Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia

Fee, Christopher; Maughan, Brandon C.; Perkins, John C.; Wolf, Stephen J.; Byyny, Richard L.; Carpenter, Christopher R.; Diercks, Deborah B.; Gemme, Seth R.; Gerardo, Charles J.; Godwin, Steven A.; Hahn, Sigrid A.; Hatten, Benjamin W.; Haukoos, Jason S.; Hickey, Sean M.; Kaji, Amy; Kwok, Heemun; Lo, Bruce M.; Mace, Sharon E.; Nazarian, Devorah J.; Promes, Susan B.; Shah, Kaushal; Shih, Richard D.; Smith, Michael D.; Thiessen, Molly E.W.; Tomaszewski, Christian; Valente, Jonathan H.; Wall, Stephen P.; Winger, Justin; Cantrill, Stephen V.; Hirshon, Jon Mark; Mims, Mandie; Schulz, Travis

doi:10.1016/j.annemergmed.2020.10.024

Cited by 7 publications

(7 citation statements)

References 96 publications

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“…Procalcitonin is currently Food and Drug Administration approved as an aid for 28-day all-cause mortality prediction based on the difference between two measurements performed on day 0 or 1 and day 4 after a clinical diagnosis of sepsis ( 35 ). However, PCT shows limited clinical utility when used as a standalone test for prognosis ( 13 , 36 ), and the SSC guidelines do not recommend its use for either risk prediction or to guide initiation of antibiotic therapy ( 6 ). A rapid gene expression–based severity score may therefore provide an important advantage given its use of a single measurement at the time of patient presentation, resulting in more rapidly actionable results.…”

Section: Discussionmentioning

confidence: 99%

“…Several groups have explored the utility of clinical scoring systems (7)(8)(9), laboratory biomarkers (10)(11)(12)(13), electronic alert systems (1,5,14,15), and machine learning algorithms (16)(17)(18)(19) to improve stratification for sepsis. Despite general advances in this area, current performance and turnaround time of these tools are largely insufficient to support use in routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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A 29-Mrna Host Response Whole-Blood Signature Improves Prediction of 28-Day Mortality and 7-Day Intensive Care Unit Care in Adults Presenting to the Emergency Department With Suspected Acute Infection and/or Sepsis

Kostaki

Wacker²,

Safarika

et al. 2022

Shock

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Background: Risk stratification of emergency department patients with suspected acute infections and/or suspected sepsis remains challenging. We prospectively validated a 29–messenger RNA host response classifier for predicting severity in these patients. Methods: We enrolled adults presenting with suspected acute infections and at least one vital sign abnormality to six emergency departments in Greece. Twenty-nine target host RNAs were quantified on NanoString nCounter and analyzed with the Inflammatix Severity 2 (IMX-SEV-2) classifier to determine risk scores as low, moderate, and high severity. Performance of IMX-SEV-2 for prediction of 28-day mortality was compared with that of lactate, procalcitonin, and quick sequential organ failure assessment (qSOFA). Results: A total of 397 individuals were enrolled; 38 individuals (9.6%) died within 28 days. Inflammatix Severity 2 classifier predicted 28-day mortality with an area under the receiver operator characteristics curve of 0.82 (95% confidence interval [CI], 0.74–0.90) compared with lactate, 0.66 (95% CI, 0.54–0.77); procalcitonin, 0.67 (95% CI, 0.57–0.78); and qSOFA, 0.81 (95% CI, 0.72–0.89). Combining qSOFA with IMX-SEV-2 improved prognostic accuracy from 0.81 to 0.89 (95% CI, 0.82–0.96). The high-severity (rule-in) interpretation band of IMX-SEV-2 demonstrated 96.9% specificity for predicting 28-day mortality, whereas the low-severity (rule-out) band had a sensitivity of 78.9%. Similarly, IMX-SEV-2 alone accurately predicted the need for day-7 intensive care unit care and further boosted overall accuracy when combined with qSOFA. Conclusions: Inflammatix Severity 2 classifier predicted 28-day mortality and 7-day intensive care unit care with high accuracy and boosted the accuracy of clinical scores when used in combination.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A 29-Mrna Host Response Whole-Blood Signature Improves Prediction of 28-Day Mortality and 7-Day Intensive Care Unit Care in Adults Presenting to the Emergency Department With Suspected Acute Infection and/or Sepsis

Kostaki

Wacker²,

Safarika

et al. 2022

Shock

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“…Pneumonia as one of the top leading causes diseases in hospitalized patient become a serious problem as it's not handled properly the inflammation process will continue and cause various complications (Ramirez et al, 2017;Smith et al, 2021). Clinicians must balance the need to accurately diagnose and treat pneumonia while ensuring that these efforts do not lead to the overuse of antimicrobial therapy.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of empiric antibiotics in hospitalized community-acquired Pneumonia

et al. 2022

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Community-Acquired Pneumonia (CAP) remains an important infectious disease due to its impact on patient outcomes. This study aimed to investigate the clinical outcome and especially costs of hospitalization for community-acquired pneumonia (CAP) concerning empirical antibiotics. This research was conducted to estimate the cost-effectiveness of levofloxacin, ceftriaxone, and a combination of ceftriaxone and azithromycin aiming to improve the clinical outcome of CAP. A retrospective observational study was conducted in secondary care, University Hospital in Surakarta, Central Java, Indonesia. The study enrolled all CAP patients hospitalized in the period January until December 2018, with ages ≥ 18 years old, and at least used antibiotic for three days. We compared costeffectiveness, as measured by total cost and proportion of patients successfully treated, of 3 empirical antibiotics for inpatient CAP, involving ceftriaxone, levofloxacin, or combination ceftriaxone + azithromycin. Our analyses were conducted based on a healthcare perspective. In all groups were analyzed based on severity classification (Pneumonia Severity Index score). The use of levofloxacin instead of ceftriaxone improved clinical response, but it is more expensive. Levofloxacin was the most cost-effective based on ACER value. Treatment using a combination of ceftriaxone + azithromycin was more expensive without added benefit. Based on this study, the use of levofloxacin as the first-line therapy for CAP could be maintained because it was more cost-effective than other alternatives. Since the limitations, a study on a broader population is needed to confirm these findings.

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“…Внебольничная пневмония является важной причиной заболеваемости и смертности во всем мире [9], так в США она является восьмой из причин смертности и наиболее частой причиной госпитализаций [10]. При лечении внебольничной пневмонии в рутинной клинической практике рекомендуется эмпирическая антибактериальная терапия.…”

Section: Introductionunclassified

Aspects of the Safe Use of Antibacterial Drugs in Community-Acquired Pneumonia: the Implications of Drug-Drug Interactions

Таубэ

Романов

Shubnikova

et al. 2022

A&Ch

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Background. Drug-drug interactions can seriously affect the safety profile of a drug and are an important problem worldwide. Due to the aging of the population, the increasing frequency of polypharmacy, as well as the spread of self-medication, adverse events that are difficult to identify may occur. It is hard to establish a causal relationship between the administration of a certain drug and the occurrence of an adverse event; it may also lead to the conversion of the adverse event into an adverse drug reaction. The risk of drug-drug interactions increases with combination therapy, as a result of misuse of a drug (off-label use), as well as in the absence of full disclosure from physician and patient about potential drug-drug interactions.One of the ways to detect an adverse reaction to a drug is a method of «spontaneous messages», when notification cards issued according to the regulated form are sent from subjects of drug circulation to the national centers for pharmacovigilance, then to the global database of the World Health Organization VigiBase.The aim of the work was a comprehensive analysis of the content compliance of the information presented in the instructions for the medical use of antibacterial drugs on potential drug-drug interactions with validated signals from the WHO global VigiBase database.Material and Methods. The study used information and analytical comparative non-quantitative, graphical, logical methods of analysis, as well as regression analysis. Objects of the study: instructions for medical use for international generic drugs ampicillin, amoxicillin, azithromycin, clarithromycin.Results. The contents of the instructions for use concerning possible interactions of ampicillin, amoxicillin, azithromycin, clarithromycin upon administration with other drugs were studied. Subsequently, a comparative analysis of the obtained data on drug-drug interactions of antibiotics with other drugs was carried out with signals of drug-drug interactions were validated by VigiBase.Conclusion. The study showed that a detailed description of the risks of potential drug-drug interactions in the instructions for medical use with the aim of informing doctors, patients, and caregivers helps to prevent the use of undesirable combinations, thereby reducing the risk of adverse reactions when drugs are used together. The study found that most of the identified information on the safe use of drugs was missing in the instructions for medical use.

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Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia

Cited by 7 publications

References 96 publications

A 29-Mrna Host Response Whole-Blood Signature Improves Prediction of 28-Day Mortality and 7-Day Intensive Care Unit Care in Adults Presenting to the Emergency Department With Suspected Acute Infection and/or Sepsis

A 29-Mrna Host Response Whole-Blood Signature Improves Prediction of 28-Day Mortality and 7-Day Intensive Care Unit Care in Adults Presenting to the Emergency Department With Suspected Acute Infection and/or Sepsis

Cost-effectiveness analysis of empiric antibiotics in hospitalized community-acquired Pneumonia

Aspects of the Safe Use of Antibacterial Drugs in Community-Acquired Pneumonia: the Implications of Drug-Drug Interactions

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