British Thoracic Society community acquired pneumonia guideline and the NICE pneumonia guideline: how they fit together

Lim, Wei Shen; Smith, David L.; Wise, Matthew Peter; Welham, Sally

doi:10.1136/thoraxjnl-2015-206881

Cited by 49 publications

(49 citation statements)

References 2 publications

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“…Similar to recommendations made in the 2009 BTS CAP Guideline, the 2016 National Institute for Health and Care Excellence Pneumonia Quality Standard advocates the following:4 5 Adults with suspected CAP in hospital have a CXR and receive a diagnosis within 4 hours of presentationAdults have a mortality risk assessment using the CURB65 score when they are diagnosed with CAP in hospitalAdults with CAP who are admitted to hospital start antibiotic therapy within 4 hours of presentation.…”

Section: Discussionmentioning

confidence: 99%

Mortality reduction in adult community-acquired pneumonia in the UK (2009–2014): results from the British Thoracic Society audit programme

Daniel

Woodhead²,

Welham

et al. 2016

Thorax

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Community-acquired pneumonia (CAP) is a leading cause of death in the UK. In this analysis of 23 315 cases from the British Thoracic Society national CAP audit, an overall reduction in 30-day inpatient mortality over 6 years was observed-2014 compared with 2009 adjusted OR 0.86 (95% CI 0.68 to 1.08, p for trend 0.004). Significant increases in the proportions of patients who had (a) a chest X-ray and (b) the first antibiotic dose within 4 hours of admission were also observed (3.7% and 11.5% increases respectively). Further reductions in mortality may follow the 2016 National Institute for Health and Care Excellence Pneumonia Quality Standard.

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Section: Discussionmentioning

confidence: 99%

Mortality reduction in adult community-acquired pneumonia in the UK (2009–2014): results from the British Thoracic Society audit programme

Daniel

Woodhead²,

Welham

et al. 2016

Thorax

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“…According to guidelines, chest X-ray is the first choice of radiological investigation when suspecting pneumonia in a hospital setting, followed by computerized tomography (CT) scan if doubt about diagnosis or suspected complications. 25 As we defined RTI to be present only if a physician noted a diagnosis of RTI in the medical record, patients admitted to the hospital with a suspected RTI that later proved to be a misdiagnosed PE would not be registered as having a RTI. Our data source was hospital medical records.…”

Section: Triggers Of Hospitalization For Vte Have Been Investigated Imentioning

confidence: 99%

Acute infection as a trigger for incident venous thromboembolism: Results from a population‐based case‐crossover study

Grimnes

Isaksen

Tichelaar

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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Essentials There is a bidirectional relation between acute infections and immobilizationWe studied the impact of infection and immobilization on risk of VTE in a case‐crossover designAcute infection was a strong trigger for VTE independent of concomitant immobilizationInfection and immobilization had a synergistic effect on the VTE‐risk BackgroundA bidirectional relation exists between acute infection and immobilization, and both are triggers for venous thromboembolism (VTE). To what extent the association between infection and VTE‐risk is explained by immobilization is unknown.AimsTo investigate the impact of hospitalization with acute infection on the VTE‐risk in patients with and without concomitant immobilization, and to explore the differential impact of respiratory‐ (RTI) and urinary‐ (UTI) tract infections on the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE).MethodsWe conducted a case‐crossover study of VTE‐patients (n = 707) recruited from a general population. Hospitalizations and VTE‐triggers were registered during the 90 days before a VTE (hazard period) and in four preceding 90‐day control periods. Conditional logistic regression was used to estimate odds ratios (ORs) for VTE according to triggers.ResultsAcute infection was registered in 267 (37.8%) of the hazard periods and in 107 (3.8%) of the control periods, corresponding to a high VTE‐risk after infection (OR 24.2, 95% CI 17.2‐34.0), that was attenuated to 15‐fold increased after adjustment for immobilization. The risk was 20‐fold increased after infection without concomitant immobilization, 73‐fold increased after immobilization without infection, and 141‐fold increased with the two combined. The risk of PE was apparently higher after RTIs (OR 48.3, 95% CI 19.4‐120.0) than UTIs (OR 12.6, 95% CI 6.4‐24.7), but diminished in sensitivity analyses excluding uncertain RTI diagnoses.ConclusionsOur findings suggest that hospitalization with infection is a strong VTE‐trigger also in non‐immobilized patients. Infection and immobilization had a synergistic effect on the VTE‐risk.

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“…Whereas doxycycline is recommended only as a second line treatment for empiric management of community-acquired pneumonia (CAP) in several national guidelines, it is a rst-line antibiotic in others, and generally considered to be safe and effective. [28][29][30][31][32] In cases of lower respiratory tract infections where acute Q fever is included in the differential diagnosis and pneumonia is suspected, use of doxycycline would thus seem an appropriate choice in an outpatient setting. Combination with hydroxychloroquine should be considered in patients with known valvular heart disease to prevent evolution to Q fever endocarditis (but is not recommended in patients with increased risk of acute Q fever endocarditis as revealed by high IgG anticardiolipin levels included in routine testing in some countries).…”

Section: Discussionmentioning

confidence: 99%

Signs and symptoms do not predict, but may help rule out acute Q fever in favour of other respiratory tract infections, and reduce antibiotics overuse in primary care

Hackert¹,

Dukers-Muijrers

Hoebe³

2020

Preprint

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Background: From early 2009, the Dutch region of South Limburg experienced a massive outbreak of Q fever, overlapping with the influenza A(H1N1)pdm09 pandemic during the second half of the year and affecting approximately 2.9% of a 300,000 population. Acute Q fever shares clinical features with other respiratory conditions. Most symptomatic acute infections are characterized by mild symptoms, or an isolated febrile syndrome. Pneumonia was present in a majority of hospitalized patients during the Dutch 2007-2010 Q fever epidemic. Early empiric doxycycline, guided by signs and symptoms and patient history, should not be delayed awaiting laboratory confirmation, as it may shorten disease and prevent progression to focalized persistent Q fever. We assessed signs’ and symptoms’ association with acute Q fever to guide early empiric treatment in primary care patients. Methods: In response to the outbreak, regional primary care and hospital-based specialty physicians tested a total of 1218 subjects for Q fever. Testing activity was bimodal, a first “wave” lasting from March to December 2009, followed by a second “wave” which lasted into 2010 and coincided with peak pandemic influenza activity. We approached all 253 notified acute Q fever cases and a random sample of 457 Q fever negative individuals for signs and symptoms of disease. Using data from 140/229(61.1%) Q fever positive and 194/391(49.6%) Q fever negative respondents from wave 1, we built symptom-based models predictive of Q-fever outcome, validated against subsets of data from wave 1 and wave 2. Results: Our models had poor to moderate AUC scores (0.68% to 0.72%), with low positive (4.6-8.3%), but high negative predictive values (91.7-99.5%). Male sex, fever, and pneumonia were strong positive predictors, while cough was a strong negative predictor of acute Q fever in these models. Conclusion: Whereas signs and symptoms of disease do not appear to predict acute Q fever, they may help rule it out in favour of other respiratory conditions, prompting a delayed or non-prescribing approach instead of early empiric doxycycline in primary care patients with non-severe presentations. Signs and symptoms thus may help reduce the overuse of antibiotics in primary care during and following outbreaks of Q fever.

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British Thoracic Society community acquired pneumonia guideline and the NICE pneumonia guideline: how they fit together

Cited by 49 publications

References 2 publications

Mortality reduction in adult community-acquired pneumonia in the UK (2009–2014): results from the British Thoracic Society audit programme

Mortality reduction in adult community-acquired pneumonia in the UK (2009–2014): results from the British Thoracic Society audit programme

Acute infection as a trigger for incident venous thromboembolism: Results from a population‐based case‐crossover study

Signs and symptoms do not predict, but may help rule out acute Q fever in favour of other respiratory tract infections, and reduce antibiotics overuse in primary care

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