Disease Characteristics and Management of Hospitalised Adolescents and Adults with Community-acquired Pneumonia in China: a Retrospective Multicentre Survey

Overview

Journal BMJ Open

Specialty General Medicine

Date 2018 Feb 17

PMID 29449294

Citations 24

Authors

Liang Chen

Fei Zhou

Hui Li

Xiqian Xing

Xiudi Han

Yiming Wang

Chunxiao Zhang

Lijun Suo

Jingxiang Wang

Guohua Yu

Guangqiang Wang

Xuexin Yao

Hongxia Yu

Lei Wang

Meng Liu

Chunxue Xue

Bo Liu

Xiaoli Zhu

Yanli Li

Ying Xiao

Xiaojing Cui

Lijuan Li

Timothy M Uyeki

Chen Wang

Bin Cao

Affiliations

Soon will be listed here.

Abstract

Objectives: To describe the clinical characteristics and management of patients hospitalised with community-acquired pneumonia (CAP) in China.

Design: This was a multicentre, retrospective, observational study.

Setting: 13 teaching hospitals in northern, central and southern China from 1 January 2014 to 31 December 2014 PARTICIPANTS: Information on hospitalised patients aged ≥14 years with radiographically confirmed pneumonia with illness onset in the community was collected using standard case report forms.

Primary And Secondary Outcome Measures: Resource use for CAP management.

Results: Of 14 793 patients screened, 5828 with radiographically confirmed CAP were included in the final analysis. Low mortality risk patients with a CURB-65 score 0-1 and Pneumonia Severity Index risk class I-II accounted for 81.2% (4434/5594) and 56.4% (2034/3609) patients, respectively. 21.7% (1111/5130) patients had already achieved clinical stability on admission. A definite or probable pathogen was identified only in 12.7% (738/5828) patients. 40.9% (1575/3852) patients without pseudomonal infection risk factors received antimicrobial overtreatment regimens. The median duration between clinical stability to discharge was 5.0 days with 30-day mortality of 4.2%.

Conclusions: These data demonstrated the overuse of health resources in CAP management, indicating that there is potential for improvement and substantial savings to healthcare systems in China.

Trial Registration Number: NCT02489578; Results.

Citing Articles

Antimicrobial use in patients with confirmed COVID-19 infection in the Philippines: a cross-sectional study.

Dominguez R, Domingo-Cereno N, Josue-Dominguez R Western Pac Surveill Response J. 2023; 14(2):1-8.

PMID: 37475781 PMC: 10354402. DOI: 10.5365/wpsar.2023.14.2.999.

Application of Different Sampling Methods Combined with Metagenomic Next-Generation Sequencing to Detect Pathogens in Children with Severe Pneumonia on Mechanical Ventilation.

Nan X, Yu J, Liang Y, Lou P, Pan G Infect Drug Resist. 2023; 16:4545-4553.

PMID: 37465185 PMC: 10350406. DOI: 10.2147/IDR.S418339.

Overuse of medications in low- and middle-income countries: a scoping review.

Albarqouni L, Palagama S, Chai J, Sivananthajothy P, Pathirana T, Bakhit M Bull World Health Organ. 2023; 101(1):36-61D.

PMID: 36593777 PMC: 9795388. DOI: 10.2471/BLT.22.288293.

Chest physiotherapy for pneumonia in adults.

Chen X, Jiang J, Wang R, Fu H, Lu J, Yang M Cochrane Database Syst Rev. 2022; 9:CD006338.

PMID: 36066373 PMC: 9447368. DOI: 10.1002/14651858.CD006338.pub4.

Economic Evaluation of Nemonoxacin, Moxifloxacin and Levofloxacin in the Treatment of Early Community-Acquired Pneumonia with Possible Pulmonary Tuberculosis.

Zhao M, Chi Z, Pan X, Yin Y, Tang W Int J Environ Res Public Health. 2022; 19(8).

PMID: 35457683 PMC: 9028707. DOI: 10.3390/ijerph19084816.

References

Shorr A, Zilberberg M, Reichley R, Kan J, Hoban A, Hoffman J . Validation of a clinical score for assessing the risk of resistant pathogens in patients with pneumonia presenting to the emergency department. Clin Infect Dis. 2011; 54(2):193-8. DOI: 10.1093/cid/cir813. View

File Jr T, Marrie T . Burden of community-acquired pneumonia in North American adults. Postgrad Med. 2010; 122(2):130-41. DOI: 10.3810/pgm.2010.03.2130. View

Broulette J, Yu H, Pyenson B, Iwasaki K, Sato R . The incidence rate and economic burden of community-acquired pneumonia in a working-age population. Am Health Drug Benefits. 2014; 6(8):494-503. PMC: 4031734. View

Coley C, Li Y, Medsger A, Marrie T, Fine M, Kapoor W . Preferences for home vs hospital care among low-risk patients with community-acquired pneumonia. Arch Intern Med. 1996; 156(14):1565-71. View

Bartlett J . Diagnostic test for etiologic agents of community-acquired pneumonia. Infect Dis Clin North Am. 2004; 18(4):809-27. PMC: 7118911. DOI: 10.1016/j.idc.2004.08.002. View

Zhou Q, He B, Zhu H . Potential for cost-savings in the care of hospitalized low-risk community-acquired pneumonia patients in China. Value Health. 2008; 12(1):40-6. DOI: 10.1111/j.1524-4733.2008.00410.x. View

Uematsu H, Kunisawa S, Sasaki N, Ikai H, Imanaka Y . Development of a risk-adjusted in-hospital mortality prediction model for community-acquired pneumonia: a retrospective analysis using a Japanese administrative database. BMC Pulm Med. 2014; 14:203. PMC: 4279890. DOI: 10.1186/1471-2466-14-203. View

Minino A, Heron M, Smith B . Deaths: preliminary data for 2004. Natl Vital Stat Rep. 2006; 54(19):1-49. View

Aschenbrenner D . The FDA Revises Boxed Warning For Fluoroquinolones-Again. Am J Nurs. 2016; 116(9):22-3. DOI: 10.1097/01.NAJ.0000494691.55746.90. View

10.

Qu J, Gu L, Wu J, Dong J, Pu Z, Gao Y . Accuracy of IgM antibody testing, FQ-PCR and culture in laboratory diagnosis of acute infection by Mycoplasma pneumoniae in adults and adolescents with community-acquired pneumonia. BMC Infect Dis. 2013; 13:172. PMC: 3637260. DOI: 10.1186/1471-2334-13-172. View

11.

. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171(4):388-416. DOI: 10.1164/rccm.200405-644ST. View

12.

Mandell L, Wunderink R, Anzueto A, Bartlett J, Campbell G, Dean N . Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44 Suppl 2:S27-72. PMC: 7107997. DOI: 10.1086/511159. View

13.

Rhew D, Riedinger M, Sandhu M, Bowers C, Greengold N, Weingarten S . A prospective, multicenter study of a pneumonia practice guideline. Chest. 1998; 114(1):115-9. DOI: 10.1378/chest.114.1.115. View

14.

Seong G, Kim M, Lee J, Lee J, Jeong S, Choi Y . Healthcare-Associated Pneumonia among Hospitalized Patients: Is It Different from Community Acquired Pneumonia?. Tuberc Respir Dis (Seoul). 2014; 76(2):66-74. PMC: 3948854. DOI: 10.4046/trd.2014.76.2.66. View

15.

Salo P, Leinonen M . Microbiological investigations. Semin Respir Infect. 1999; 14(2):128-34. View

16.

Woodhead M, Macfarlane J, McCracken J, Rose D, Finch R . Prospective study of the aetiology and outcome of pneumonia in the community. Lancet. 1987; 1(8534):671-4. DOI: 10.1016/s0140-6736(87)90430-2. View

17.

Mirza I, Khan F, Khan K, Satti L, Ghafoor T, Fayyaz M . Extensively and pre-extensively drug resistant tuberculosis in clinical isolates of multi-drug resistant tuberculosis using classical second line drugs (levofloxacin and amikacin). J Coll Physicians Surg Pak. 2015; 25(5):337-41. DOI: 05.2015/JCPSP.337341. View

18.

Qi F, Zhang G, She D, Liang Z, Wang R, Yang Z . Healthcare-associated Pneumonia: Clinical Features and Retrospective Analysis Over 10 Years. Chin Med J (Engl). 2015; 128(20):2707-13. PMC: 4736886. DOI: 10.4103/0366-6999.167294. View

19.

Jain S, Self W, Wunderink R, Fakhran S, Balk R, Bramley A . Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med. 2015; 373(5):415-27. PMC: 4728150. DOI: 10.1056/NEJMoa1500245. View

20.

Almirall J, Bolibar I, Vidal J, Sauca G, Coll P, Niklasson B . Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir J. 2000; 15(4):757-63. DOI: 10.1034/j.1399-3003.2000.15d21.x. View