Background: Ceftriaxone (CTRX) and ampicillin/sulbactam (ABPC/SBT) are recommended by various guidelines as the first-line antibiotics for community-acquired pneumonia (CAP). However, which of these antibiotics is more effective for treating non-aspiration CAP remains unclear. Methods: This study was a prospective, single-center, open-label, quasi-randomized controlled trial. Patients with adult CAP without risk for aspiration were allocated to either a CTRX or ABPC/SBT group based on the date of hospital admission. Macrolide was added to patients in each group. The primary outcome was the clinical response in the validated per-protocol (VPP) population at end of treatment (EOT). The secondary outcomes were clinical response during treatment and at end of study (EOS) in the VPP population, and mortality rate at day 30 in the modified intention-to-treat (MITT) population.
The discriminative power of CURB-65 for mortality in community-acquired pneumonia (CAP) is suspected to decrease with age. However, a useful prognostic prediction model for older patients with CAP has not been established. This study aimed to develop and validate a new scoring system for predicting mortality in older patients with CAP. We recruited two prospective cohorts including patients aged ≥ 65 years and hospitalized with CAP. In the derivation (n = 872) and validation cohorts (n = 1,158), the average age was 82.0 and 80.6 years and the 30-day mortality rate was 7.6% (n = 66) and 7.4% (n = 86), respectively. A new scoring system was developed based on factors associated with 30-day mortality, identified by multivariate analysis in the derivation cohort. This scoring system named CHUBA comprised five variables: confusion, hypoxemia (SpO2 ≤ 90% or PaO2 ≤ 60 mmHg), blood urea nitrogen ≥ 30 mg/dL, bedridden state, and serum albumin level ≤ 3.0 g/dL. With regard to 30-day mortality, the area under the receiver operating characteristic curve for CURB-65 and CHUBA was 0.672 (95% confidence interval, 0.607–0.732) and 0.809 (95% confidence interval, 0.751–0.856; P < 0.001), respectively. The effectiveness of CHUBA was statistically confirmed in the external validation cohort. In conclusion, a simpler novel scoring system, CHUBA, was established for predicting mortality in older patients with CAP.
Background
Detailed differences in clinical information between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia (CP), which is the main phenotype of SARS-CoV-2 disease, and influenza pneumonia (IP) are still unclear.
Methods
A prospective, multicenter cohort study was conducted by including patients with CP hospitalized between January and June 2020 and a retrospective cohort of patients with IP hospitalized from 2009 to 2020. We compared the clinical presentations and studied the prognostic factors of CP and IP.
Results
Compared with the IP group (n=66), in the multivariate analysis, the CP group (n=362) had a lower percentage of patients with underlying asthma or chronic obstructive pulmonary disease (p<0.01), lower neutrophil-to-lymphocyte ratio (p<0.01), lower systolic blood pressure (p<0.01), higher diastolic blood pressure (p<0.01), lower aspartate aminotransferase levels (p<0.05), higher serum sodium levels (p<0.05), and more frequent multilobar infiltrates (p<0.05). The diagnostic scoring system based on these findings showed excellent differentiation between CP and IP (area under the receiver operating characteristic curve, 0.889). Moreover, the prognostic predictors were different between CP and IP.
Conclusions
Comprehensive differences between CP and IP were revealed, highlighting the need for early differentiation between these two pneumonias in clinical settings.
We present a case report of a 92‐year‐old patient with thoracic empyema, who was successfully treated via CT‐guided insertion of a pigtail catheter. The advanced age of the patient often poses challenges in managing pyothorax due to limited physical activity and cognitive decline stemming from decreased activities of daily living. In instances where thoracic drainage is not feasible, the course of treatment is protracted and the prognosis is poor. Our case report exemplifies the successful treatment of pyothorax in a geriatric patient via CT‐guided insertion of a pigtail catheter. We believe that this educational case serves as a testament to the fact that even the most aged patients can be successfully treated with resourcefulness.
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