Predictors of in-hospital mortality and length of stay in community-acquired pneumonia: a 5-year multi-centre case control study of adults in a developing country

Iroezindu, Michael; Isiguzo, Godsent; Chima, E I; Mbata, G C; Onyedibe, Kenneth I.; Onyedum, Cajetan C; John-Maduagwu, Obiageli J.; Okoli, Leo E; Young, Ekenechukwu

doi:10.1093/trstmh/trw057

Cited by 14 publications

(17 citation statements)

References 34 publications

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“…In fact, Hi was the most common non-pneumococcal pathogen isolate in our study. In the literature, the role of non-pneumococcal pathogens is described as an independent predictor of mortality [29]. Our study described that non-pneumococcal infections were significantly correlated with severe pneumonia possibly because those patients had also compromised a general condition, were undernourished, and had more comorbidities.…”

Section: Discussionmentioning

confidence: 66%

Factors That Negatively Affect the Prognosis of Pediatric Community-Acquired Pneumonia in District Hospital in Tanzania

Caggiano

Ullmann

Vitis

et al. 2017

IJMS

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Community-acquired pneumonia (CAP) is still the most important cause of death in countries with scarce resources. All children (33 months ± 35 DS) discharged from the Pediatric Unit of Itigi Hospital, Tanzania, with a diagnosis of CAP from August 2014 to April 2015 were enrolled. Clinical data were gathered. Dried blood spot (DBS) samples for quantitative real-time polymerase chain reaction (PCR) for bacterial detection were collected in all 100 children included. Twenty-four percent of patients were identified with severe CAP and 11% died. Surprisingly, 54% of patients were admitted with a wrong diagnosis, which increased complications, the need for antibiotics and chest X-rays, and the length of hospitalization. Comorbidity, found in 32% of children, significantly increased severity, complications, deaths, need for chest X-rays, and oxygen therapy. Malnourished children (29%) required more antibiotics. Microbiologically, Streptococcus pneumonia (S. p.), Haemophilus influenza type b (Hib) and Staphylococcus aureus (S. a.) were the bacteria more frequently isolated. Seventy-five percent of patients had mono-infection. Etiology was not correlated with severity, complications, deaths, oxygen demand, or duration of hospitalization. Our study highlights that difficult diagnoses and comorbidities negatively affect clinical evolution. S. p. and Hib still play a large role; thus, implementation of current vaccine strategies is needed. DBS is a simple and efficient diagnostic method for bacterial identification in countries with scarce resources.

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Section: Discussionmentioning

confidence: 66%

Factors That Negatively Affect the Prognosis of Pediatric Community-Acquired Pneumonia in District Hospital in Tanzania

Caggiano

Ullmann

Vitis

et al. 2017

IJMS

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“… Hedlund et al [ 20 ] 2002 Retrospective Cohort Sweden 17 hospitals 982 5 Outcome Seven university hospitals, 10 county hospitals. The mean PSI varied between 0.9 and 1.9 at different sites Iroezindu et al [ 21 ] 2016 Prospective Case control Nigeria 4 hospitals 400 6 Outcome Not reported All tertiary hospitals Not reported Klausen et al [ 31 ] 2012 Retrospective Analysis of Administrative data Denmark 22 hospitals 11,322 8.5 Outcome Not reported All Danish public health hospitals Not reported Laing et al [ 22 ] 2004 Prospective Cohort New Zealand 2 hospitals 474 7 Both Similar demographics between the two populations except significant differences in ethnicity and rates of COPD. “Similar institutions” No significant differences in disease severity by PSI.…”

Section: Resultsmentioning

confidence: 99%

“…Studies differed in design: seventeen were cohort studies (nine retrospective, seven prospective and one mixed), three were analyses of administrative data, [ 11 , 23 , 31 ] one was a case control study [ 21 ] and one study analysed the baseline population from a randomised control trial [ 29 ]. The median number of units compared across studies was five (IQR 4–15) with a median of 1022 (IQR 445–2009) cases of CAP.…”

Section: Resultsmentioning

confidence: 99%

Variation in clinical outcomes and process of care measures in community acquired pneumonia: a systematic review

2020

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Background Variation in outcomes of patients with community acquired pneumonia (CAP) has been reported in some, but not all, studies. Although some variation is expected, unwarranted variation in healthcare impacts patient outcomes and equity of care. The aim of this systematic review was to: i) summarise current evidence on regional and inter-hospital variation in the clinical outcomes and process of care measures of patients hospitalised with CAP and ii) assess the strength of this evidence. Methods Databases were systematically searched from inception to February 2018 for relevant studies and data independently extracted by two investigators in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Included studies enrolled adults hospitalised with CAP and reported a measure of variation between two or more units in healthcare outcomes or process of care measures. Outcomes of interest were mortality, length of hospital stay (LOS) and re-admission rates. A structured synthesis of the studies was performed. Results Twenty-two studies were included in the analysis. The median number of units compared across studies was five (IQR 4–15). Evidence for variation in mortality between units was inconsistent; of eleven studies that performed statistical significance testing, five found significant variation. For LOS, of nine relevant studies, all found statistically significant variation. Four studies reported site of admission accounted for 1–24% of the total observed variation in LOS. A shorter LOS was not associated with increased mortality or readmission rates. For readmission, evidence was mixed; of seven studies, 4 found statistically significant variation. There was consistent evidence for variation in the use of intensive care, obtaining blood cultures on admission, receiving antibiotics within 8 h of admission and duration of intravenous antibiotics. Across all outcome measures, only one study accounted for natural variation between units in their analysis. Conclusion There is consistent evidence of moderate quality for significant variation in length of stay and process of care measures but not for in-patient mortality or hospital re-admission. Evidence linking variation in outcomes with variation in process of care measures was limited; where present no difference in mortality was detected despite POC variation. Adjustment for natural variation within studies was lacking; the proportion of observed variation due to chance is not quantified by existing evidence.

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“…The first is the importance of time to initiation/administration of antibiotics relative to the time of presentation with CAP. Although there has been the odd study suggesting that time to initiation of antibiotics has no impact on various patient outcomes 42 , this contention is not supported by the majority of additional studies 25 , 26 , 43 , 44 . All of the studies from the CAPUCI II Consortium of critically ill patients with CAP indicated that early antibiotic administration (<3 hours) was independently associated with a lower ICU mortality 25 , 26 , 43 .…”

Section: Antibiotic Treatment Of Community-acquired Pneumoniamentioning

confidence: 97%

“…All of the studies from the CAPUCI II Consortium of critically ill patients with CAP indicated that early antibiotic administration (<3 hours) was independently associated with a lower ICU mortality 25 , 26 , 43 . An additional study of hospitalized patients with CAP indicated that delay of the first dose of antibiotics beyond 4 hours was one of the independent predictors of mortality (adjusted OR 3.9) 44 . Furthermore, the systematic review by Lee et al 34 , assessing three aspects of antibiotic therapy in hospitalized patients with CAP, noted that administration of antibiotics within 4 to 8 hours of hospital arrival was associated with a reduction in mortality, although the quality of evidence was assessed as being relatively poor.…”

Section: Antibiotic Treatment Of Community-acquired Pneumoniamentioning

confidence: 99%

Appropriate antibiotic management of bacterial lower respiratory tract infections

Feldman

Richards

2018

F1000Res

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Lower respiratory tract infections are the leading cause of infectious disease deaths worldwide and are the fifth leading cause of death overall. This is despite conditions such as pneumococcal infections and influenza being largely preventable with the use of appropriate vaccines. The mainstay of treatment for the most important bacterial lower respiratory tract infections, namely acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and community-acquired pneumonia (CAP), is the use of antibiotics. Yet despite a number of recent publications, including clinical studies as well as several systematic literature reviews and meta-analyses, there is considerable ongoing controversy as to what the most appropriate antibiotics are for the empiric therapy of CAP in the different settings (outpatient, inpatient, and intensive care unit). Furthermore, in the case of AECOPD, there is a need for consideration of which of these exacerbations actually need antibiotic treatment. This article describes these issues and makes suggestions for appropriately managing these conditions, in the setting of the need for antimicrobial stewardship initiatives designed to slow current emerging rates of antibiotic resistance, while improving patient outcomes.

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Predictors of in-hospital mortality and length of stay in community-acquired pneumonia: a 5-year multi-centre case control study of adults in a developing country

Abstract: Several modifiable patient-related and process-of-care factors predicted in-hospital mortality, and length of hospital stay among survivors. Our findings should be used to improve CAP outcomes in developing countries.

Cited by 14 publications

References 34 publications

Factors That Negatively Affect the Prognosis of Pediatric Community-Acquired Pneumonia in District Hospital in Tanzania

Factors That Negatively Affect the Prognosis of Pediatric Community-Acquired Pneumonia in District Hospital in Tanzania

Variation in clinical outcomes and process of care measures in community acquired pneumonia: a systematic review

Appropriate antibiotic management of bacterial lower respiratory tract infections

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