[Show abstract][Hide abstract] ABSTRACT: Community-acquired pneumonia (CAP) severity scores can identify patients at low risk for mortality who may be suitable for ambulatory care. Here, we follow the clinical course of hospitalized patients with CAP due to 2009 H1N1 influenza.
To evaluate the role of CAP severity scores as predictors of mortality.
This was a secondary data analysis of patients hospitalized with CAP due to 2009 H1N1 influenza confirmed by reverse transcriptase polymerase chain reaction enrolled in the CAPO (Community-Acquired Pneumonia Organization) international cohort study. CAP severity scores PSI (Pneumonia Severity Index), CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) and CRB-65 (confusion, respiratory rate, blood pressure, age ≥ 65 years) were calculated. Actual and predicted mortality rates were compared. A total of 37 predictor variables were evaluated to define those associated with mortality.
Data from 250 patients with CAP due to 2009 H1N1 influenza were analyzed. Patients with low predicted mortality rates (0-1.5%) had actual mortality rates ranging from 2.6% to 17.5%. Obesity and wheezing were the only novel variables associated with mortality.
The decision to hospitalize a patient with CAP due to 2009 H1N1 influenza should not be based on current CAP severity scores, as they underestimate mortality rates in a significant number of patients. Patients with obesity or wheezing should be considered at an increased risk for mortality.
The International Journal of Tuberculosis and Lung Disease 04/2011; 15(4):542-6. · 2.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Controversy still exists in the international literature regarding the need to use antimicrobials covering atypical pathogens when initially treating hospitalized patients with community-acquired pneumonia (CAP). In different regions of the world, monotherapy with a beta-lactam antimicrobial is common.
We sought to correlate the incidence of CAP due to atypical pathogens in different regions of the world with the proportion of patients treated with an atypical regimen in those same regions. In addition, we sought to compare clinical outcomes of patients with CAP treated with and without atypical coverage.
A secondary analysis was performed using two comprehensive international databases. World regions were defined as North America (I), Europe (II), Latin America (III), and Asia and Africa (IV). Time to reach clinical stability, length of hospital stay, and mortality were compared between patients treated with and without atypical coverage.
The incidence of CAP due to atypical pathogens from 4,337 patients was 22, 28, 21, and 20% in regions I-IV, respectively. The proportion of patients treated with atypical coverage from 2,208 patients was 91, 74, 53, and 10% in regions I-IV, respectively. Patients treated with atypical coverage had decreased time to clinical stability (3.7 vs. 3.2 d, p < 0.001), decreased length of stay (7.1 vs. 6.1 d, p < 0.01), decreased total mortality (11.1 vs. 7%, p < 0.01), and decreased CAP-related mortality (6.4 vs. 3.8%, p = 0.05).
The significant global presence of atypical pathogens and the better outcomes associated with antimicrobial regimens with atypical coverage support empiric therapy for all hospitalized patients with CAP with a regimen that covers atypical pathogens.
American Journal of Respiratory and Critical Care Medicine 05/2007; 175(10):1086-93. · 11.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A total of 33 hospitals in 13 countries in North America, Europe, Africa, Asia and Latin America.
To investigate the relationship between the pneumonia severity index (PSI) and the time to clinical stability from intravenous to oral antibiotic therapy in hospitalized adult patients with community-acquired pneumonia (CAP).
An international, retrospective, observational study of random adult patients meeting the definition of CAP between June 2001 and May 2004.
The risk class (RC) according to the PSI was calculated for all patients. The criteria to define when a patient is clinically stable were evaluated daily during the first 7 days of hospitalization in all patients. The mean time to clinical stability for 254 patients in RC I was 4.2 days, for 233 patients in RC II it was 3.9 days, for 395 patients in RC III it was 4.6 days, for 644 patients in RC IV it was 5.0 days and for 296 patients in RC V it was 6.0 days. Significant positive correlations were observed between RC and time to clinical stability (P < 0.0001).
The PSI is a tool that can be used to predict time to clinical stability (i.e., time to antimicrobial switch therapy) in hospitalized patients with CAP.
The International Journal of Tuberculosis and Lung Disease 07/2006; 10(7):739-43. · 2.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In a case-control study, outcomes for 58 human immunodeficiency virus (HIV)-positive patients with community-acquired pneumonia (CAP) were compared with outcomes for 174 HIV-negative patients with CAP. No differences were found in the time to clinical stability, the length of hospitalization, and mortality. Clinical outcomes for hospitalized patients with CAP may not be influenced by HIV infection.