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1.
Rev. bras. med. fam. comunidade ; 17(44): 3067, 20220304. tab
Article in Portuguese | LILACS, ColecionaSUS | ID: biblio-1379772

ABSTRACT

Introdução: Infecção urinária é motivo comum de consulta na Atenção Primária, requerendo tratamento empírico. Para a seleção do antimicrobiano, é necessário conhecer o perfil de resistência dos uropatógenos na comunidade. Objetivo: Analisar o perfil de resistência antimicrobiana em uroculturas realizadas em pacientes da Atenção Primária à Saúde do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição, de julho de 2017 a junho de 2019. Métodos: Estudo transversal, observacional e descritivo com uroculturas de pacientes ambulatoriais das Unidades de Saúde do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição, nas Zonas Norte e Nordeste de Porto Alegre, de julho de 2017 a junho de 2019. Os dados das uroculturas foram fornecidos pelo laboratório do Grupo Hospitalar e analisados por meio das proporções, por sexo, micro-organismo e resistência antimicrobiana. Resultados: Encontraram-se 2.000 uroculturas positivas no período, principalmente por Escherichia coli (75,50%), Klebsiella pneumoniae (7,80%), Staphylococcus saprophyticus (4,95%), Enterococcus specie (3,35%) e Proteus mirabilis (2,85%). Entre os antibióticos orais testados, a maior resistência foi para ampicilina (48,95%), seguida por sulfametoxazol+trimetoprima (25,85%), norfloxacino (18,05%), ciprofloxacino (18,00%), amoxicilina+clavulanato (11,05%) e nitrofurantoína (8,60%). Considerando-se apenas E. coli, as resistências foram 47,75% para ampicilina, 29,74% para sulfametoxazol+trimetoprima, 19,74% para norfloxacino e ciprofloxacino, 8,08% para amoxicilina+clavulanato e 1,99% para nitrofurantoína. Conclusões: O perfil de resistência antimicrobiana nas Zonas Norte e Nordeste de Porto Alegre sugere que sejam utilizados para tratamento empírico de infecção do trato urinário nessa localidade nitrofurantoína ou amoxicilina+clavulanato.


Introduction: Urinary tract infection is a common reason for consultation in primary care, requiring empirical treatment. For the selection of the antimicrobial, it is necessary to know the resistance profile of uropathogens in the community. Objective: To analyze the profile of antimicrobial resistance in urine cultures performed on primary health care patients from the Community Health Service of Grupo Hospitalar Conceição from July 2017 to June 2019. Methods: Cross-sectional, observational and descriptive study with urine cultures of outpatients from the Health Units from the Community Health Service of Grupo Hospitalar Conceição, in North and Northeast Porto Alegre, Brazil, from July 2017 to June 2019. The data on urine cultures were provided by the Grupo Hospitalar laboratory and analyzed through proportions, by sex, microorganism, and antimicrobial resistance. Results: Two thousand positive urine cultures were found in the period, mainly for Escherichia coli (75.50%), Klebsiella pneumoniae (7.80%), Staphylococcus saprophyticus (4.95%), Enterococcus specie (3.35%) and Proteus mirabilis (2.85%). Among the oral antibiotics tested, the most frequent resistance was to ampicillin (48.95%), followed by trimethoprim+sulfamethoxazole (25.85%), norfloxacin (18.05%), ciprofloxacin (18.00%), amoxicillin-clavulanate (11.05%) and nitrofurantoin (8.60%). Considering only E. coli, resistance was 47.75% to ampicillin, 29.74% to trimethoprim+sulfamethoxazole, 19.74% to norfloxacin and ciprofloxacin, 8.08% to amoxicillin-clavulanate and 1.99% to nitrofurantoin. Conclusions: The profile of antimicrobial resistance in the North and Northeast Zones of Porto Alegre suggests that nitrofurantoin or amoxicillin-clavulanate should be used for empirical treatment of urinary tract infection in this locality.


Introducción: La infección del tracto urinario es un motivo frecuente de consulta en atención primaria, requiriendo tratamiento empírico. Para la selección del antimicrobiano, es necesario conocer el perfil de resistencia de los uropatógenos en la comunidad. Objetivo: Analizar el perfil de resistencia antimicrobiana en urocultivos realizados en pacientes de atención primaria de salud de Serviço de Saúde Comunitária de Grupo Hospitalar Conceição de julio de 2017 a junio de 2019. Métodos: Estudio transversal, observacional y descriptivo con urocultivos de pacientes ambulatorios de las Unidades de Salud de Serviço de Saúde Comunitária de Grupo Hospitalar Conceição, en las Zonas Norte y Nordeste de Porto Alegre, de julio de 2017 a junio de 2019. Los datos de urocultivos fueron proporcionados por el laboratorio de Grupo Hospitalar y analizados a través de proporciones, por sexo, microorganismos y resistencia a los antimicrobianos. Resultados: En el período se encontraron 2.000 urocultivos positivos, principalmente por Escherichia coli (75,50%), Klebsiella pneumoniae (7,80%), Staphylococcus saprophyticus (4,95%), Enterococcus especie (3,35%) y Proteus mirabilis (2,85%). Entre los antibióticos orales probados, la mayor resistencia fue para la ampicilina (48,95%), seguida de sulfametoxazol+trimetoprima (25,85%), norfloxacina (18,05%), ciprofloxacina (18,00%), amoxicilina+clavulanato (11,05%) y nitrofurantoína (8,60%). %). Considerando solo a E. coli, la resistencia fue del 47,75% para ampicilina, 29,74% para sulfametoxazol + trimetoprima, 19,74% para norfloxacina y ciprofloxacina, 8,08% para amoxicilina + clavulanato y 1,99% para nitrofurantoína. Conclusiones: El perfil de resistencia a los antimicrobianos en las regiones Norte y Nordeste de Porto Alegre sugiere que se utilizan para el tratamiento empírico de la infección del tracto urinario en esta localidad nitrofurantoína o amoxicilina+clavulanato.


Subject(s)
Urinary Tract Infections , Drug Resistance , Drug Resistance, Bacterial , Escherichia coli , Community-Acquired Infections
2.
Singapore medical journal ; : 219-224, 2022.
Article in English | WPRIM | ID: wpr-927281

ABSTRACT

INTRODUCTION@#We aimed to compare the early clinical manifestations, laboratory results and chest computed tomography (CT) images of COVID-19 patients with those of other community-acquired pneumonia (CAP) patients to differentiate CAP from COVID-19 before reverse transcription-polymerase chain reaction results are obtained.@*METHODS@#The clinical and laboratory data and chest CT images of 51 patients were assessed in a fever observation ward for evidence of COVID-19 between January and February 2020.@*RESULTS@#24 patients had laboratory-confirmed COVID-19, whereas 27 individuals had negative results. No statistical difference in clinical features was found between COVID-19 and CAP patients, except for diarrhoea. There was a significant difference in lymphocyte and eosinophil counts between COVID-19 and CAP patients. In total, 22 (91.67%) COVID-19 patients had bilateral involvement and multiple lesions according to their lung CT images; the left lower lobe (87.50%) and right lower lobe (95.83%) were affected most often, and all lesions were located in the peripheral zones of the lung. The most common CT feature of COVID-19 was ground-glass opacity, found in 95.83% of patients, compared to 66.67% of CAP patients.@*CONCLUSION@#Diarrhoea, lymphocyte counts, eosinophil counts and CT findings (e.g. ground-glass opacity) could help to distinguish COVID-19 from CAP at an early stage of infection, based on findings from our fever observation ward.


Subject(s)
COVID-19/diagnostic imaging , China , Community-Acquired Infections/diagnostic imaging , Diarrhea/pathology , Fever , Humans , Lung/diagnostic imaging , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed/methods
3.
Annals of Medical Research and Practice ; 3(4): 1-7, 2022. tables, figures
Article in English | AIM | ID: biblio-1379326

ABSTRACT

OBJECTIVES: Infection prevention and control (IPC) practice in health facility (HF) is abysmally low in developing countries, resulting in significant preventable morbidity and mortality. This study assessed and compared health workers' (HWs) practice of IPC strategies in public and private secondary HFs in Kaduna State. MATERIAL AND METHODS: A cross-sectional comparative study was employed. Using multistage sampling, 227 participants each were selected comprising of doctors, midwives, and nurses from public and private HF. Data were collected using interviewer-administered questionnaire and observation checklist and analyzed using bivariate and multivariate analysis. Statistical significance determined at P < 0.05. RESULTS: The practice of infection prevention was poor. Overall, 42.3% of the HWs did not change their gowns in-between patients, with the significantly higher rates in 73.1% of private compared to 42.3% of public HF workers (P < 0.001). In addition, 30.5% and 10.1% of HWs do not use face mask and eye goggle, respectively, when conducting procedures likely to generate splash of body fluids, however, there was no significant difference in these poor practices in public compared to private HFs. The mean IPC practice was 51.6 ± 12.5%, this was significantly lower among public (48.8 ± 12.5%) compared to private (54.5 ± 11.9%) HF workers (P < 0.0001). Private HF workers were 3 times more likely to implement IPC interventions compared to public HF workers. CONCLUSION: IPC practice especially among public HF workers was poor.


Subject(s)
Humans , Male , Female , Infant, Newborn , Disease Prevention , Hospitals , Community-Acquired Infections , Defensive Medicine , Hospitals, Maternity , Infections
4.
Int. j. med. surg. sci. (Print) ; 8(2): 1-15, jun. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1284390

ABSTRACT

La importancia de la evaluación inicial de la gravedad del paciente con neumonía es una acción diagnóstica de importancia bien establecida. El objetivo del trabajo fue evaluar la relación entre la frecuencia y calidad del proceso de estratificación de pacientes con neumonía, y el cumplimiento de las sugerencias de ubicación intrahospitalaria y de tratamiento antimicrobiano inicial de un instrumento de estratificación. Se realizó un estudio descriptivo sobre una población de 1,809 pacientes hospitalizados durante 10 años. Se analizó el comportamiento de los índices de ubicación intrahospitalaria y tratamiento antimicrobiano inicial acorde a la sugerencia de un instrumento de estratificación utilizado; en el análisis estadístico se utilizó el Odds ratio y el estadígrafo X2, con un nivel de significación de 95%. En los resultados se destacan que la ubicación intrahospitalaria estuvo acorde a la sugerencia del instrumento en el 96%, con el valor más bajo en los pacientes con neumonía grave y altas probabilidades de recuperación (82%, p<,05). Se constató mayor frecuencia de ubicación intrahospitalaria acorde a la sugerencia del instrumento en los pacientes bien estratificados (p<,05), fundamentalmente en los pacientes con neumonía grave y altas probabilidades de recuperación. La correspondencia del tratamiento antimicrobiano inicial con la propuesta del instrumento fue del 61%; el estrato IIIA mostró el valor más elevado (80%, p<,05). Como conclusiones del estudio se constató un elevado desempeño en el cumplimiento de la sugerencia de ubicación intrahospitalaria del instrumento de estratificación, no así en el cumplimiento de la sugerencia de tratamiento antimicrobiano inicial. Se demostró la existencia de una relación entre el proceso de estratificación y el cumplimiento de la ubicación intrahospitalaria sugerida por el instrumento empleado.


The initial evaluation of the patient's condition with pneumonia is a very important assistance action. The objective was evaluate the relationship between the frequency and quality of the stratification process of the patient with pneumonia, and the execution of suggestions of intrahospitalary location and the initial antimicrobial treatment of stratification instrument. A descriptive study was done on a population of 1,809 patients hospitalized during 10 years. The indexes of intrahospitalary location and of antimicrobian initial treatment were analized according to the suggestions of the instrument; in the statistical analysis it was used the odds ratio and the statistician X2, with a significant level of 95%. The intrahospitalary location was in agreement with the suggestion of the instrument in 96% of the cases, with the lowest value in patients with serious pneumonia and high recovery probabilities (82%, p <,05). The frequency of intrahospitalary location was bigger and veryfied with the suggestion of the instrument in the termed well stratified patients (p <,05), fundamentally in the patients with serious pneumonia and high recovery probabilities. The correspondence of the initial antimicrobial treatment with the proposal of the instrument was of 61%; the stratum IIIA showed the highest value (80%, p <,05). As conclusions, a high performance in the execution of the suggestion of the intrahospitalary location has been one of the characteristics of the process, although as a negative element it stands out the frequent non-fulfillment of the suggestion of the initial antimicrobial treatment. There was a relationship between the stratification process and the execution of the suggestion of the intrahospitalary location.


Subject(s)
Humans , Patient Admission/statistics & numerical data , Pneumonia/diagnosis , Pneumonia/drug therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Anti-Infective Agents/therapeutic use , Severity of Illness Index , Total Quality Management , Cuba , Patient Acuity , Hospitalization/statistics & numerical data
5.
Rev. pediatr. electrón ; 18(1): 33-44, abr. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1369717

ABSTRACT

OBJETIVO. Comparar la gravedad de las infecciones respiratorias agudas bajas (IRAb) producidas por Adenovirus (ADV) entre los años 2015 y 2016, en el Hospital de Niños Roberto del Río. MÉTODOS. Se identificó a pacientes hospitalizados por IRAb por ADV, y se registró edad, sexo, días de hospitalización, ingreso a unidad de paciente crítico (UPC), necesidad de ventilación mecánica (VM), entre otros. Se comparó la evolución de los pacientes, y se analizó la relación entre gravedad y presencia de infecciones asociadas a atención de salud (IAAS). RESULTADOS. Se identificó 158 pacientes hospitalizados por IRAb por ADV. La relación hombre: mujer fue 6:4, con una edad promedio de 17.4 meses. La media de días de hospitalización fue de 9.88 el 2015 y 16.06 el 2016 (p=0.01). El promedio de días de oxigenoterapia fue de 5.86 el 2015 y 8.76 el 2016. Un 22.8% (n:36) de los pacientes ingresó a UPC, y el 20.25% (n:32) requirió VM. Un 41.8% de los casos (n:66) correspondió a IAAS. 3 pacientes fallecieron. CONCLUSIONES. Durante el 2016 hubo hospitalizaciones más prolongadas en comparación al 2015, sin diferencias estadísticamente significativas en relación a requerimientos de oxigenoterapia, VM y fallecimiento. La prolongación de la hospitalización se podría asociar a mayor presencia de IAAS.


OBJETIVE. To compare the severity of lower respiratory infections produced by Adenovirus between 2015 and 2016 at the Hospital de Niños Roberto del Río. METHODS. We identified patients hospitalized for lower respiratory tract infection for ADV and we recorded age, sex, days of hospitalization, admission to Intensive Care Unit (ICU), need for mechanical ventilation (MV), among others. The evolution of the patients between the two years were compared. The relationship between severity and the presence of nosocomial infections was also analyzed. RESULTS. We identified 158 hospitalized patients for ADV. The male:female ratio was 6:4, with an average age of 17.4 months. The mean of hospitalization days was 9.88 days in 2015 and 16.06 days in 2016 (p = 0.01). The average number of oxygen therapy days was 5.86 in 2015 and 8.76 in 2016. The 22.8% (n: 36) of cases required admission in the ICU, and 20.25% (n: 32) required MV. The 41.8% (n: 66) of cases corresponded to nosocomial infections. 3 patients died. CONCLUSIONS. During 2016, there were longer hospitalizations for adenovirus infections compared to 2015, without significant differences in relation to oxygen therapy, MV requirements and death. The prolongation of the hospitalization could be associated by the greater presence of nosocomial infections.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Respiratory Tract Infections/complications , Cross Infection , Community-Acquired Infections , Adenoviridae Infections/complications , Hospitals, Pediatric/statistics & numerical data , Oxygen Inhalation Therapy , Respiration, Artificial , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/therapy , Respiratory Tract Infections/epidemiology , Vasoconstrictor Agents/therapeutic use , Polymerase Chain Reaction , Acute Disease , Retrospective Studies , Fluorescent Antibody Technique , Adenoviridae Infections/diagnosis , Adenoviridae Infections/therapy , Adenoviridae Infections/epidemiology , Length of Stay
7.
Rev. cuba. med ; 60(1): e1397, tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156559

ABSTRACT

Introducción: Un instrumento ha sido utilizado para la estratificación de pacientes con neumonía adquirida en la comunidad en el Departamento de urgencias desde 2006. Objetivo: Evaluar el proceso de estratificación de pacientes con neumonía adquirida en la comunidad de pacientes hospitalizados. Métodos: Estudio descriptivo que incluyó 1 809 pacientes hospitalizados en el Departamento de urgencias entre los años 2009 y 2019. Para la evaluación del proceso se realizó una estratificación de control que permitió determinar la frecuencia y calidad de la estratificación inicial, así como la coincidencia entre esta y la estratificación real. En el análisis estadístico se utilizó la razón de productos cruzados (Odds Ratio) y el estadígrafo X2 para diferencias de proporciones; se aceptó un nivel de significación de 95 por ciento. Resultados: El índice de estratificación de la serie fue de 86 por ciento, y el índice de estratificación adecuada fue de 80 por ciento. Predominaron los pacientes con neumonía moderada y altas probabilidades de evolución desfavorable. La menor estratificación se comprobó en los pacientes con neumonía grave y altas probabilidades de recuperación (p<,05). Hubo diferencias en la calidad de la estratificación entre las agrupaciones de los estratos IA-IB-IIA y IIB-IIIA-IIIB (p<,05). Estos tres últimos estratos presentaron las cifras más altas del valor predictivo positivo de la estratificación inicial (p<,05). Conclusiones: El proceso de estratificación de pacientes con neumonía adquirida en la comunidad hospitalizados se caracterizó por una elevada frecuencia de estratificación y una adecuada calidad. No obstante, fueron identificados grupos de pacientes y situaciones específicas que se consideran áreas de superación de importancia para el mejoramiento de la calidad asistencia(AU)


Introduction: An instrument has been used for stratifying patients with community-acquired pneumonia in the emergency department since 2006. Objective: To evaluate the stratifying process of patients with community-acquired pneumonia in hospitalized patients. Methods: A descriptive study that included 1 809 patients hospitalized in the emergency department from 2009 to 2019 was carried out. A control stratification evaluated the process, which allowed determining the frequency and quality of the initial stratification, as well as the coincidence between this and the actual stratification. In the statistical analysis, the ratio of crossed products (Odds Ratio) and X2 statistic were used for differences in proportions; a significance level of 95 percent was accepted. Results: The stratification index of the series was 86 percent, and the adequate stratification index was 80 percent. Patients with moderate pneumonia and high probabilities of unfavorable evolution predominated. The lowest stratification was found in patients with severe pneumonia and high probability of recovery (p <.05). There were differences in the quality of stratification between the groupings of strata IA-IB-IIA and IIB-IIIA-IIIB (p <.05); these last three strata sowed the highest figures of the positive predictive value of the initial stratification (p <.05). Conclusions: The stratification process of hospitalized community-acquired pneumonia patients was characterized by high stratification frequency and adequate quality. However, this study identified groups of patients and specific situations that were considered as areas of improvement, important for improving the quality of care(AU)


Subject(s)
Humans , Pneumonia/epidemiology , Emergency Medical Services , Epidemiology, Descriptive , Community-Acquired Infections/etiology
8.
Medicina (B.Aires) ; 81(1): 37-46, mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1287239

ABSTRACT

Resumen La neumonía adquirida en la comunidad (NAC) representa un importante problema sanitario y ~20% de los pacientes requiere hospitalización. El objetivo principal del trabajo fue determinar las características clínico-imagenológicas de los episodios de NAC que requirieron internación. Los objetivos secundarios fueron determinar el rédito diagnóstico de los estudios microbiológicos e identificar las complicaciones. Realizamos un estudio analítico retrospectivo en un hospital de tercer nivel durante el período 2017-2019, en adultos admitidos por NAC, excluyendo embarazadas. Identificamos 340 episodios en 321 pacientes, la mediana de edad fue 75 años (rango intercuartil 57-85). Los factores de riesgo más frecuentes fueron inmunocompromiso (30%), enfermedad neurológica (22%) y enfermedad renal crónica (17%). Según tres scores pronósticos de gravedad, CURB65, qSOFA y PSI/PORT, 216 (63.5%), 290 (85.3%) y 130 (38%) episodios fueron identificados como de bajo riesgo, respectivamente. Del total de los episodios, 49 (14.4%) requirieron internación en unidad de cuidados intensivos, 39 (11.5%) ventilación mecánica y se registraron 30 (8.8%) muertes durante la hospitalización. Los patrones de imagen más frecuentes fueron consolidativo en 134 (39.4%), intersticio-alveolar en 98 (28.8%) y mixto entre ambos patrones en 67 (19.7%) episodios. Identificamos el agente causal en 79 (23.2%) episodios. Los microorganismos aislados más frecuentemente fueron influenza en 37 (10.9%) y Streptococcus pneumoniae en 11 (3.2%). La mayoría de los episodios afectaron pacientes ancianos y el principal patrón radiológico fue el consolidativo. El agente causal se pudo identificar en uno de cada cuatro episodios y el método con mayor rédito diagnóstico fue el test para influenza.


Abstract Community-acquired pneumonia (CAP) represents a major health issue and ~20% of the patients require in-hospital attention. The main objective of the study was to determine clinical-imaging features of CAP episodes requiring hospitalization. The secondary objectives were to determine the diagnostic yield of microbiological analyses and the medical complications. A retrospective analytical study was conducted on adults admitted due to CAP in a third-level hospital in the period 2017-2019. Pregnant women were excluded. A total of 340 CAP episodes were identified in 321 patients; the median age was 75 years old (interquartile range 57-85). The most frequent risk factors were immunocompromise 102 (30%), neurological disease 75 (22%), and chronic kidney disease 58 (17%). According to three prognostic scores, CURB65, qSOFA and PSI/PORT, 216 (63.5%), 290 (83.5%) and 130 (38%) patients were identified as low risk, respectively. A total of 49 (14.4%) episodes required admission at the critical care unit and 39 (11.5%) required mechanical ventilation; 30 patients (8.8%) died during hospitalization. The radiologic patterns most frequently found were consolidation in 134 (39.4%), interstitial-alveolar pattern in 98 (28.8%), and the combination of both patterns in 67 (19.7%) episodes. Identification of the causal agent was achieved in 79 (23.2%) episodes. The most frequently isolated microorganisms were influenza virus in 37 (10.9%) episodes and Streptococcus pneumoniae in 11 (3.2%). Most of the hospitalized CAP patients were elderly with consolidative radiological patterns. The causal agent could be identified in less than a quarter of the patients, with the influenza test being the method with the highest diagnostic yield.


Subject(s)
Humans , Female , Adult , Aged , Pneumonia/epidemiology , Pneumonia/diagnostic imaging , Pneumonia, Pneumococcal , Community-Acquired Infections/diagnosis , Community-Acquired Infections/therapy , Community-Acquired Infections/epidemiology , Streptococcus pneumoniae , Retrospective Studies , Hospitalization
9.
Arch. argent. pediatr ; 119(1): 11-17, feb. 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1147054

ABSTRACT

Introducción. Las infecciones por Staphylococcus aureus resistente a meticilina adquirido de la comunidad (SARM-AC) se han incrementado en los últimos años. Neumonías necrotizantes y empiemas por SARM-AC son cada vez más frecuentes en niños.Objetivos. Determinar la prevalencia de neumonías por SARM-AC y sus características clínico-epidemiológicas, en comparación con las neumonías por Streptococcus pneumoniae (SP) en la misma población.Material y métodos. Estudio descriptivo, observacional, transversal, de pacientes internados con neumonía por SARM-AC en el Hospital de Niños Víctor J. Vilela (período: 1/2008-12/2017).Resultados. De 54 neumonías por Staphylococcus aureus, 46 (el 85 %) fueron SARM-AC. El índice de neumonías por SARM-AC varió de 4,9/10 000 (2008) a 10/10 000 egresos (2017). Presentaron sepsis/shock séptico el 41 %; empiema, el 96 %; neumotórax, el 35 %; requirieron drenaje pleural el 90 % y toilette quirúrgica el 55 %. Ingresaron a Terapia Intensiva el 65 %; la mitad necesitó asistencia respiratoria mecánica. Hubo dos muertes. Resistencia de las cepas: el 17 % a gentamicina, el 13 % a eritromicina, el 11 % a clindamicina. En las neumonías por SARM-AC vs. las neumonías por SP, se observó mayor riesgo de sepsis (IC 95 %; RR 7,38; 3,32-16,38) e ingreso a Terapia Intensiva (RR 4,29; 2,70-6,83). No hubo muertes por SP.Conclusiones. La prevalencia de neumonías por SARM-AC se duplicó durante la última década. Comparadas con las neumonías por SP, las neumonías por SARM-AC se acompañaron, más frecuentemente, de cuadros de sepsis y shockséptico, ingreso a Terapia Intensiva y asistencia respiratoria.


Introduction. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased in recent years. CA-MRSA necrotizing pneumonia and empyema are now more common in children.Objectives. To determine the prevalence of CA-MRSA pneumonia and its clinical and epidemiological characteristics compared to Streptococcus pneumoniae (SP) pneumonia in the same population.Material and methods. Descriptive, observational, cross-sectional study of patients hospitalized due to CA-MRSA pneumonia at Hospital de Niños Víctor J. Vilela (period: January 2008-December 2017).Results. Out of 54 Staphylococcus aureus pneumonia cases, 46 (85 %) corresponded to CA-MRSA. The rate of CA-MRSA pneumonia ranged from 4.9/10 000 (2008) to 10/10 000 hospital discharges (2017). Sepsis/septic shock was observed in 41 %; empyema, in 96 %; pneumothorax, in 35 %; 90 % of cases required pleural drainage and 55 %, surgical debridement. Also, 65 % of patients were admitted to the intensive care unit (ICU); half of them required assisted mechanical ventilation. Two patients died. Strain resistance: 17 %, gentamicin; 13 %, erythromycin; and 11 %, clindamycin. Compared to SP pneumonia, CA-MRSA pneumonia showed a higher risk for sepsis (95 % confidence interval; relative risk: 7.38; 3.32-16.38) and admission to the ICU (RR: 4.29; 2.70-6.83). No patient died due to SP pneumonia.Conclusions. The prevalence of CA-MRSA pneumonia doubled in the past decade. Compared to SP pneumonia, CA-MRSA pneumonia was more commonly accompanied by sepsis and septic shock, admission to the ICU, and ventilatory support requirement


Subject(s)
Humans , Male , Female , Child , Adolescent , Staphylococcal Infections/epidemiology , Community-Acquired Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus , Argentina/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/microbiology , Microbial Sensitivity Tests , Epidemiology, Descriptive , Incidence , Prevalence , Cross-Sectional Studies , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Hospitals, Pediatric
10.
J. pediatr. (Rio J.) ; 97(1): 13-21, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154730

ABSTRACT

Abstract Objectives: To review, analyze, and present the available evidence on the usefulness of point-of-care pulmonary ultrasound in the diagnosis and monitoring of community-acquired pneumonia (CAP), aiming to facilitate its potential inclusion into pediatric clinical reference guidelines. Source of data: A non-systematic research was carried out in the MEDLINE (PubMed), LILACS, and SciELO databases, from January 1985 to September 2019. The articles that were considered the most relevant were selected. Synthesis of data: CAP is a relevant cause of morbidity and mortality in pediatrics and its clinical management remains a major challenge. The systematic use of chest X-ray for its diagnosis is controversial because it exposes the child to ionizing radiation and there are interobserver differences in its interpretation. Recently, the use of point-of-care pulmonary ultrasound by the pediatrician has been presented as an alternative for the diagnosis and monitoring of CAP. A great deal of evidence has disclosed its high sensitivity and diagnostic specificity, with the advantages of no ionizing radiation, relatively low cost, immediate results, portability, and the possibility of repetition according to the requirements of disease evolution. Moreover, its use can help rule out possible bacterial etiology and thus prevent inappropriate antibiotic treatments that favor bacterial resistance. Conclusions: Point-of-care ultrasonography represents an opportunity to improve the diagnosis and monitoring of CAP. However, as an operator-dependent technique, training is required for adequate image acquisition, correct interpretation, and integration with clinical data for correct decision-making.


Subject(s)
Humans , Child , Pneumonia/diagnostic imaging , Community-Acquired Infections/diagnostic imaging , Follow-Up Studies , Ultrasonography , Point-of-Care Systems , Pediatricians
11.
Braz. j. infect. dis ; 25(1): 101539, jan., 2021. tab, graf
Article in English | LILACS | ID: biblio-1249301

ABSTRACT

ABSTRACT Background: Community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) emerged in the 1990s as a global community pathogen primarily involved in skin and soft tissue infections (SSTIs) and pneumonia. To date, the CG-MRSA SSTI burden in Latin America (LA) has not been assessed. Objective: The main objective of this study was to report the rate and genotypes of community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) causing community-onset skin and soft tissue infections (CO-SSTIs) in LA over the last two decades. In addition, this research determined relevant data related to SSTIs due to CG-MRSA, including risk factors, other invasive diseases, and mortality. Data sources: Relevant literature was searched and extracted from five major databases: Embase, PubMed, LILACS, SciELO, and Web of Science. Methods: A systematic review was performed, and a narrative review was constructed. Results: An analysis of 11 studies identified epidemiological data across LA, with Argentina presenting the highest percentage of SSTIs caused by CG-MRSA (88%). Other countries had rates of CG-MRSA infection ranging from 0 to 51%. Brazil had one of the lowest rates of CG-MRSA SSTI (4.5-25%). In Argentina, being younger than 50 years of age and having purulent lesions were predictive factors for CG-MRSA CO-SSTIs. In addition, the predominant genetic lineages in LA belonged to sequence types 8, 30, and 5 (ST8, ST30, and ST5). Conclusion: There are significant regional differences in the rates of CG-MRSA causing CO-SSTIs. It is not possible to conclude whether or not CG-MRSA CO-SSTIs resulted in more severe SSTI presentations or in a higher mortality rate.


Subject(s)
Humans , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcal Skin Infections/drug therapy , Staphylococcal Skin Infections/epidemiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Soft Tissue Infections/drug therapy , Soft Tissue Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus/genetics , Argentina , Brazil , Genotype , Latin America/epidemiology , Anti-Bacterial Agents/therapeutic use
12.
Frontiers of Medicine ; (4): 139-143, 2021.
Article in English | WPRIM | ID: wpr-880941

ABSTRACT

The rationale for the antibiotic treatment of viral community-acquired pneumonia (CAP) in adults was analyzed to develop a clinical reference standard for this condition. Clinical data from 166 patients diagnosed with viral pneumonia across 14 hospitals in Beijing from November 2010 to December 2017 were collected. The indications for medications were evaluated, and the rationale for the use of antibiotics was analyzed. A total of 163 (98.3%) patients with viral pneumonia were treated with antibiotics. A combination of C-reactive protein (CRP) and procalcitonin (PCT) was used as markers to analyze the possible indications for antibiotic use. With threshold levels set at 0.25 µg/L for PCT and 20 mg/L for CRP, the rate of unreasonable use of antibiotics was 55.2%. By contrast, at a CRP level threshold of 60 mg/L, the rate of antibiotic misuse was 77.3%. A total of 39 of the 163 (23.9%) patients did not meet the guidelines for drug selection for viral CAP in adults. The unreasonable use of antibacterial drugs for the treatment of viral CAP in adults is a serious concern. Clinicians must reduce the unnecessary use of antibiotics.


Subject(s)
Adult , Anti-Bacterial Agents/therapeutic use , Biomarkers , Calcitonin , Community-Acquired Infections/drug therapy , Humans , Pneumonia/drug therapy , Protein Precursors
13.
Article in English | WPRIM | ID: wpr-879311

ABSTRACT

In the era of coronavirus disease 2019 (COVID-19) pandemic, imported COVID-19 cases pose great challenges to many countries. Chest CT examination is considered to be complementary to nucleic acid test for COVID-19 detection and diagnosis. We report the first community infected COVID-19 patient by an imported case in Beijing, which manifested as nodular lesions on chest CT imaging at the early stage. Deep Learning (DL)-based diagnostic systems quantitatively monitored the progress of pulmonary lesions in 6 days and timely made alert for suspected pneumonia, so that prompt medical isolation was taken. The patient was confirmed as COVID-19 case after nucleic acid test, for which the community transmission was prevented timely. The roles of DL-assisted diagnosis in helping radiologists screening suspected COVID cases were discussed.


Subject(s)
Adult , Beijing , COVID-19/diagnostic imaging , COVID-19 Testing/methods , Community-Acquired Infections/diagnostic imaging , Deep Learning , Humans , Lung/diagnostic imaging , Male , Tomography, X-Ray Computed/methods
14.
Article in Chinese | WPRIM | ID: wpr-879029

ABSTRACT

To systemically evaluate the efficacy and safety of Maxing Shigan Decoction in the treatment of community acquired pneumonia(CAP) and provide a reference for the treatment of CAP. Databases of CNKI, Wanfang, VIP, SinoMed, EMbase, Cochrane Library, Web of Science and PubMed were searched(from inception to May 30, 2020) to screen the randomized controlled trials(RCTs) of Maxing Shigan Decoction in treating CAP. Two authors independently screened and selected relevant literature and extracted data based on the inclusion and exclusion criteria. Any disagreement or differences was resolved through discussion. The bias risk assessment tool recommended by Cochrane handbook was used to evaluate the quality of the included studies, and RevMan 5.3 software was used for data analysis. Seventeen RCTs were finally included, involving 1 309 patients. Meta-analysis showed that Maxing Shigan Decoction combined with conventional Western medicine treatment could improve clinical efficacy in patients with CAP more effectively as compared with conventional Western medicine treatment alone, mainly in terms of anti-inflammatory effects, a decrease in C-reactive protein(CRP) content(MD=-6.01, 95%CI[-10.95,-1.06], P=0.02)and white blood cell(WBC) count, a decrease in procalcitonin(PCT) level(MD=-0.74, 95%CI[-0.77,-0.71], P<0.000 1), and shortened recovery time of cough and fever. Maxing Shigan Decoction has certain curative effect on CAP, but there are problems in the methodology of included studies. High-quality stu-dies are still needed for further verification.


Subject(s)
Community-Acquired Infections/drug therapy , Cough , Drugs, Chinese Herbal , Humans , Pneumonia/drug therapy , Randomized Controlled Trials as Topic , Treatment Outcome
15.
J. bras. pneumol ; 47(1): e20200257, 2021. tab, graf
Article in English | LILACS | ID: biblio-1154695

ABSTRACT

ABSTRACT Objective: To compare the performance of Charlson Comorbidity Index (CCI) with those of the mental Confusion, Urea, Respiratory rate, Blood pressure, and age = 65 years (CURB-65) score and the Pneumonia Severity Index (PSI) as predictors of all-cause in-hospital mortality in patients with community-acquired pneumonia (CAP). Methods: This was a cohort study involving hospitalized patients with CAP between April of 2014 and March of 2015. Clinical, laboratory, and radiological data were obtained in the ER, and the scores of CCI, CURB-65, and PSI were calculated. The performance of the models was compared using ROC curves and AUCs (95% CI). Results: Of the 459 patients evaluated, 304 met the eligibility criteria. The all-cause in-hospital mortality rate was 15.5%, and 89 (29.3%) of the patients were admitted to the ICU. The AUC for the CCI was significantly greater than those for CURB-65 and PSI (0.83 vs. 0.73 and 0.75, respectively). Conclusions: In this sample of hospitalized patients with CAP, CCI was a better predictor of all-cause in-hospital mortality than were the PSI and CURB-65.


RESUMO Objetivo: Comparar o desempenho do Índice de Comorbidade de Charlson (ICC) com o do mental Confusion, Urea, Respiratory rate, Blood pressure, and age = 65 years (CURB-65, Confusão mental, Ureia, frequência Respiratória, Pressão arterial e idade = 65 anos) e do Pneumonia Severity Index (PSI, Índice de Gravidade da Pneumonia) como preditores de mortalidade hospitalar por qualquer causa em pacientes com pneumonia adquirida na comunidade (PAC). Métodos: Estudo de coorte com pacientes hospitalizados com PAC entre abril de 2014 e março de 2015. Dados clínicos, laboratoriais e radiológicos foram obtidos no PS, e o ICC, CURB-65 e PSI foram calculados. O desempenho dos modelos foi comparado por meio de curvas ROC e ASC (IC95%). Resultados: Dos 459 pacientes avaliados, 304 preencheram os critérios de elegibilidade. A taxa de mortalidade hospitalar por qualquer causa foi de 15,5%, e 89 (29,3%) dos pacientes foram admitidos na UTI. A ASC do ICC foi significativamente maior do que a do CURB-65 e do PSI (0,83 vs. 0,73 e 0,75, respectivamente). Conclusões: Nesta amostra de pacientes hospitalizados com PAC, o ICC foi um preditor melhor de mortalidade hospitalar por qualquer causa do que o PSI e o CURB-65.


Subject(s)
Humans , Adult , Aged , Pneumonia , Community-Acquired Infections , Prognosis , Severity of Illness Index , Comorbidity , Cohort Studies , Hospital Mortality
16.
Article in English | AIM | ID: biblio-1292916

ABSTRACT

Objectives: Infection prevention and control (IPC) practice in health facility (HF) is abysmally low in developing countries, resulting in significant preventable morbidity and mortality. This study assessed and compared health workers' (HWs) practice of IPC strategies in public and private secondary HFs in Kaduna State. Material and Methods: A cross-sectional comparative study was employed. Using multistage sampling, 227 participants each were selected comprising of doctors, midwives, and nurses from public and private HF. Data were collected using interviewer-administered questionnaire and observation checklist and analyzed using bivariate and multivariate analysis. Statistical significance determined at P < 0.05. Results: The practice of infection prevention was poor. Overall, 42.3% of the HWs did not change their gowns in-between patients, with the significantly higher rates in 73.1% of private compared to 42.3% of public HF workers (P < 0.001). In addition, 30.5% and 10.1% of HWs do not use face mask and eye goggle, respectively, when conducting procedures likely to generate splash of body fluids, however, there was no significant difference in these poor practices in public compared to private HFs. The mean IPC practice was 51.6 ± 12.5%, this was significantly lower among public (48.8 ± 12.5%) compared to private (54.5 ± 11.9%) HF workers (P < 0.0001). Private HF workers were 3 times more likely to implement IPC interventions compared to public HF workers. Conclusion: IPC practice especially among public HF workers was poor. Keywords: Hospital-acquired infection, Infection prevention and control, Maternity unit, Practice


Subject(s)
Humans , Community-Acquired Infections , Disease Prevention , Practice Guidelines as Topic , Hospitals , Hospitals, Maternity , Infections
17.
Rev. cuba. pediatr ; 92(3): e1056, jul.-set. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126762

ABSTRACT

Introducción: La presencia de tuberculosis infantil constituye una señal de alerta de transmisión en la comunidad. Objetivos: Determinar incidencia y características de la tuberculosis infantil en Cuba en su etapa más reciente. Métodos: Estudio descriptivo, transversal y retrospectivo de los 107 casos diagnosticados 0-18 años, periodo 2013-2017, según datos de la Dirección de Registros Médicos y Estadísticas de Salud, la ficha epidemiológica y datos del Centro de Referencia Nacional de tuberculosis infantil. Se estudiaron variables demográficas, epidemiológicas, clínicas y de estudios que contribuyeron al diagnóstico, así como a la evolución final de los casos. Resultados: Predominó el grupo de edad de 15 - 18 años (52,0 - 48,6 por ciento) , sexo masculino (59,0-55,1 por ciento) y los procedentes de La Habana (43,0 - 40,2 por ciento). La tuberculosis en menores de 19 años representó entre 1,8 y 4,4 por ciento del total de casos en el país. La tasa de incidencia por 100 mil habitantes se comportó en menores de 15 años entre 0,4 y 0,8 con tendencia descendente; en el grupo 15-18 años, entre 0,8 y 3,0 con tendencia ascendente. Predominaron las formas pulmonares (87,0 - 82,6 por ciento) con pobre confirmación bacteriológica (49,0 - 45,7 por ciento). Ningún caso tuvo coinfección VIH-TB ni drogorresistencia. Hubo una fallecida (0,9 por ciento). Conclusiones: Cuba tiene muy baja incidencia de tuberculosis infantil, no es un problema de salud, pero sí un indicador de transmisión de la enfermedad en la comunidad. Para su eliminación, hay que fortalecer las acciones del Programa Nacional de Control, particularmente en La Habana y en el grupo de edad de 15 a 18 años(AU)


Introduction: The presence of children tuberculosis constitutes a transmission alert sign in the community. Objectives: To determine the incidence and characteristics of children tuberculosis in Cuba in its earliest stage. Methods: Descriptive, cross-sectional and restrospective study of 107 diagnosed cases in the ages from 0 to 18 years during the period 2013-2017, according to data provided by the National Division of Medical Records and Health Statistics, epidemiological records and data from the Center of National Reference on Children Tuberculosis. There were studied demographic, epidemiological, clinical and study variables which contributed to the diagnosis as well as to the final evolution of the cases. Results: There was a predominance of the age of group of 15 - 18 years (52.0 - 48.6 percent), masculine sex (59.0 - 55.1 percent) and patients from Havana city (43.0 - 40.2 percent). Tuberculosis in patients under 19 years represented between the 1.8 and 4.4 percent of all the cases in the country. The incidence rate per 100 000 inhabitants in patients under 15 years was 0.4 to 0.8 with a decreasing trend; in the group age of 15 to 18 years it was between 0.8 and 3.0 with an increasing trend. Pulmonary conditions predominated (87.0 - 82.6 percent) with poor bacteriological confirmation (49.0 - 45.7 percent). None of the cases had HIV-TB co-infection nor drugs resistance. There was one deceased girl (0,9 percent). Conclusions: Cuba has a very low incidence of children tuberculosis; it does not represent a health problem but it actually is an indicator of transmission of the disease in the community. For its erradication, it is needed to strenght the actions of the Control´s National Program, particularly in Havana city and the age group of 15 to 18 years(AU)


Subject(s)
Humans , Male , Female , Adolescent , Tuberculosis/prevention & control , Tuberculosis/epidemiology , Community-Acquired Infections/transmission , National Health Programs/standards , Cuba
18.
J. pediatr. (Rio J.) ; 96(supl.1): 29-38, Mar.-Apr. 2020.
Article in English | LILACS | ID: biblio-1098362

ABSTRACT

Abstract Objective To provide cutting-edge information for the management of community-acquired pneumonia in children under 5 years, based on the latest evidence published in the literature. Data source A comprehensive search was conducted in PubMed, by using the expressions: "community-acquired pneumonia" AND "child" AND "etiology" OR "diagnosis" OR "severity" OR "antibiotic". All articles retrieved had the title and the abstract read, when the papers reporting the latest evidence on each subject were identified and downloaded for complete reading. Data synthesis In the era of largely implemented bacterial conjugate vaccines and widespread use of amplification nucleic acid techniques, respiratory viruses have been identified as the most frequent causative agents of community-acquired pneumonia in patients under 5 years. Hypoxemia (oxygen saturation ≤96%) and increased work of breathing are signs most associated with community-acquired pneumonia. Wheezing detected on physical examination independently predicts viral infection and the negative predictive value (95% confidence interval) of normal chest X-ray and serum procalcitonin <0.25 ng/dL was 92% (77-98%) and 93% (90-99%), respectively. Inability to drink/feed, vomiting everything, convulsions, lower chest indrawing, central cyanosis, lethargy, nasal flaring, grunting, head nodding, and oxygen saturation <90% are predictors of death and can be used as indicators for hospitalization. Moderate/large pleural effusions and multilobar infiltrates are predictors of severe disease. Orally administered amoxicillin is the first line outpatient treatment, while ampicillin, aqueous penicillin G, or amoxicillin (initiated initially by intravenous route) are the first line options to treat inpatients. Conclusions Distinct aspects of childhood community-acquired pneumonia have changed during the last three decades.


Resumo Objetivo Fornecer informações de ponta para o manejo de crianças menores de cinco anos com pneumonia adquirida na comunidade, com base nas evidências mais recentes publicadas na literatura. Fonte de dados Uma pesquisa abrangente foi feita no PubMed, com as expressões: "community-acquired pneumonia" + "child" + "etiology" ou "diagnosis" ou "severity" ou "antibiotic". Todos os artigos encontrados tiveram o título e o resumo lidos e os artigos que relatavam as evidências mais recentes sobre cada assunto foram identificados e recuperados para leitura completa. Síntese dos dados Na era das vacinas bacterianas conjugadas amplamente usadas e do uso difundido de técnicas de amplificação de ácidos nucléicos, os vírus respiratórios foram identificados como os agentes causadores mais frequentes de pneumonia adquirida na comunidade em pacientes com menos de cinco anos. A hipoxemia (saturação de oxigênio ≤ 96%) e o aumento do esforço respiratório são os sinais mais associados à pneumonia adquirida na comunidade. A sibilância detectada ao exame físico prediz de forma independente a infecção viral e o valor preditivo negativo (intervalo de confiança de 95%) da radiografia de tórax normal e a procalcitonina sérica < 0,25 ng/dL foi de 92% (77-98%) e 93% (90-99%), respectivamente. Incapacidade de beber e se alimentar, vomitar todo o alimento, convulsões, retração torácica subcostal, cianose central, letargia, aleteo nasal, estridor e saturação de oxigênio < 90% são preditores de óbito e podem ser usados como indicadores de hospitalização. Derrames pleurais moderados/grandes e infiltrados multilobulares são preditores de doença grave. A amoxicilina administrada por via oral é a opção de primeira linha para tratar pacientes ambulatoriais e a ampicilina ou penicilina cristalina G ou amoxicilina (administrada inicialmente por via intravenosa) são as opções de primeira linha para tratar pacientes hospitalizados. Conclusões Aspectos distintos da pneumonia adquirida na comunidade durante a infância mudaram durante as últimas três décadas.


Subject(s)
Humans , Infant , Child, Preschool , Child , Pneumonia/diagnosis , Pneumonia/drug therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Cross-Sectional Studies , Anti-Bacterial Agents/therapeutic use
19.
Article in English, Portuguese | LILACS, SES-SP | ID: biblio-1136736

ABSTRACT

ABSTRACT Objective: To describe the clinical profile of children and adolescents hospitalized with community-acquired pneumonia (CAP). They were divided into two groups: those with and those without comorbidities. Methods: An observational, cross-sectional, descriptive study with prospective data collection, was carried out in a cohort of patients aged zero to 11, who were hospitalized with a clinical and radiological diagnosis of community-acquired pneumonia, from January 2010 to January 2012. As an exploratory study, the two groups were compared through logistic regression for possible risk factors associated with community-acquired pneumonia. Relative risk (RR) was used with a 95% confidence interval (95%CI). The process of selection for independent variables was stepwise forward, with a significance level of 5%. Results: There were 121 cases of community-acquired pneumonia evaluated, and 47.9% had comorbidities. In the bivariate analysis, patients with comorbidities demonstrated higher chances for: age >60 months (p=0.005), malnutrition (p=0.002), previous use of antibiotics (p=0.008) and previous hospitalization for community-acquired pneumonia in the last 24 months (p=0.004). In the multivariate analysis, these variables were independent predictors of community-acquired pneumonia in patients with the comorbidities: age >60 months (p=0.002; RR=5.39; 95%CI 1.89-15.40); malnutrition (p=0.008; RR=1.75; 95%CI 1.75-44.60); previous use of antibiotics (p=0.0013; RR=3.03; 95%CI 1.27-7.20); and previous hospitalization for community-acquired pneumonia (p=0.035; RR=2.91; 95%CI 1.08-7.90). Conclusions: Most patients with community-acquired pneumonia and comorbidities were aged >60 months, were malnourished, had used antibiotics and had been hospitalized for community-acquired pneumonia. Comorbidities were associated with a higher chance of malnutrition and hospitalizations for community-acquired pneumonia in an older age group, compared to children without comorbidities. Knowledge of this clinical profile may contribute to better assist pediatric patients with community-acquired pneumonia hospitalized in referral centers.


RESUMO Objetivo: Descrever o perfil clínico de crianças e adolescentes hospitalizados com pneumonia adquirida na comunidade, separando-os em dois grupos: com e sem comorbidades. Métodos: Estudo observacional, transversal, descritivo, com coleta prospectiva de dados, realizado na coorte de pacientes de zero a 11 anos, hospitalizados com diagnósticos clínico e radiológico de pneumonia adquirida na comunidade de janeiro de 2010 a janeiro de 2012. De modo exploratório, buscou-se comparar os dois grupos por regressão logística quanto a possíveis fatores de risco para pneumonia adquirida na comunidade, por meio de risco relativo (RR) com intervalo de confiança de 95% (IC95%). O processo de seleção das variáveis independentes foi o de stepwise forward, a 5%. Resultados: Foram avaliados 121 casos; 47,9% tinham comorbidades. Na análise bivariada, pacientes com comorbidades mostraram maiores chances de apresentar: idade >60 meses (p=0,005), desnutrição (p=0,002), uso prévio de antibióticos (p=0,008) e hospitalização por pneumonia adquirida na comunidade nos últimos 24 meses (p=0,004). Na análise multivariada, estas foram variáveis preditoras independentes para pneumonia adquirida na comunidade, nos pacientes com comorbidades: idade >60 meses (p=0,002; RR=5,39; IC95% 1,89-15,40); desnutrição (p=0,008; RR=1,75; IC95% 1,75-44,60); uso prévio de antimicrobianos (p=0,0013; RR=3,03; IC95% 1,27-7,20) e hospitalização prévia por pneumonia adquirida na comunidade (p=0,035; RR=2,91; IC95% 1,08-7,90). Conclusões: A maioria dos pacientes com pneumonia adquirida na comunidade e comorbidades tinha idade >60 meses, desnutrição, fizera uso prévio de antibióticos e havia sido hospitalizado por pneumonia adquirida na comunidade. As comorbidades relacionam-se à maior chance de desnutrição e a hospitalizações por pneumonia adquirida na comunidade em faixa etária mais elevada do que crianças sem comorbidades. O conhecimento desse perfil clínico pode contribuir para melhor assistência da pneumonia adquirida na comunidade em pacientes pediátricos hospitalizados em serviços de referência.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Pneumonia/epidemiology , Brazil/epidemiology , Case-Control Studies , Comorbidity , Cross-Sectional Studies , Prospective Studies , Surveys and Questionnaires , Risk Factors , Community-Acquired Infections/epidemiology
20.
Article in Chinese | WPRIM | ID: wpr-828033

ABSTRACT

To systematically evaluate the clinical efficacy and safety of modified Qingjin Huatan Decoction in the treatment of community-acquired pneumonia in the elderly, and provide evidence-based reference for the clinical application of this prescription. Randomized controlled trials of Qingjin Huatan Decoction in the treatment of community-acquired pneumonia in the elderly were collected by searching PubMed, EMbase, Cochrane Library, CNKI, China Biomedical Literature database, VIP database and WanFang database. Outcome indicators included clinical effective rate, inflammation index, symptom improvement time, chest radiograph improvement time, hospitalization time and adverse reactions. RevMan 5.3 and Stata/IC 15.1 software were used for Meta-analysis; TSA 0.9.5.10 Beta software was used for trial sequential analysis, and GRADE profiler 3.6 was used for grade evidence quality evaluation. Thirteen studies were included finally, including 1 058 patients, 536 patients in the experimental group and 522 patients in the control group.Meta-analysis showed that, the clinical effective rate of the experimental group was significantly higher than that of the control group(RR=1.16, 95%CI[1.10, 1.21], P<0.000 01); fever time(MD=-1.32, 95%CI[-1.93,-0.71], P<0.000 1), cough time(MD=-1.95, 95%CI[-2.69,-1.21), P<0.000 01), time to rale disappearance(MD=-1.55, 95%CI[-2.37,-0.73], P=0.000 2), time to chest radiograph improvement(MD=-1.72, 95%CI[-2.98,-0.46], P=0.007), and hospitalization time(MD=-3.16, 95%CI[-4.58,-1.74], P<0.000 01) in the experimental group were significantly shorter than those in the control group. The improvement in CRP(WMD=-3.44,95%CI[-4.50,-2.38],P<0.001), WBC(WMD=-2.04,95%CI[-3.31,-0.78],P<0.01), IL-6(WMD=-4.27,95%CI[-4.62,-3.92],P<0.001), and TNF-α(WMD=-0.47,95%CI[-0.55,-0.39], P<0.001) of the experimental group was significantly better than that of the control group. There was no significant difference in PCT improvement between the two groups(WMD=-0.63, 95%CI[-1.65, 0.40], P=0.23). No serious adverse reactions occurred in both groups. Sequential analysis of the trial showed that in the studies with cumulative inclusion of clinical effective rate, the data passed the traditional threshold and TSA threshold, further confirming its clinical efficacy. GRADE evaluation showed that the evidence level was low to extremely low. Western medicine treatment combined with Qingjin Huatan Decoction may improve clinical efficiency in the treatment of community-acquired pneumonia in the elderly, improve clinical symptoms faster, reduce CRP, WBC and other inflammatory indicators, and shorten hospital stay. The level of evidence obtained in this study is low, which needs to be further verified by high-quality multi-center, randomized controlled trials.


Subject(s)
Aged , China , Community-Acquired Infections , Cough , Drugs, Chinese Herbal , Humans , Pneumonia
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