Shift in bacterial etiology from the CAPNETZ cohort in patients with community-acquired pneumonia: data over more than a decade

Braeken, Dionne C.W.; Essig, Andreas; Panning, Marcus; Hoerster, Robert; Nawrocki, M.; Dalhoff, K; Suttorp, Norbert; Welte, Tobias; Pletz, Mathias W.; Witzenrath, Martin; Rohde, Gernot; Rupp, Jan

doi:10.1007/s15010-021-01605-w

Cited by 19 publications

(11 citation statements)

References 18 publications

(22 reference statements)

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“…NTHi as the most prevalent CAP pathogen in our study, is in line with recent studies from Denmark [ 3 ] and Germany [ 19 ]. Traditionally, community-acquired lower respiratory tract infections in patients with structural pulmonary diseases, especially chronic obstructive pulmonary disease (COPD), are more likely to be caused by NTHi [ 4 , 20 ].…”

Section: Discussionsupporting

confidence: 93%

Diagnostic stewardship aiming at expectorated or induced sputum promotes microbial diagnosis in community-acquired pneumonia

et al. 2022

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Purpose Studies on aetiology of community-acquired pneumonia (CAP) vary in terms of microbial sampling methods, anatomical locations, and laboratory analyses, since no gold standard exists. In this large, multicentre, retrospective, regional study from Norway, our primary objective was to report the results of a strategic diagnostic stewardship intervention, targeting diagnostic yield from lower respiratory tract sampling. The secondary objective was to report hospitalized CAP aetiology and the diagnostic yield of various anatomical sampling locations. Methods Medical records from cases diagnosed with hospitalized CAP were collected retrospectively from March throughout May for three consecutive years at six hospitals. Between year one and two, we launched a diagnostic stewardship intervention at the emergency room level for the university teaching hospital only. The intervention was multifaceted aiming at upscaling specimen collection and enhancing collection techniques. Year one at the interventional hospital and every year at the five other emergency hospitals were used for comparison. Results Of the 1280 included cases of hospitalized CAP, a microbiological diagnosis was established for 29.1% among 1128 blood cultures and 1444 respiratory tract specimens. Blood cultures were positive for a pathogenic respiratory tract microbe in 4.9% of samples, whereas upper and lower respiratory tract samples overall provided a probable microbiological diagnosis in 21.3% and 47.5%, respectively. Expectorated or induced sputum overall provided aetiology in 51.7% of the samples. At the interventional hospital, the number of expectorated or induced sputum samples were significantly increased, and diagnostic yield from expectorated or induced sputum was significantly enhanced from 41.2 to 62.0% after the intervention (p = 0.049). There was an over-representation of samples from the interventional hospital during the study period. Non-typeable Haemophilus influenza and Streptococcus pneumoniae accounted for 25.3% and 24.7% of microbiologically confirmed cases, respectively. Conclusion Expectorated or induced sputum outperformed other sampling methods in providing a reliable microbiological diagnosis for hospitalized CAP. A diagnostic stewardship intervention significantly improved diagnostic yield of lower respiratory tract sampling.

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Section: Discussionsupporting

confidence: 93%

Diagnostic stewardship aiming at expectorated or induced sputum promotes microbial diagnosis in community-acquired pneumonia

et al. 2022

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“…NTHi as the most prevalent CAP pathogen in our study, is in line with recent studies from Denmark [3] and Germany [17]. Traditionally, community-acquired lower respiratory tract infections in patients with structural pulmonary diseases, especially chronic obstructive pulmonary disease (COPD), are more likely to be caused by NTHi [4,18].…”

Section: Discussionsupporting

confidence: 88%

Diagnostic Stewardship Aiming at Expectorated or Induced Sputum Promotes Microbial Diagnosis in Community-Acquired Pneumonia

Waagsbø

Buset²,

Longva

et al. 2021

Preprint

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PurposeStudies on aetiology of community-acquired pneumonia (CAP) vary in terms of microbial sampling methods, anatomical locations, and laboratory analyses, since no gold standard exists. In this large, multicentre, retrospective, regional study from Norway, our primary objective was to report the results of a strategic diagnostic stewardship intervention, targeting diagnostic yield from lower respiratory tract sampling. The secondary objective was to report in-hospital CAP aetiology and the diagnostic yield of various anatomical sampling locations.MethodsMedical records from cases diagnosed with in-hospital CAP were collected retrospectively from March throughout May for three consecutive years at six hospitals. Between year one and two, we launched a diagnostic stewardship intervention at the emergency room level for the university teaching hospital only. The intervention was multifaceted aiming at upscaling specimen collection and enhancing collection techniques. Year one at the interventional hospital and every year at the five other emergency hospitals were used for comparison.ResultsOf the 1280 included cases of in-hospital CAP, a microbiological diagnosis was established for 29.1 % among 1128 blood cultures and 1444 respiratory tract specimens. Blood cultures were positive for a pathogenic respiratory tract microbe in 4.9 % of samples, whereas upper and lower respiratory tract samples overall provided a probable microbiological diagnosis in 21.3 % and 47.5 %, respectively. Expectorated or induced sputum overall provided aetiology in 51.7 % of the samples. At the interventional hospital, diagnostic yield from expectorated or induced sputum was significantly enhanced from 41.2 % to 62.0 % after the intervention. Non-typeable Haemophilus influenza and Streptococcus pneumoniae accounted for 25.3 % and 24.7 % of microbiologically confirmed cases, respectively.ConclusionExpectorated or induced sputum outperformed other sampling methods in providing a reliable microbiological diagnosis for in-hospital CAP. A diagnostic stewardship intervention significantly improved diagnostic yield of lower respiratory tract sampling.

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“…S . pneumoniae is estimated to cause approximately 30%-50% of community-acquired pneumonia (CAP) requiring hospitalization in adults in Europe and the United States (US) [ 1 , 2 ]. The Institute for Quality Assurance and Transparency in Healthcare (IQTIG) estimates there to be approximately 255,000 CAP cases annually in Germany (non-hospital acquired and in patients over 18 years) [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Pneumococcal vaccination rates in immunocompromised patients in Germany: A retrospective cohort study to assess sequential vaccination rates and changes over time

Sprenger

Häckl

Kossack³

et al. 2022

PLoS ONE

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Background Pneumococcal vaccination is recommended by the German Standing Committee on Vaccination (STIKO) for infants, elderly 60+ years and patients at risk. In 2016, a sequential pneumococcal vaccination schedule (conjugate vaccine followed by polysaccharide vaccine 6–12 months later) supplemented this recommendation for immunocompromised patients ≥2 years of age. Previous research showed low pneumococcal vaccination rates (pnc-VR) in this vulnerable group. Moreover, no evidence is available on adherence to the newer sequential schedule. This study aimed to analyze the development of pnc-VRs in immunocompromised patients and rates of sequential vaccinations according to the STIKO recommendations. Methods Using a representative health claims database, we assigned incident immunocompromised patients ≥2 years of age to one of two successive cohorts to observe trends over time: cohort A (first diagnosis of immunocompromised condition between 01/2013 and 12/2014), and cohort B (first diagnosis between 01/ 2015 and 12/2017). Pnc-VR within two years after first diagnosis and cumulative pnc-VR was compared among both cohorts. In cohort B, we assessed sequential pnc-VR within 15 months of the first vaccination. For additional analyses, patients were stratified by age, gender and immunocompromising condition. Results Cohort A and B comprised 193,521 and 289,279 patients, respectively. Overall pnc-VR increased over time from 4.3% (cohort A; 95%-confidence interval: 4.3%-4.4%) to 6.0% (cohort B; 5.9%-6.1%), with highest pnc-VRs in men ≥60 years (11.3%: 11.1%-11.6%) and HIV patients (15.2%: 13.1%-17.4%). Cumulative pnc-VRs in cohort B were higher in any quarter following diagnosis when compared with cohort A. Overall sequential pnc-VR in cohort B was 4.0% (3.7%-4.3%), with a higher rate observed in patients aged 16–59 (6.8%: 6.0%-7.7%) vs. patients aged ≥60 years (3.1%: 2.8%-3.4%). Conclusion While some improvements were seen over time, pnc-VRs remain very low in immunocompromised patients, as did sequential vaccination rates. Current recommendations to protect immunocompromised patients from pneumococcal infections are not being sufficiently implemented.

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Shift in bacterial etiology from the CAPNETZ cohort in patients with community-acquired pneumonia: data over more than a decade

Cited by 19 publications

References 18 publications

Diagnostic stewardship aiming at expectorated or induced sputum promotes microbial diagnosis in community-acquired pneumonia

Diagnostic stewardship aiming at expectorated or induced sputum promotes microbial diagnosis in community-acquired pneumonia

Diagnostic Stewardship Aiming at Expectorated or Induced Sputum Promotes Microbial Diagnosis in Community-Acquired Pneumonia

Pneumococcal vaccination rates in immunocompromised patients in Germany: A retrospective cohort study to assess sequential vaccination rates and changes over time

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