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Rationale and design of the CAPAMIS study: Effectiveness of pneumococcal vaccination against community-acquired pneumonia, acute myocardial infarction and stroke
Angel Vila-Corcoles, Inmaculada Hospital-Guardiola, Olga Ochoa-Gondar, Cinta de Diego, Elisabet Salsench, Xavier Raga, Cruz M Fuentes-Bellido
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-25
Abstract: Cohort study including 27,000 individuals 60 years or older assigned to nine Primary Care Centers in the region of Tarragona, Spain. According to the reception of PPV-23 before the start of the study, the study population will be divided into vaccinated and nonvaccinated groups, which will be followed during a consecutive 30-month period. Primary Care and Hospitals discharge databases will initially be used to identify study events (community-acquired pneumonia, hospitalisation for acute myocardial infarction and stroke), but all cases will be further validated by checking clinical records. Multivariable Cox regression analyses estimating hazard ratios (adjusted for age, sex and comorbidities) will be used to estimate vaccine effectiveness.The results of the study will contribute to clarify the controversial effect of the PPV-23 in preventing community-acquired pneumonia and they will be critical in determining the posible role of pneumococcal vaccination in cardiovascular prevention.Infections caused by Streptococcus pneumoniae remain a major public health problem throughout the world. Susceptibility to pneumococcal infections varies with age, being highest in young children and older adults, who experience substantial morbidity and mortality (especially in those with underlying high-risk medical conditions) [1,2].The main reservoir of pneumococcus is the nasopharynx, and the possible outcomes after colonisation are the clearance by the organism, the asymptomatic persistence for several months (carrier state), or the progression to disease. During the disease the bacteria can spread to adjacent mucosal tissues causing mucosal infections (otitis, sinusitis, bronchitis and pneumonias) or it can invade the bloodstream, or other sterile sites, producing an invasive pneumococcal disease (IPD). In adults, S. pneumoniae is the most frequent isolate from clinical samples of respiratory tract infections. It is responsible for approximately 50% of overall cases of community-
Community-acquired lobar pneumonia in children in the era of universal 7-valent pneumococcal vaccination: a review of clinical presentations and antimicrobial treatment from a Canadian pediatric hospital
Anne Rowan-Legg, Nicholas Barrowman, Nazih Shenouda, Khaldoun Koujok, Nicole Le Saux
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-133
Abstract: A retrospective review of healthy immunocompetent children admitted to a tertiary pediatric hospital from January 2007 to December 2008 with clinical features consistent with pneumonia and a radiographically-confirmed consolidation was performed. Clinical, microbiological and antimicrobial data were collected.One hundred and thirty-five hospitalized children with pneumonia were evaluated. Mean age at admission was 4.8?years (range 0–17?years). Two thirds of patients had been seen by a physician in the 24?hours prior to presentation; 56 (41.5%) were on antimicrobials at admission. 52 (38.5%) of patients developed an effusion, and 22/52 (42.3%) had pleural fluid sampled. Of 117 children who had specimens (blood/pleural fluid) cultured, 9 (7.7%) had pathogens identified (7 Streptococcus pneumoniae, 1 Group A Streptococcus, and 1 Rhodococcus). 55% of patients received 2 or more antimicrobials in hospital. Cephalosporins were given to 130 patients (96.1%) in hospital. Only 21/126 patients (16.7%) were discharged on amoxicillin. The median length of stay was 3?days (IQR 2–4) for those without effusion and 9 (IQR 5–13) for those with effusion. No deaths were related to pneumonia.This study provides comprehensive data on the clinical characteristics of hospitalized children with CAP in the pneumococcal 7-valent vaccine era. Empiric antimicrobial choice at our institution is variable, highlighting a need for heightened antimicrobial stewardship.Pediatric community-acquired pneumonia (CAP) is a common and potentially serious childhood infection, which often results in hospital admission. The World Health Organization has estimated that in developed countries, one in twenty children under the age of five years will have an episode of pneumonia each year, and 1 to 4 per 1000 children are admitted to hospital annually [1]. S. pneumoniae continues to be the most important pathogen in bacterial pneumonia. The 7-valent pneumococcal conjugate vaccine (Prevnar?, PCV-7) became availab
Mortality predictors in community-acquired pneumonia
M.O Tanimowo
Nigerian Journal of Clinical Practice , 2009,
Abstract: To determine mortality predictors among patients admitted for community-acquired pneumonia to themedicalwards of Ladoke Akintola University ofTeaching Hospital between Jan. 2003 andDec. 2005. The case notes of 65 patients admitted for community-acquired pneumoniawere studiedwith respect to their admission Pneumonia Severity Index (PSI) (Score) and functional class.The duration of admission, side of lung affected on chestX-ray, co-morbid illness and outcomewere also noted. The mean Pneumonia Severity Index score for patients who were discharged and those who died was 65.48 32.6 and 95.47 32.9 respectively (.P<0.05). Bedridden patients have highermortality than patients who walked without problems on admission (P<0.05). The mean duration of admission of discharged patients was 9.5 8.9 dayswhile that of patientswho diedwas 4.82 2.7 days (P<0.05).The side of lung involvement of chest X-ray does not seemto affectmortality (P>0.05). Sixteen co-morbid illnesseswere identified. The Pneumonia Severity Index score remains an important mortality predictor in patients with community-acquired pneumonia, but there is need to widen its scope to include functional class, duration of admission, and locally important co-morbid illnesses. KeyWords: Community-Acquired Pneumonia, Mortality Predictors
Pneumococcal Aetiology and Serotype Distribution in Paediatric Community-Acquired Pneumonia  [PDF]
Iris De Schutter, Anne Vergison, David Tuerlinckx, Marc Raes, Julie Smet, Pierre R. Smeesters, Jan Verhaegen, Fran?oise Mascart, Filip Surmont, Anne Malfroot
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0089013
Abstract: Community-acquired pneumonia (CAP) is a major cause of morbidity in children. This study estimated the proportion of children with pneumococcal CAP among children hospitalised with CAP in Belgium and describes the causative serotype distribution after implementation of the 7-valent pneumococcal conjugate vaccine. Children 0–14 years hospitalised with X-ray-confirmed CAP were prospectively enrolled in a multicentre observational study. Acute and convalescent blood samples were collected. Pneumococcal aetiology was assessed by conventional methods (blood or pleural fluid cultures with Quellung reaction capsular typing or polymerase chain reaction [PCR] in pleural fluid), and recently developed methods (real-time PCR in blood and World Health Organization-validated serotype-specific serology). A total of 561 children were enrolled. Pneumococcal aetiology was assessed by conventional methods in 539, serology in 171, and real-time PCR in blood in 154. Pneumococcal aetiology was identified in 12.2% (66/539) of the children by conventional methods alone but in 73.9% by the combination of conventional and recently developed methods. The pneumococcal detection rate adjusted for the whole study population was 61.7%. Serotypes 1 (42.3%), 5 (16.0%), and 7F(7A) (12.8%) were predominant. In conclusion, Streptococcus pneumoniae remains the predominant bacteria in children hospitalised for CAP in Belgium after implementation of 7-valent pneumococcal conjugate vaccine, with non-vaccine-serotypes accounting for the majority of cases. The use of recently developed methods improves diagnosis of pneumococcal aetiology.
Predictors of inhospital mortality and re-hospitalization in older adults with community-acquired pneumonia: a prospective cohort study
Binod Neupane, Stephen D Walter, Paul Krueger, Tom Marrie, Mark Loeb
BMC Geriatrics , 2010, DOI: 10.1186/1471-2318-10-22
Abstract: A prospective cohort study was conducted from July 2003 to April 2005 in two Canadian cities. Patients aged 65 years or older hospitalized for community-acquired pneumonia were followed up for up to 30 days from initial hospitalization for mortality and these patients who were discharged alive within 30 days of initial hospitalization were followed up to 90 days of initial hospitalization for re-hospitalization. Separate logistic regression analyses were performed identify the predictors of mortality and re-hospitalization.Of 717 enrolled patients hospitalized for community-acquired pneumonia, 49 (6.8%) died within 30 days of hospital admission. Among these patients, 526 were discharged alive within 30 days of hospitalization of whom 58 (11.2%) were re-hospitalized within 90 days of initial hospitalization. History of hip fracture (odds ratio (OR) = 4.00, 95% confidence interval (CI) = (1.46, 10.96), P = .007), chronic obstructive pulmonary disease (OR = 2.31, 95% CI = (1.18, 4.50), P = .014), cerebrovascular disease (OR = 2.11, 95% CI = (1.03, 4.31), P = .040) were associated with mortality. Male sex (OR = 2.35, 95% CI = (1.13, 4.85), P = .022) was associated with re-hospitalization while vitamin E supplementation was protective (OR = 0.37 (0.16, 0.90), P = .028). Lower socioeconomic status, prior influenza and pneumococcal vaccinations, appropriate antibiotic prescription upon admission, and lower nutrition risk were not significantly associated with mortality or re-hospitalization.Chronic comorbidities appear to be the most important predictors of death and re-hospitalization in older adults hospitalized with community-acquired pneumonia while vitamin E supplementation was protective.Community-acquired pneumonia (CAP) is one of the leading causes of mortality in older adults aged 65 years or more [1-6]. Re-hospitalization due to pneumonia after premature hospital discharge or due to new or worsening of co-existing medical complications is associated with extra us
Etiology of childhood community acquired pneumonia and its implications for vaccination
Nascimento-Carvalho, Cristiana M.C.;
Brazilian Journal of Infectious Diseases , 2001, DOI: 10.1590/S1413-86702001000200007
Abstract: pneumonia is an important cause of morbidity and mortality among children throughout the world. vaccines are available for some organisms, but they are underutilized and/or still in development. to evaluate the potential impact of vaccines, we review studies in which the etiology of childhood community-acquired pneumonia was recorded. in north america and europe (9 studies), the etiology of pneumonia was established in 62% of studied children (range 43%-88%) by use of noninvasive specific methods for microbiologic diagnosis. the most often identified agents were s. pneumoniae (22%), respiratory syncytial virus (rsv) (20%), haemophilus influenzae (7%), and mycoplasma pneumoniae (15%). in africa and south america (8 studies), bacteria were recovered from 56% (range 32%-68%) of severely ill children studied by lung aspirate. the most often isolated bacteria were streptococcus pneumoniae (33%) and haemophilus influenzae (21%). a high percentage of h. influenzae strains were not serotype b. throughout the world, children requiring hospitalization were most likely to have infection caused by pneumococcus h. influenzae or rsv. out patients also had mycoplasma pneumoniae. countries in africa and asia recorded 2 to 10 times more children with pneumonia (7 to 40/100 annually) than in the usa. widespread use of pneumococcal and h. influenzae type b conjugate vaccines could reduce the frequency of childhood pneumonia by one-third. further reduction will require development of non-type b h. influenzae, rsv and m. pneumoniae vaccines. this could result in a > 50% reduction of pneumonia in children. this goal should be sought and achieved as soon as possible.
Etiology of childhood community acquired pneumonia and its implications for vaccination  [cached]
Nascimento-Carvalho Cristiana M.C.
Brazilian Journal of Infectious Diseases , 2001,
Abstract: Pneumonia is an important cause of morbidity and mortality among children throughout the world. Vaccines are available for some organisms, but they are underutilized and/or still in development. To evaluate the potential impact of vaccines, we review studies in which the etiology of childhood community-acquired pneumonia was recorded. In North America and Europe (9 studies), the etiology of pneumonia was established in 62% of studied children (range 43%-88%) by use of noninvasive specific methods for microbiologic diagnosis. The most often identified agents were S. pneumoniae (22%), respiratory syncytial virus (RSV) (20%), Haemophilus influenzae (7%), and Mycoplasma pneumoniae (15%). In Africa and South America (8 studies), bacteria were recovered from 56% (range 32%-68%) of severely ill children studied by lung aspirate. The most often isolated bacteria were Streptococcus pneumoniae (33%) and Haemophilus influenzae (21%). A high percentage of H. influenzae strains were not serotype b. Throughout the world, children requiring hospitalization were most likely to have infection caused by pneumococcus H. influenzae or RSV. Out patients also had Mycoplasma pneumoniae. Countries in Africa and Asia recorded 2 to 10 times more children with pneumonia (7 to 40/100 annually) than in the USA. Widespread use of pneumococcal and H. influenzae type b conjugate vaccines could reduce the frequency of childhood pneumonia by one-third. Further reduction will require development of non-type b H. influenzae, RSV and M. pneumoniae vaccines. This could result in a > 50% reduction of pneumonia in children. This goal should be sought and achieved as soon as possible.
Failure of levofloxacin treatment in community-acquired pneumococcal pneumonia
Andrea Endimiani, Gioconda Brigante, Alessia A Bettaccini, Francesco Luzzaro, Paolo Grossi, Antonio Q Toniolo
BMC Infectious Diseases , 2005, DOI: 10.1186/1471-2334-5-106
Abstract: A 72-year-old patient with long history of chronic obstructive pulmonary disease and multiple fluoroquinolone treatments for recurrent lower respiratory tract infections developed fever, increased sputum production, and dyspnea. He was treated with oral levofloxacin (500 mg bid). Three days later, because of acute respiratory insufficiency, the patient was hospitalized. Levofloxacin treatment was supplemented with piperacillin/tazobactam. Microbiological tests detected a S. pneumoniae strain intermediate to penicillin (MIC, 1 mg/L) and resistant to macrolides (MIC >256 mg/L) and fluoroquinolones (MIC >32 mg/L). Point mutations were detected in gyrA (Ser81-Phe), parE (Ile460-Val), and parC gene (Ser79-Phe; Lys137-Asn). Complete clinical response followed treatment with piperacillin/tazobactam.This is the first Italian case of community-acquired pneumonia due to a fluoroquinolone-resistant S. pneumoniae isolate where treatment failure of levofloxacin was documented. Molecular analysis showed a group of mutations that have not yet been reported from Italy and has been detected only twice in Europe. Treatment with piperacillin/tazobactam appears an effective means to inhibit fluoroquinolone-resistant strains of S. pneumoniae causing community-acquired pneumonia in seriously ill patients.Streptococcus pneumoniae is the leading cause of community-acquired pneumonia (CAP) and a major cause of meningitis and otitis media. Recent reports show an high global incidence of macrolide and penicillin resistance, whereas fluoroquinolone (FQ) resistance is not frequent [1-3]. Current guidelines for suspected bacterial CAP in patients with co-morbidity factors and recent antibiotic therapy recommend initial empiric therapy using one respiratory FQ or one macrolide associated to other drugs (amoxicillin, amoxicillin/clavulanate, broad-spectrum cephalosporins) [4,5].Resistance to FQ in S. pneumoniae is determined by efflux mechanisms and/or mutations in the quinolone resistance-determi
Factores pronósticos, evolución y mortalidad en el adulto inmunocompetente hospitalizado por neumonía neumocócica adquirida en la comunidad Prognostic factors and mortality in immunocompetent adult patients hospitalized with community-acquired pneumococcal pneumonia
Fernando Saldías P,Paola Viviani G,Dahiana Pulgar B,Francisco Valenzuela F
Revista médica de Chile , 2009,
Abstract: Background: Streptococcus pneumoniae is the main cause of community-acquired pneumonia in adults. Aim: To describe baseline characteristics, risk factors and clinical outcomes of adult patients hospitalized with pneumococcal pneumonia. Material and methods: Prospective study of adult patients admitted for a community acquired pneumonia in a clinical hospital. Immune deficient patients and those with a history of a recent hospitalization were excluded. Results: One hundred fifty one immuno-competent patients, aged 16 to 92 years, 58% males, were studied. Seventy-five percent had other diseases, 26% were admitted to the intensive care unit and 9% needed mechanical ventilation. There were no differences in clinical features, ICU admission or hospital length of stay among bacteremic and non-bacteremic patients. Thirty days lethality for bacteremic and non-bacteremic patients was 10.9% and 11.5%, respectively. The predictive values for lethality of Fine pneumonia severity index and CURB-65 (Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older) had an area under the ROC curve of 0.8 and 0.69, respectively. Multivariate analysis disclosed blood urea nitrogen over 30 mg/ dL (odds ratio (OR), 6.8), need for mechanical ventilation (OR, 7.4) and diastolic blood pressure below 50 mmHg (OR, 3.9), as significant independent predictors of death. Conclusions: Pneumococcal pneumonia was associated with a substantial rate of complications and mortality. Clinical presentation and outcome did not differ significantly among patients with and without bacteremia.
Overview of Community-Acquired Pneumonia and the Role of Inflammatory Mechanisms in the Immunopathogenesis of Severe Pneumococcal Disease  [PDF]
Helen C. Steel,Riana Cockeran,Ronald Anderson,Charles Feldman
Mediators of Inflammation , 2013, DOI: 10.1155/2013/490346
Abstract: Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality among the infectious diseases. Despite the implementation of national pneumococcal polyvalent vaccine-based immunisation strategies targeted at high-risk groups, Streptococcus pneumoniae (the pneumococcus) remains the most common cause of CAP. Notwithstanding the HIV pandemic, major challenges confronting the control of CAP include the range of bacterial and viral pathogens causing this condition, the ever-increasing problem of antibiotic resistance worldwide, and increased vulnerability associated with steadily aging populations in developed countries. These and other risk factors, as well as diagnostic strategies, are covered in the first section of this review. Thereafter, the review is focused on the pneumococcus, specifically the major virulence factors of this microbial pathogen and their role in triggering overexuberant inflammatory responses which contribute to the immunopathogenesis of invasive disease. The final section of the review is devoted to a consideration of pharmacological, anti-inflammatory strategies with adjunctive potential in the antimicrobial chemotherapy of CAP. This is focused on macrolides, corticosteroids, and statins with respect to their modes of anti-inflammatory action, current status, and limitations. 1. Overview of Community-Acquired Pneumonia 1.1. Introduction Community-acquired pneumonia (CAP) is commonly described as an acute infection of the lung parenchyma acquired in the community. It is most commonly bacterial in nature and is associated with clinical and/or radiological evidence of consolidation of part or parts of one or both lungs [1]. CAP is associated with a considerable burden of disease in most regions of the world [2–6]. It is one of the most important serious infectious diseases, accounting for a considerable number of hospital admissions, with an increasing incidence in many parts of the world and an increasing rate of serious complications [7]. As part of the burden of respiratory infections, CAP is well recognised to be a leading cause of death among the infectious diseases [6, 8]. The reason that CAP is so common relates to the very high prevalence of specific risk factors for this infection in patients worldwide [6]. While a myriad of microorganisms may cause CAP, in reality a relatively small number of pathogens predominate, in particular the bacteria, of which Streptococcus pneumoniae (pneumococcus) is by far the most common [7]. There is considerable concern about the emerging resistance among the usual CAP
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