Problems of assessing the severity of the state of elderly patients with community-acquired pneumonia caused by Klebsiella pneumoniae

Sakharov, V. I.; Миронов, П И; Ruslyakova, I. A.; Руднов, В. А.

doi:10.21292/2078-5658-2020-17-6-45-53

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…All of these effects can inhibit the immune system, including via the pleiotropic dysregulation of innate and adaptive immune responses and decrease in white blood cells activities, further diminishing local defense mechanisms and organ function [ 24 , 25 ]. The SOFA score is a well-validated scoring system for prognostic stratification in patients with infection and has moderate predictive ability in ventilated patients with elderly patients with community-acquired pneumonia caused by K. pneumoniae [ 26 ]. Our study provides evidence that the SOFA score also plays a prognostic role in elderly patients with various types of K. pneumoniae infections, further broadening its potential for clinical application.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Outcomes of Community-Acquired Carbapenem-Resistant Klebsiella pneumoniae Infection in Elderly Patients

Chen,

Tsai,

Lai

et al. 2024

Antibiotics

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The increasing prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections is a global concern. Elderly patients have a diminished immune response and functional reserve, and are thus more vulnerable to bacterial infection. This study aimed to investigate the risk factors and outcomes in elderly patients with community-acquired CRKP infections. We performed a retrospective cohort study in a tertiary medical center between 1 January 2021, and 31 December 2021. All elderly patients who visited the emergency department during this period with culture-positive K. pneumoniae were enrolled, and their baseline demographics, laboratory profiles, management strategies, and outcomes were recorded and analyzed. We identified 528 elderly patients with K. pneumonia infection, and the proportion of patients with CRKP infection was 10.2% (54/528). Recent intensive care unit (ICU) admission and prior carbapenem use are independent risk factors for CRKP infection in elderly patients. Compared to patients with carbapenem-sensitive K. pneumoniae infection, those with CRKP infection had a significantly higher risk of adverse outcomes, including ICU care, respiratory failure, septic shock, and 90-day mortality. CRKP infection was also identified as an independent risk factor for 90-day mortality. Clinicians should be aware of the increasing prevalence of CRKP infections in elderly patients and judiciously choose appropriate antibiotics for these patients.

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Section: Discussionmentioning

confidence: 99%

Risk Factors and Outcomes of Community-Acquired Carbapenem-Resistant Klebsiella pneumoniae Infection in Elderly Patients

Chen,

Tsai,

Lai

et al. 2024

Antibiotics

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“…Chien et al [28] 2015 40 (25/ 15) Prospective Taiwan, China Sakharov et al [29] 2020 60 (30/ 30) Retrospective Russia Abdelaziz et al [30] 2021 100 (59/ 41) Prospective Egypt…”

Section: Study Design Countrymentioning

confidence: 99%

Predictors of mortality in severe pneumonia patients: A systematic review and meta-analysis

Xie,

Guan,

Kong

et al. 2023

Preprint

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Background: Severe pneumonia has consistently been associated with high mortality. We sought to identify risk factors for the mortality of severe pneumonia to assist in reducing mortality for medical treatment. Methods: Electronic databases including PubMed, Web of Science, EMBASE, Cochrane Library, and Scopus were systematically searched till June 1, 2023. All human research were incorporated into the analysis, regardless of language, publication date, or geographical location. To pool the estimate, a mixed-effect model was used. The Newcastle-Ottawa Scale (NOS) was employed for assessing the quality of included studies that were included in the analysis. Results: In total, 22 studies with a total of 3655 severe pneumonia patients and 1107 cases (30.29%) of death were included in the current meta-analysis. Significant associations were found between age [5.76 years, 95% confidence interval [CI] (3.43, 8.09), P<0.00001], male gender [odds ratio (OR)=1.46, 95% CI (1.06, 2.01), P=0.02] and risk of death from severe pneumonia. The comorbidity of neoplasm [OR=3.37, 95% CI (1.07, 10.57), P=0.04], besides the presence of complications such as diastolic hypotension [OR=2.60, 95% CI (1.45, 4.66), P=0.001], ALI/ARDS [OR=3.65, 95% CI (1.80, 7.40), P=0.0003], septic shock [OR=9.43, 95% CI (4.39, 20.28), P<0.00001], MOF [OR=4.32, 95% CI (2.35, 7.94), P<0.00001], acute kidney injury [OR=2.45, 95% CI (1.14, 5.26), P=0.02], and metabolic acidosis [OR=5.88, 95% CI (1.51, 22.88), P=0.01] were associated with significantly higher risk of death amongst patients with severe pneumonia. Those who died, compared with those who survived, differed on multiple biomarkers on admission including serum creatinine [Scr: +67.77 mmol/L, 95% CI (47.21, 88.34), P<0.00001], blood urea nitrogen [BUN: +6.26 mmol/L, 95% CI (1.49, 11.03), P=0.01], C-reactive protein [CRP: +33.09 mg/L, 95% CI (3.01, 63.18), P=0.03], leukopenia [OR=2.95, 95% CI (1.40, 6.23), P=0.005], Sodium < 136 mEq/L [OR=2.89, 95% CI (1.17, 7.15), P=0.02], albumin [-5.17 g/L, 95% CI (-7.09, -3.25), P<0.00001], PaO2/ FiO2 [-55.05 mmHg, 95% CI (-60.11, -50.00), P<0.00001], arterial blood PH [-0.09, 95% CI (-0.15, -0.04), P=0.0005], gram-negative microorganism [OR=2.57, 95% CI (1.15, 5.73), P=0.02], multilobar or bilateral involvement [OR=3.68, 95% CI (2.71, 5.00), P<0.00001] and bilateral chest X-ray involvement [OR=2.21, 95% CI (1.13, 4.31), P=0.02]. Conclusions: Older age, male gender might face a greater risk of death in severe pneumonia individuals. The mortality of severe pneumonia may also be significantly impacted by complications such diastolic hypotension, ALI/ARDS, septic shock, MOF, acute kidney injury, and metabolic acidosis, as well as the comorbidity of neoplasm, and laboratory indicators involving Scr, BUN, CRP, leukopenia, sodium, albumin, PaO2/FiO2, arterial blood PH, gram-negative microorganism, multilobar or bilateral involvement.

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“…Выше нами было сказано о возможных причинах частой манифестации ОПП у данной категории пациентов, стоит повторно отметить корреляцию между частотой развития почечного повреждения и возбудителем пневмонии -Kl.pneumoniae [6]. Трудности дифференцировки между гематологическим ДВС-синдромом и сепсис-ассоциированной коагулопатией остаются вопросами дискуссии, хотелось бы лишь отразить почти поголовную частоту нарушений…”

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Features of the clinical course of severe community-acquired pneumonia caused by Klebsiella pneumoniae in patients with acute leukemia

Saharov

Миронов

Lutfarakhmanov

et al. 2023

jour

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Aim: To compare the course of severe community-acquired pneumonia caused by Kl. pneumonia in patients with acute lymphoblastic and myeloblastic leukaemia.Materials and methods. The study was designed as a retrospective, single-centre, controlled and non-randomized study and included 40 patients. They were divided into two groups: patients with acute myeloblastic leukaemia (22), mortality of 59% (13 patients) and patients with acute lymphoblastic leukaemia (18), mortality of 38% (7 patients).Results and discussion. The combination of acute myeloblastic leukaemia and severe community-acquired pneumonia caused by Kl. pneumonia showed a higher mortality rate, a longer duration of respiratory support, as well as a greater frequency of involvement of organs and systems in the infectious process than in acute lymphoblastic leukaemia.Conclusions: The development of pneumonia caused by Kl. pneumonia in patients with acute myeloblastic leukaemia is characterized by a more severe course. SOFA, APACHE-II, and PSI/PORT scales have limited predictive ability in patients with acute leukaemia and severe community-acquired pneumonia caused by Kl. Pneumoniae.

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Problems of assessing the severity of the state of elderly patients with community-acquired pneumonia caused by Klebsiella pneumoniae

Cited by 5 publications

References 21 publications

Risk Factors and Outcomes of Community-Acquired Carbapenem-Resistant Klebsiella pneumoniae Infection in Elderly Patients

Risk Factors and Outcomes of Community-Acquired Carbapenem-Resistant Klebsiella pneumoniae Infection in Elderly Patients

Predictors of mortality in severe pneumonia patients: A systematic review and meta-analysis

Features of the clinical course of severe community-acquired pneumonia caused by Klebsiella pneumoniae in patients with acute leukemia

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