Community-acquired pneumonia: still a major burden of disease

Feldman, Charles

doi:10.1097/mcc.0000000000000340

Cited by 18 publications

(7 citation statements)

References 53 publications

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“…As both SARS-CoV-2-associated and community-acquired pneumonias present frequently in older people (those older than 65) but their contagiousness and treatment are different, the discrimination of these entities is a high public health priority [ 15 , 16 ]. In the present case-control study with historical controls, we found that routinely collected information at the emergency department could well discriminate (with ROC AUCs above 80%) between pneumonias associated with SARS-CoV-2 and other community-acquired pneumonias.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, more than half of pneumonia-related deaths occur in very old people (older than 84 years) [ 17 ]. The incidence of community-acquired pneumonia and hospitalization due to CAP is highest in adults 65 to 79 years old, and even higher in those with a known viral cause [ 16 , 19 , 20 ]. In contrast, the mean age of patients with SARS-CoV-2-associated pneumonia is much younger (50 to 60 years) [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…The significantly lower level observed in our SARS-CoV-2 cases (75 mg/l) well corresponds to reported values of approximately 50 mg/l in other clinical cohorts [ 21 , 22 ]. The higher observed CRP values in the historical pneumonia cases probably relates to the fact that a substantial proportion of community-acquired pneumonias are caused by a bacterial pathogen [ 16 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of clinical characteristics of patients with pandemic SARS-CoV-2-related and community-acquired pneumonias in Hungary – a pilot historical case-control study

et al. 2020

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The distinction between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related and community-acquired pneumonias poses significant difficulties, as both frequently involve the elderly. This study aimed to predict the risk of SARS-CoV-2-related pneumonia based on clinical characteristics at hospital presentation. Case-control study of all patients admitted for pneumonia at Semmelweis University Emergency Department. Cases (n = 30) were patients diagnosed with SARS-CoV-2-related pneumonia (based on polymerase chain reaction test) between 26 March 2020 and 30 April 2020; controls (n = 82) were historical pneumonia cases between 1 January 2019 and 30 April 2019. Logistic models were built with SARS-CoV-2 infection as outcome using clinical characteristics at presentation. Patients with SARS-CoV-2-related pneumonia were younger (mean difference, 95% CI: 9.3, 3.2–15.5 years) and had a higher lymphocyte count, lower C-reactive protein, presented more frequently with bilateral infiltrate, less frequently with abdominal pain, diarrhoea, and nausea in age- and sex-adjusted models. A logistic model using age, sex, abdominal pain, C-reactive protein, and the presence of bilateral infiltrate as predictors had an excellent discrimination (AUC 0.88, 95% CI: 0.81–0.96) and calibration (p = 0.27–Hosmer-Lemeshow test). The clinical use of our screening prediction model could improve the discrimination of SARS-CoV-2 related from other community-acquired pneumonias and thus help patient triage based on commonly used diagnostic approaches. However, external validation in independent datasets is required before its clinical use.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of clinical characteristics of patients with pandemic SARS-CoV-2-related and community-acquired pneumonias in Hungary – a pilot historical case-control study

et al. 2020

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“…Among the other putative adjunctive therapies, corticosteroids currently appear to be the most promising agents on the basis of a number of recent studies and meta-analyses 98 – 100 . Statins and antiplatelet agents appear to be interesting because of the particular role they may play in preventing the occurrence of cardiovascular events in patients with CAP, whereas a myriad of other agents have also been mentioned, the potential benefits of which have been reviewed elsewhere 95 , 96 , 101 .…”

Section: Antibiotic and Adjunctive Therapymentioning

confidence: 99%

Epidemiology, virulence factors and management of the pneumococcus

Feldman

Anderson

2016

F1000Res

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Pneumococcal infections continue to cause significant morbidity and mortality in patients throughout the world. This microorganism remains the most common bacterial cause of community-acquired pneumonia and is associated with a considerable burden of disease and health-care costs in both developed and developing countries. Emerging antibiotic resistance has been a concern because of its potential negative impact on the outcome of patients who receive standard antibiotic therapy. However, there have been substantial changes in the epidemiology of this pathogen in recent years, not least of which has been due to the use of pneumococcal conjugate vaccines in children, with subsequent herd protection in unvaccinated adults and children. Furthermore, much recent research has led to a better understanding of the virulence factors of this pathogen and their role in the pathogenesis of severe pneumococcal disease, including the cardiac complications, as well as the potential role of adjunctive therapy in the management of severely ill cases. This review will describe recent advances in our understanding of the epidemiology, virulence factors, and management of pneumococcal community-acquired pneumonia.

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“…Community-acquired pneumonia (CAP) is an infectious disease with a clinical severity ranging from mild to life-threatening. CAP has high mortality rates and is costly to treat 1. In the US in 2012, the total direct medical costs related to CAP were estimated at US$ 7,220 to US$ 11,443 2.…”

Section: Introductionmentioning

confidence: 99%

<p>Cost-Effectiveness Of Culture-Based Versus Empirical Antibiotic Treatment For Hospitalized Adults With Community-Acquired Pneumonia In Indonesia: A Real-World Patient-Database Study</p>

Purba

Ascobat

Muchtar

et al. 2019

CEOR

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ObjectiveThis study analyzes the cost-effectiveness of culture-based treatment (CBT) versus empirical treatment (ET) as a guide to antibiotic selection and use in hospitalized patients with community-acquired pneumonia (CAP).Patients and methodsA model was developed from the individual patient data of adults with CAP hospitalized at an academic hospital in Indonesia between 2014 and 2017 (ICD-10 J.18x). The directed antibiotic was assessed based on microbiological culture results in terms of the impact on hospital costs and life expectancy (LE). We conducted subgroup analyses for implementing CBT and ET in adults under 60 years, elderly patients (≥ 60 years), moderate-severe CAP (PSI class III-V) cases, and ICU patients. The model was designed with a lifetime horizon and adjusted patients’ ages to the average LE of the Indonesian population with a 3% discount each for cost and LE. We applied a sensitivity analyses on 1,000 simulation cohorts to examine the economic acceptability of CBT in practice. Willingness to pay (WTP) was defined as 1 or 3 times the Indonesian GDP per capita (US$ 3,570).ResultsCBT would effectively increase the patients’ LE and be cost-saving (dominant) as well. The ET group’s hospitalization cost had the greatest influence on economic outcomes. Subgroup analyses showed that CBT’s dominance remained for Indonesian patients aged under 60 years or older, patients with moderate-severe CAP, and patients in the ICU. Acceptability rates of CBT over ET were 74.9% for 1xWTP and 82.8% for 3xWTP in the base case.ConclusionBoth sputum and blood cultures provide advantages for cost-saving and LE gains for hospitalized patients with CAP. CBT is cost-effective in patients all ages, PSI class III or above patients, and ICU patients.

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Community-acquired pneumonia: still a major burden of disease

Abstract: Although questions remain, particularly with regard to prediction of outcome, recent studies of CAP, both clinical and experimental, have contributed novel insights into disease pathogenesis that may enable improvement of current treatment strategies.

Cited by 18 publications

References 53 publications

Comparison of clinical characteristics of patients with pandemic SARS-CoV-2-related and community-acquired pneumonias in Hungary – a pilot historical case-control study

Comparison of clinical characteristics of patients with pandemic SARS-CoV-2-related and community-acquired pneumonias in Hungary – a pilot historical case-control study

Epidemiology, virulence factors and management of the pneumococcus

<p>Cost-Effectiveness Of Culture-Based Versus Empirical Antibiotic Treatment For Hospitalized Adults With Community-Acquired Pneumonia In Indonesia: A Real-World Patient-Database Study</p>

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