Severe Community-acquired Pneumonia
The aim of the study was to determine risk factors for severe community-acquired pneumonia (CAP) as well as to compare microbial patterns of severe CAP to a previous study from our respiratory intensive care unit (ICU) originating from 1984 to 1987. Patients admitted to the ICU according to clinical judgment were defined as having severe CAP. For the study of risk factors, a hospital-based case-control design was used, matching each patient with severe CAP to a patient hospitalized with CAP but not requiring ICU admission. Microbial investigation included noninvasive and invasive techniques. Overall, 89 patients with severe CAP were successfully matched to a control patient. The presence of an alcohol ingestion of ⩾ 80 g/d (odds ratio [OR] 3.9, 95% confidence interval [CI] 1.4 to 10.6, p = 0.008) was found to be an independent risk factor for severe CAP and prior ambulatory antimicrobial treatment (OR 0.37, 95% CI 0.17 to 0.79, p = 0.009) to be protective. Streptococcus pneumoniae (24%) continued to be the most frequent pathogen; however, 48% of strains were drug-resistant. “Atypical” bacterial pathogens were significantly more common (17% versus 6%, p = 0.006) and Legionella spp. less common (2% versus 14%, p = 0.004) than in our previous study, whereas gram-negative enteric bacilli (GNEB) and Pseudomonas aeruginosa continued to represent important pathogens (6% and 5%, respectively). Our findings provide additional evidence for the importance of the initiation of early empiric antimicrobial treatment for a favorable outcome of CAP. Variations of microbial patterns are only in part due to different epidemiological settings. Therefore, initial empiric antimicrobial treatment will also have to take into account local trends of changing microbial patterns. Continue reading >>
Mask: Diabetes, Abnormal Blood Pressure Increase Risk Of Pneumonia In Elderly
Video Playback Not Supported Play Video Play Mute Current Time 0:00 / Duration Time 0:00 Loaded: 0% Progress: 0% Stream TypeLIVE Remaining Time -0:00 Playback Rate 1 Chapters Chapters descriptions off, selected Descriptions subtitles off, selected Subtitles captions settings, opens captions settings dialog captions off, selected Captions Fullscreen Autoplay: On / Off This is a modal window. This video is not supported on your platform. Please make sure flash is installed. Captions Settings Dialog Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Opaque Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Defaults Done Mask: Diabetes, abnormal blood pressure increase risk of pneumonia in elderly Are you still watching? Yes, ContinueNo Pneumonia can be a serious threat to health and life, especially among the elderly, but easy changes can help prevent the infection. Pneumonia is an infection of the air sacs of one or both lungs. These air sacs may be filled with fluid and pus which can be caused by a variety of organisms, including viruses, bacteria and fungus. As people get past the age of 50, their immunities begin to decline. Major risk factors for pneumonia include smoking, diabetes, alcohol abuse, heart disease, cancer and neurological diseases, such as Parkinson's disease, whic Continue reading >>
Are Dpp-4 Inhibitors Really A Risk Factor For Pneumonia?
An international team of researchers examined a cohort of nearly 50,000 patients to find out…. Dipeptidyl peptidase-4 (DPP-4) inhibitors may alter the immune response and increase the risk of infections, but evidence for this association is limited. The United Kingdom Clinical Practice Research Datalink (CPRD) and the Hospital Episodes Statistics (HES) database were used to conduct a nested case-control analysis within a cohort of new users of anti-diabetic drugs between 2007 and 2012. Incident cases of hospitalized community-acquired pneumonia were matched with up to 20 controls on age, duration of treated diabetes, calendar year, and duration of follow-up. Conditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of hospitalized community-acquired pneumonia associated with current use of DPP-4 inhibitors compared with current use of two or more oral anti-diabetic drugs. The cohort included 49,653 patients, of whom 562 were hospitalized for community-acquired pneumonia during follow-up (incidence rate: 5.2/1000 person-years). Compared with current use of two or more oral anti-diabetic drugs, current use of DPP-4 inhibitors was not associated with an increased risk of hospitalized community-acquired pneumonia overall (adjusted OR: 0.80, 95% CI: 0.50–1.29) or according to duration of use (p-trend = 0.57). The use of DPP-4 inhibitors was not associated with an increased risk of hospitalization for community-acquired pneumonia. Additional research is needed to assess the association between these drugs and other serious infections. Practice Pearls: Very low risk for hospitalization for pneumonia by using DPP-4 inhibitors was seen. DPP-4 inhibitors suppress DNA synthesis of mononucleocytes and T-cells in vitro. Eve Continue reading >>
Risk Factors For Developing Acute Kidney Injury In Older People With Diabetes And Community-acquired Pneumonia: A Population-based Uk Cohort Study
Abstract Background Acute kidney injury (AKI) is being increasingly recognised in ageing populations. There are a paucity of data about AKI risk factors among older individuals with diabetes and infections, who are at particularly high risk of AKI. The objective of this study was to evaluate the risk factors for developing acute kidney injury (AKI) amongst older patients with diabetes and community-acquired pneumonia (CAP) in England, and whether the impact of underlying kidney function varied with age. This was a population-based retrospective cohort study over 7 years (01/04/2004–31/3/2011) using electronic health records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics. The study population comprised individuals with diabetes aged ≥65 years with CAP. Associations between demographic, lifestyle factors, co-morbidities and medications and development of AKI within 28 days of CAP were explored in a logistic regression model. Among 3471 patients with CAP and complete covariate data, 298 patients developed subsequent AKI. In multivariable analyses, factors found to be independently associated with AKI included: male sex (adjusted odds ratio, aOR: 1.56 95% confidence interval (CI): 1.20–2.04), hypertension (aOR1.36 95% CI 1.01–1.85), being prescribed either angiotensin-converting-enzyme inhibitors or angiotensin-II-receptor-blockers (aOR: 1.59 95% CI: 1.19–2.13), or insulin (aOR: 2.27 95% CI: 1.27–4.05), presence of proteinuria (aOR 1.27 95% CI 0.98–1.63), and low estimated glomerular filtration rate (eGFR). The odds of AKI were more graded amongst older participants aged ≥80 years compared to those of younger age: for eGFR of ≤29 mL/min/1.73m2 (vs 60 ml/min/1.73m2) aOR: 5.51 95% CI 3.28–9.27 and for eGFR 30–59 mL/min Continue reading >>
Pneumonia - What Increases Your Risk
You are more likely to get pneumonia if you: Have another medical condition, especially lung diseases such as chronic obstructive pulmonary disease (COPD) or asthma. Are younger than 1 year of age or older than 65. Have an impaired immune system. Drink excessive amounts of alcohol. Recently had a cold or the flu. You are more likely to have complications of pneumonia and need to go to the hospital if you: Are older than 65. Have some other illness (such as COPD, diabetes, or asthma), or have gone to the hospital for a medical problem within the last 3 months. Have had your spleen removed or do not have a working spleen (such as in sickle cell disease). Have an alcohol use problem. Have a weak immune system. Reside in a place where people live close together, such as a college dorm or nursing home. This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.© 1995-2015 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Continue reading >>
Risk Factors For Developing Pneumonia In Patients With Diabetes Mellitus Following Acute Ischaemic Stroke
Patients with diabetes mellitus (n = 106) who were hospitalized after acute ischaemic stroke with (n = 32) or without (n = 74) pneumonia at admission were included in the study. Levels of C-reactive protein (CRP) and interleukin-6 (IL-6), white blood cell (WBC) count, mean body temperature and severity of stroke on the National Institutes of Health Stroke Scale were measured at the time of admission. The degree of disability according to the modified Rankin Scale was assessed after 30 days. Raised levels of IL-6 and CRP, older age, more severe stroke, longer duration of hospitalization and dysphagia were significantly associated with the development of pneumonia. Patients with pneumonia had significantly worse outcomes compared with nonpneumonia patients after 1 month. Raised WBC count and mean body temperature were not significant predictors of pneumonia. Continue reading >>
Pneumonia Patients With High Glucose Levels At Greater Risk Of Death
Community acquired pneumonia is one of the leading infectious disease in developed nations and is a major cause of morbidity and mortality. Now, researchers have found that patients without pre-existing diabetes who have hyperglycemia on admission to hospital with community acquired pneumonia are at a significantly greater risk of death than patients with normal glucose levels on admission. Findings from the study, published in British Medical Journal (BMJ), indicate that these patients may require intensified care in order to reduce their risk of death. Although some studies state there is a link between hyperglycemia and mortality from pneumonia, results from other studies show no clear association. In order to determine whether glucose levels (or pre-existing diabetes) predict adverse outcomes in patients admitted to hospital with community acquired pneumonia, a team of European researchers examined 6,891 patients admitted to hospitals and private practices with community acquired pneumonia between 2003 and 2009 in Germany, Austria, and Switzerland. The researchers measured the severity of patients pneumonia using a standard test known as the CRB-65 score, and recorded information on their age, sex, co-morbidity, and current smoking status. Death at 28, 90 and 180 days was calculated according to blood sugar levels on admission to hospital. In all patients, the team found that hyperglycemia was linked with increased mortality at 28 and 90 days. In addition, those with hyperglycemia on admission were considerably more likely to die than patients with normal sugar levels on admission. According to the researchers, the risk of mortality increased as admission glucose levels increased. The team found that patients with diabetes had the highest mortality rate (14%) after Continue reading >>
Etiology And Outcome Of Community-acquired Pneumonia In Patients With Diabetes Mellitus
Study objectives: It has been suggested that diabetes mellitus is associated with an increased susceptibility to infection, the risk of using more aggressive therapeutic agents, and increased morbidity and mortality; however, current evidence supporting these events in the field of pneumonia is scarce. The aim of the present study was to provide information on clinical and microbiological characteristics and the outcome of community-acquired pneumonia in patients with diabetes mellitus. Design: Prospective study of cases. Setting: A university hospital in Lleida, Spain. Patients: During a 5-year period, we prospectively studied the clinical and radiologic characteristics, the spectrum of causative agents and other microbiological data, and the outcomes of 660 consecutive episodes of community-acquired pneumonia. Data derived from 106 patients with diabetes mellitus were analyzed and compared with data obtained from the remaining population. Measurements and results: Patients with diabetes mellitus were significantly older (p = 0.001) and more frequently had other concomitant comorbid conditions (p = 0.018). Diabetes was also significantly associated with the development of pleural effusion (p = 0.015) and mortality (p = 0.002); for both events, diabetes remained as an independent predictive factor in multivariate analyses. By contrast, the incidence of the main etiologic agents, and the bacteremia or empyema rates did not show significant differences in relation to the remaining patients. In the subgroup of patients with diabetes, mortality was associated with the presence of multilobar infiltrates (p = 0.004), concomitant underlying diseases (p = 0.004), and some diabetes-related complications (nephropathy, p = 0.040; and vasculopathy, p = 0.002), although only multilo Continue reading >>
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Community-acquired Pneumonia More Likely To Develop In Diabetics With High Mortality Rates: Study
Home » Diabetes » Community-acquired pneumonia more likely to develop in diabetics with high mortality rates: Study Community-acquired pneumonia is more likely to develop in diabetes patients with higher mortality rates. Community-acquired pneumonia (CAP) is a type of pneumonia commonly contracted in the community, meaning it occurs outside of hospital or extended healthcare facilities. Pneumonia is the seventh leading cause of death in the U.S. despite the availability of treatments and preventative measures. Prevalence of community-acquired pneumonia ranges from four to five million cases annually, with roughly 25 percent of cases requiring hospitalization. The best way to prevent community-acquired pneumonia is by getting vaccinated annually for influenza, and if you are over the age of 60 receiving the pneumonia vaccination. Proper hygiene can also reduce your risk of contracting pneumonia, along with avoiding those who are sick and steering clear of others when you are sick to reduce the spread of the illness. Related Reading: Is Pneumonia Contagious? Diabetes patients more likely to develop community-acquired pneumonia, study Diabetes patients have been found to be more likely to develop community-acquired pneumonia. Lead researcher Madalena Martins along with colleagues wrote, “In line with studies that suggest that patients with [diabetes] are at higher risk for [community-acquired pneumonia], we observed that the [diabetes] prevalence in [community-acquired pneumonia] admissions between 2009 and 2012 was consistently higher, and more than double, when compared to the estimations of the [diabetes] prevalence in Portugal.” The researchers conducted a retrospective, nationwide register analysis where they looked at data from 74,175 adult patients with commun Continue reading >>
Liver Cirrhosis And Diabetes Mellitus Are Risk Factors For Staphylococcus Aureus Infection In Patients With Healthcare-associated Or Hospital-acquired Pneumonia
Copyright © 2016 Huang-Pin Wu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background. The risk factors for Staphylococcus aureus (S. aureus) pneumonia are not fully identified. The aim of this work was to find out the clinical characteristics associated with S. aureus infection in patients with healthcare-associated pneumonia (HCAP) and hospital-acquired pneumonia (HAP), which may be applicable for more appropriate selection of empiric antibiotic therapy. Methods. From July 2007 to June 2010, patients who were admitted to the intensive care unit with severe HCAP/HAP and severe sepsis were enrolled in this study. Lower respiratory tract sample was semiquantitatively cultured. Initial broad-spectrum antibiotics were chosen by Taiwan or American guidelines for pneumonia management. Standard bundle therapies were provided to all patients according to the guidelines of the Surviving Sepsis Campaign. Results. The most frequently isolated pathogens were Pseudomonas aeruginosa, S. aureus, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli. Patients with positive isolation of S. aureus in culture had significantly higher history of liver cirrhosis and diabetes mellitus, with odds ratios of 3.098 and 1.899, respectively. The S. aureus pneumonia was not correlated with history of chronic obstructive pulmonary disease, hypertension, and hemodialysis. Conclusion. Liver cirrhosis and diabetes mellitus may be risk factors for S. aureus infection in patients with severe HCAP or HAP. 1. Introduction In present medical practice, severe pneumonia with CURB-65 score (confusion, uremia, r Continue reading >>
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Diabetes Mellitus And Infection
Some types of infection occur more frequently in patients with diabetes. This increased risk is largely attributable to an altered immune response due to chronic hyperglycaemia, but increased susceptibility to infection may also result from diabetic complications such as diabetic neuropathy and vascular insufficiency. Risk of most common infections is only modestly increased (e.g. 1.2 fold), but a number of rare but potentially fatal infections occur primarily or even almost exclusively in patients with diabetes. These include mucormycosis, emphysematous urinary tract infections, emphysematous cholecystitis, necrotizing fasciitis and malignant otitis externa. Immediate antimicrobial and/or surgical treatment is needed to prevent serious complications from these infections, including death. In general, antimicrobial treatment of infections in patients with diabetes is not different than in patients without diabetes. Glucose lowering therapy often needs to be increased to counter the loss of control associated with infection. Vaccinations against influenza and pneumococcal infections are recommended for patients with diabetes. Incidence and contributing factors People with diabetes are reported to experience 21% more infections than the general population[1]. Several factors may contribute to this, for example possible ‘reporting bias’: more frequent medical visits due to diabetes may lead to better recording of infectious complications. Even so, it seems clear that the risk of many common infections increases in proportion to hyperglycemia. Special problems may also arise in relations to diabetic nephropathy, which may undermine host defences against infection, and peripheral vascular disease which may impair tissue nutrition, oxygen supply and the ability to mount a Continue reading >>
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• Mitigare® is indicated for prophylaxis of gout flares in adults. The safety and effectiveness of Mitigare® for acute treatment of gout flares during prophylaxis has not been studied. • Mitigare® is not an analgesic medication and should not be used to treat pain from other causes. • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®. • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children. • Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia and aplastic anemia have been reported with colchicine used in therapeutic doses. • Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death. • Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®. • The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting and abdominal pain. You are encouraged to report negative side effects of prescription drugs to Continue reading >>
Diabetes A Risk Factor For Community-acquired Pneumonia, Research Suggests
Researchers at several Portuguese clinical and research institutions have found that patients with diabetes mellitus are more likely to develop community-acquired pneumonia, experience longer hospitalization periods, and have higher mortality rates than patients without diabetes. The findings suggest that diabetes is a risk factor for community-acquired pneumonia and therefore, proper healthcare measures and precautions should be put into practice. The article describing the findings is titled “Diabetes hinders community-acquired pneumonia outcomes in hospitalized patients,” and was published in the journal BMJ Open Diabetes Research & Care. Previous research had pointed to a possible association between diabetes and a higher risk for community-acquired pneumonia (CAP). In the current epidemiology study, researchers aimed to investigate the prevalence of diabetes mellitus (DM) in hospitalized patients with CAP, and the impact of the disease on hospital stay length and mortality rates. Researchers analyzed patient data from CAP adult patients admitted to hospitals between 2009 and 2012. In total, 74,175 patients were included in the study, and researchers searched for diagnoses of diabetes in patient records using nationwide diabetes statistics from the national diabetes prevalence study (PREVADIAB). Patients were stratified according to age, sex, hospitalization time, and mortality rate, and the rates of community-acquired pneumonia with and without concomitant diabetes were compared. Results indicated that, among the analyzed patients, 19,212 (25.9 percent) had diabetes. Those patients with CAP and diabetes experienced longer hospital stays when compared to patients with pneumonia but no diabetes. The difference in length of stay was 0.8 to 1 days longer for patien Continue reading >>
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Risk Factors For Pneumonia In The Elderly☆
Abstract purpose: To investigate the prevalence of certain chronic conditions among the elderly and to estimate the relative risk for pneumonia associated with each condition. patients and methods: Medical records of all inhabitants aged 60 years or more (4,175 persons) in one township (population 24,716) in Finland were reviewed, seeking 15 chronic conditions. Which patients had pneumonia in the same population was prospectively ascertained over a period of 3 years (185 patients). results: Hypertension was the most frequent chronic condition (36.4%) in the study population. Other common conditions were heart disease (23.7%, with chronic compensated heart failure in 96.3% of these), other cardiovascular disease (13.1%), and diabetes (13.1%). The prevalence of any other condition was less than 5%. The following conditions were significantly more common among pneumonia patients than among control subjects: heart disease (38.4% versus 23.0%), lung disease (13.0% versus 3.8%), bronchial asthma (11.9% versus 3.1%), immunosuppressive therapy (2.7% versus 0.8%), alcoholism (2.2% versus 0.3%), and institutionalization (8.6% versus 3.9%). By multivariate logistic regression analysis, independent risk factors for pneumonia were alcoholism (relative risk [RR]= 9.0, confidence interval [Cl] = 5.1 to 16.2), bronchial asthma (RR = 4.2, Cl = 3.3 to 5.4), immunosuppressive therapy (RR = 3.1, Cl = 1.9 to 5.1), lung disease (RR = 3.0, Cl = 2.3 to 3.9), heart disease (RR = 1.9, Cl = 1.7 to 2.3), institutionalization (RR = 1.8, Cl = 1.4 to 2.4), and age (70 years or more versus 60 to 69 years; RR = 1.5, Cl = 1.3 to 1.7). One third of the study population and 57% of the pneumonia patients had one or more of these risk factors. Diabetes, chronic pyelonephritis, and malignancies of sites othe Continue reading >>
