream infections from the gastrointestinal tract have not yet been reported. PATIENT CONCERNS: A 73-year-old male with the chief presentation of gastrointestinal symptoms was initially diagnosed with acute gastroenteritis and showed poor clinical response to empirical antibiotic therapy. DIAGNOSES: The diagnosis of CSAB enterogenic sepsis was established based on results of blood culture, elevated serum procalcitonin level, and specific hemodynamic changes related to septic shock. INTERVENTIONS: The patient initially received empirical antibiotic treatment (cefodizime 2.0 q12 hours plus moxifloxacin 0.4 qd); then, treatment was changed to the conventional dose of carbapenem (imipenem 0.5 q6 hour). OUTCOMES: Finally, CSAB was eliminated from the bloodstream, and the patient was discharged. LESSONS: Although severe, CA CSAB enterogenic sepsis is often misdiagnosed because of its clinical rarity. Early diagnosis and appropriate initial empirical antibiotic therapy are crucial for treating such cases.


Assuntos
Infecções por Acinetobacter/diagnóstico , Acinetobacter baumannii/efeitos dos fármacos , Carbapenêmicos/farmacologia , Sepse/diagnóstico , Infecções por Acinetobacter/tratamento farmacológico , Idoso , Carbapenêmicos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Humanos , Enteropatias/diagnóstico , Enteropatias/tratamento farmacológico , Enteropatias/microbiologia , Masculino , Testes de Sensibilidade Microbiana , Sepse/tratamento farmacológico
14.
Monaldi Arch Chest Dis ; 89(2)2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170776

RESUMO

Acute fibrinous organizing pneumonia (AFOP) is a rare, non-infective lung pathology histologically characterized by patchy distribution of intra-alveolar fibrin "balls" and organizing pneumonia. It needs to be differentiated from other forms of acute pneumonia like community acquired pneumonia (CAP) because the treatment modalities are contrastingly different. Interesting case of a 45-year-old male initially suspected as a case of acute bacterial pneumonia but finally diagnosed as case of AFOP, is being reported. Initial empirical antimicrobial therapy was ineffective, and the main treatment to which the patient responded was corticosteroids.


Assuntos
Corticosteroides/administração & dosagem , Infecções Comunitárias Adquiridas/diagnóstico , Pneumonia/diagnóstico , Doença Aguda , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/tratamento farmacológico , Pneumonia/fisiopatologia , Pneumonia Bacteriana/diagnóstico
15.
Biomed Res Int ; 2019: 1701276, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31183362

RESUMO

Community-acquired pneumonia (CAP) is a dangerous disease caused by a spectrum of bacterial and viral pathogens. The choice of specific therapy and the need for hospitalization or transfer to the intensive care unit are determined by the causative agent and disease severity. The microbiological analysis of sputum largely depends on the quality of the material obtained. The prediction of severity and the duration of therapy are determined individually, and existing prognostic scales are used generally. This review examines the possibilities of using specific serological biomarkers to detect the bacterial or viral aetiology of CAP and to assess disease severity. Particular emphasis is placed on the use of biomarker signatures and the discovery of biomarker candidates for a single multiplex analysis.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Escarro/metabolismo , Biomarcadores/metabolismo , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/metabolismo , Feminino , Hospitalização , Humanos , Masculino , Pneumonia/diagnóstico , Pneumonia/metabolismo
16.
Br J Gen Pract ; 69(684): e444-e453, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31208974

RESUMO

BACKGROUND: The overall clinical impression ('clinical gestalt') is widely used for diagnosis but its accuracy has not been systematically studied. AIM: To determine the accuracy of clinical gestalt for the diagnosis of community-acquired pneumonia (CAP), acute rhinosinusitis (ARS), acute bacterial rhinosinusitis (ABRS), and streptococcal pharyngitis, and to contrast it with the accuracy of clinical decision rules (CDRs). DESIGN AND SETTING: Systematic review and meta-analysis of outpatient diagnostic accuracy studies in ambulatory care. METHOD: PubMed and Google were searched for studies in outpatients that reported sufficient data to calculate accuracy of the overall clinical impression and that used the same reference standard. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), and measures of accuracy calculated using bivariate meta-analysis. RESULTS: The authors identified 16 studies that met the inclusion criteria. The summary estimates for the positive (LR+) and negative likelihood ratios (LR-) were LR+ 7.7, 95% confidence interval (CI) = 4.8 to 11.5, and LR- 0.54, 95% CI = 0.42 to 0.65 for CAP in adults, LR+ 2.7, 95% CI = 1.1 to 4.3 and LR- 0.63, 95% CI = 0.20 to 0.98 for CAP in children, LR+ 3.0, 95% CI = 2.1 to 4.4 and LR- 0.37, 95% CI = 0.29 to 0.46 for ARS in adults, LR+ 3.9, 95% CI = 2.4 to 5.9 and LR- 0.33, 95% CI = 0.20 to 0.50 for ABRS in adults, and LR+ 2.1, 95% CI = 1.6 to 2.8 and LR- 0.47, 95% CI = 0.36 to 0.60 for streptococcal pharyngitis in adults and children. The diagnostic odds ratios were highest for CAP in adults (14.2, 95% CI = 9.0 to 21.0), ARS in adults (8.3, 95% CI = 4.9 to 13.1), and ABRS in adults (13.0, 95% CI = 5.0 to 27.0), as were the C-statistics (0.80, 0.77, and 0.84 respectively). CONCLUSION: The accuracy of the overall clinical impression compares favourably with the accuracy of CDRs. Studies of diagnostic accuracy should routinely include the overall clinical impression in addition to individual signs and symptoms, and research is needed to optimise its teaching.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Faringite/diagnóstico , Pneumonia/diagnóstico , Rinite/diagnóstico , Sinusite/diagnóstico , Infecções Estreptocócicas/diagnóstico , Doença Aguda , Humanos , Razão de Chances , Sensibilidade e Especificidade
17.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31217309

RESUMO

BACKGROUND: Previous studies examining bacteremia in hospitalized children with pneumonia are limited by incomplete culture data. We sought to determine characteristics of children with bacteremic pneumonia using data from a large prospective study with systematic blood culturing. METHODS: Children <18 years hospitalized with pneumonia and enrolled in the multicenter Etiology of Pneumonia in the Community study between January 2010 and June 2012 were eligible. Bivariate comparisons were used to identify factors associated with bacteremia. Associations between bacteremia and clinical outcomes were assessed by using Cox proportional hazards regression for length of stay and logistic regression for ICU admission and invasive mechanical ventilation or shock. RESULTS: Blood cultures were obtained in 2143 (91%) of 2358 children; 46 (2.2%) had bacteremia. The most common pathogens were Streptococcus pneumoniae (n = 23, 50%), Staphylococcus aureus (n = 6, 13%), and Streptococcus pyogenes (n = 4, 9%). Characteristics associated with bacteremia included male sex, parapneumonic effusion, lack of chest indrawing or wheezing, and no previous receipt of antibiotics. Children with bacteremia had longer lengths of stay (median: 5.8 vs 2.8 days; adjusted hazard ratio: 0.79 [0.73-0.86]) and increased odds of ICU admission (43% vs 21%; adjusted odds ratio: 5.21 [3.82-6.84]) and invasive mechanical ventilation or shock (30% vs 8%; adjusted odds ratio: 5.28 [2.41-11.57]). CONCLUSIONS: Bacteremia was uncommonly detected in this large multicenter cohort of children hospitalized with community-acquired pneumonia but was associated with severe disease. S pneumoniae was detected most often. Blood culture was of low yield in general but may have greater use in those with parapneumonic effusion and ICU admission.


Assuntos
Bacteriemia/epidemiologia , Pneumonia Bacteriana/epidemiologia , Adolescente , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Bacteriemia/terapia , Hemocultura , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/terapia , Cuidados Críticos , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/terapia , Prevalência , Modelos de Riscos Proporcionais , Estudos Prospectivos , Respiração Artificial , Fatores de Risco , Resultado do Tratamento , Estados Unidos/epidemiologia
19.
BMC Infect Dis ; 19(1): 403, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077143

RESUMO

BACKGROUND: Implementation of sputum Gram stain in the initial assessment of community-acquired pneumonia (CAP) patients is still controversial. We performed a systematic review and meta-analysis to investigate the usefulness of sputum Gram stain for defining the etiologic diagnosis of CAP in adult patients. METHODS: We systematically searched the Medline, Embase, Science Direct, Scopus and LILACS databases for full-text articles. Relevant studies were reviewed by at least three investigators who extracted the data, pooled them using a random effects model, and carried out quality assessment. For each bacterium (Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Gram-negative bacilli), pooled sensitivity, specificity, positive and negative likelihood ratios were reported. RESULTS: After a review of 3539 abstracts, 20 articles were included in the present meta-analysis. The studies included yielded 5619 patients with CAP. Pooled sensitivity and pooled specificity of sputum Gram stain were 0.59 (95% CI, 0.56-0.62) and 0.87 (95% CI, 0.86-0.89) respectively for S. pneumoniae, 0.78 (95% CI, 0.72-0.84) and 0.96 (95% CI, 0.94-0.97) for H. influenzae, 0.72 (95% CI, 0.53-0.87) and 0.97 (95% CI, 0.95-0.99) for S. aureus, and 0.64 (95% CI, 0.49-0.77) and 0.99 (95% CI, 0.97-0.99) for Gram-negative bacilli. CONCLUSION: Sputum Gram stain test is sensitive and highly specific for identifying the main causative pathogens in adult patients with CAP. TRIAL REGISTRATION: This study has been registered at PROSPERO International prospective register of systematic reviews under registration no. CRD42015015337 .


Assuntos
Bactérias/isolamento & purificação , Infecções Comunitárias Adquiridas/diagnóstico , Violeta Genciana , Fenazinas , Pneumonia/diagnóstico , Escarro/microbiologia , Coloração e Rotulagem , Bactérias/classificação , Infecções Comunitárias Adquiridas/microbiologia , Haemophilus influenzae , Humanos , Pneumonia/microbiologia , Staphylococcus aureus , Streptococcus pneumoniae
20.
BMC Infect Dis ; 19(1): 423, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092207

RESUMO

BACKGROUND: Determining the etiology of pneumonia is essential to guide public health interventions. Diagnostic test results, including from polymerase chain reaction (PCR) assays of upper respiratory tract specimens, have been used to estimate prevalence of pneumococcal pneumonia. However limitations in test sensitivity and specificity and the specimen types available make establishing a definitive diagnosis challenging. Prevalence estimates for pneumococcal pneumonia could be biased in the absence of a true gold standard reference test for detecting Streptococcus pneumoniae. METHODS: We conducted a case control study to identify etiologies of community acquired pneumonia (CAP) from April 2014 through August 2015 in Thailand. We estimated the prevalence of pneumococcal pneumonia among adults hospitalized for CAP using Bayesian latent class models (BLCMs) incorporating results of real-time polymerase chain reaction (qPCR) testing of upper respiratory tract specimens and a urine antigen test (UAT) from cases and controls. We compared the prevalence estimate to conventional analyses using only UAT as a reference test. RESULTS: The estimated prevalence of pneumococcal pneumonia was 8% (95% CI: 5-11%) by conventional analyses. By BLCM, we estimated the prevalence to be 10% (95% CrI: 7-16%) using binary qPCR and UAT results, and 11% (95% CrI: 7-17%) using binary UAT results and qPCR cycle threshold (Ct) values. CONCLUSIONS: BLCM suggests a > 25% higher prevalence of pneumococcal pneumonia than estimated by a conventional approach assuming UAT as a gold standard reference test. Higher quantities of pneumococcal DNA in the upper respiratory tract were associated with pneumococcal pneumonia in adults but the addition of a second specific pneumococcal test was required to accurately estimate disease status and prevalence. By incorporating the inherent uncertainty of diagnostic tests, BLCM can obtain more reliable estimates of disease status and improve understanding of underlying etiology.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Pneumopatias/diagnóstico , Adulto , Idoso , Antígenos de Bactérias/urina , Teorema de Bayes , Estudos de Casos e Controles , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/patologia , DNA Bacteriano/genética , DNA Bacteriano/metabolismo , Feminino , Humanos , Pneumopatias/epidemiologia , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Nasofaringe/microbiologia , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/isolamento & purificação , Tailândia/epidemiologia
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