Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Factors contributing to mortality in healthcare-associated pneumonia (HCAP) have not been investigated fully. We reviewed the etiology and identified prognostic factors of HCAP in hospitalized patients. We conducted a retrospective study of 500 Japanese patients with HCAP to assess these factors, with special emphasis on microbial etiology. Patients with HCAP were older (73.4±11.4 years), more predominantly male (74.4%), and had more smoking history and comorbidity than did community-acquired pneumonia (CAP) patients. Microbes were identified in 52.8% of HCAP patients. The most frequent causative microbial agents were Streptococcus pneumoniae (n = 108, 21.6%), influenza virus (n = 47, 9.4%), and Pseudomonas aeruginosa (n = 40, 8.0%). Multiple drug-resistant (MDR) pathogens were more frequent in HCAP patients (9.8%) than CAP patients. Overall, 47 HCAP patients (9.4%) died, with mortality being higher in HCAP than CAP patients. The three leading causes of non-survival from HCAP were S. pneumoniae, influenza virus, and P. aeruginosa. MDR pathogens accounted for 21.3% of non-survivors. Multivariate analysis revealed disease severity on admission and treatment failure of initial antibiotics as independent factors for 30-day mortality. Among patients with treatment failure of initial antibiotics, 29.9% had received appropriate antibiotics. The most frequent pathogens in HCAP were S. pneumoniae, influenza virus, and P. aeruginosa, in both survivors and non-survivors. Disease severity on admission and treatment failure of initial antibiotics were independent factors for mortality. MDR pathogens are important therapeutic targets to mitigate negative results, and treatment strategies other than antibiotic selection are also required

Incidence and etiology of chronic pulmonary infections in patients with idiopathic pulmonary fibrosis.

BACKGROUND:The incidence and etiologies of chronic pulmonary infection (CPI) in patients with idiopathic pulmonary fibrosis (IPF) have been poorly investigated. METHODS:We conducted a retrospective study of 659 patients with IPF to assess the incidence, etiologies, and risk factors of CPI development. CPI was defined if the etiology of infection was diagnosed one or more months after the onset of symptoms or upon the appearance of new shadows on pulmonary radiological images. RESULTS:At IPF diagnosis, 36 (5.5%) patients had CPI, and 46 (7.0%) patients without CPI at IPF diagnosis developed CPI over a median follow-up period of 6.1 years. The incidence density of CPI development was 18.90 cases per 1000 person-years. Detected organisms from these 46 patients were Mycobacterium avium complex in 20 patients, other nontuberculous mycobacteria in 4, M. tuberculosis in 7, Aspergillus spp. in 22, and Nocardia sp. in one. In a multivariate Cox regression hazard model, PaO2 <70 Torr and KL-6 ≥2000 U/mL were associated with CPI development. CONCLUSIONS:Nontuberculous mycobacteria, M. tuberculosis, and Aspergillus and Nocardia spp. were the four most frequent etiologies of CPI in patients with IPF. During follow-up of IPF, clinicians should pay attention to the development of CPI, especially in patients with PaO2 <70 Torr or KL-6 ≥2000 U/mL

Clinical characteristics and prognostic factors of pneumonia in patients with and without rheumatoid arthritis.

BACKGROUND:To elucidate the characteristics of pneumonia in rheumatoid arthritis (RA) patients and to assess whether pneumonia in RA patients differs from that in non-RA patients. METHODS:We retrospectively divided pneumonia patients into two groups, those with RA and those without RA, and compared the two groups. We evaluated the risk factors for mortality with univariate and multivariate logistic regression analysis. RESULTS:Among 1549 patients, 71 had RA. The RA patients with pneumonia were 71.0±8.9 years old, 54.9% were female, 40.9% had a smoking history, and 71.8% had underlying respiratory disease. Female sex, non-smoker, and respiratory comorbidities were statistically more frequent in the RA patients than non-RA patients. The most frequent causative microbial agents of pneumonia in the RA patients were Streptococcus pneumoniae, Pseudomonas aeruginosa, Haemophilus influenzae, Mycoplasma pneumoniae, and influenza virus, whereas those of pneumonia in non-RA patients were S. pneumoniae, influenza virus, M. pneumoniae, Legionella spp., P. aeruginosa, H. influenzae, and Moraxella catarrhalis. Polymicrobial infection were identified as etiologies more frequently in the RA patients than non-RA patients. Although the severity of pneumonia did not differ between the two groups, mortality was statistically higher in the RA patients than non-RA patients. Multivariate analysis showed RA to be an independent risk factor for mortality. CONCLUSIONS:P. aeruginosa, H. influenzae, M. catarrhalis, and polymicrobial infection were statistically more frequent etiologies of pneumonia in the RA patients than non-RA patients. RA itself was found to be an independent risk factor for mortality from pneumonia

Allergic bronchopulmonary aspergillosis successfully treated with mepolizumab: Case report and review of the literature

A 56-year-old woman was referred to our hospital for recurrent asthma of 20 years duration. She was diagnosed as having allergic bronchopulmonary aspergillosis on the basis of clinical symptoms, peripheral blood eosinophilia, elevated total serum immunoglobulin E value, positive results of specific IgE and precipitating antibodies against Aspergillus sp., central bronchiectasis, and mucoid impaction. Systemic corticosteroids and anti-fungal therapy improved her symptoms, but the cessation of these treatments led to frequent exacerbations. Omalizumab improved her asthmatic symptoms to the point that corticosteroids could be stopped; however, radiological findings were not improved, and coexisting eosinophilic sinusitis and otitis media worsened. After her treatment was changed from omalizumab to mepolizumab, not only her asthmatic symptoms but also her sinusitis and otitis media became well controlled, and chest radiological findings improved. Keywords: Allergic bronchopulmonary aspergillosis, Omalizumab, Mepolizumab, Corticosteroid, Itraconazol

Incidence and predictive factors of lung cancer in patients with idiopathic pulmonary fibrosis

The incidence and risk factors of lung cancer in patients with idiopathic pulmonary fibrosis (IPF) have been poorly investigated. We conducted a retrospective study of 632 patients with IPF to assess the incidence and risk factors of lung cancer development. Seventy patients developed lung cancer over a median follow-up period of 3.8 years. The incidence density of lung cancer development was 25.2 cases per 1000 person-years. The most frequent type was squamous cell carcinoma (30%), the majority developed lung cancer in the peripheral lung (82.9%) and adjacent to usual interstitial pneumonia (75.7%). In a multivariate Cox regression hazard model, pack-years of smoking ≥35 and coexisting emphysema were associated with lung cancer development. The 1-, 3- and 5-year all-cause mortality rates after lung cancer diagnosis were 53.5%, 78.6% and 92.9%, respectively. The incidence density of lung cancer is high in IPF patients and occurs more frequently in patients with smoking history of pack-years of smoking ≥35 and with coexisting emphysema. The majority of lung cancers develop adjacent to usual interstitial pneumonia. Knowledge of these factors may help direct efforts for early detection of lung cancer and disease management

The long-term clinical course of chronic eosinophilic pneumonia

Objective The long-term clinical course and prognosis of patients with chronic eosinophilic pneumonia (CEP) including factors predictive of the relapse of CEP have not been fully investigated. The aim of the present study was to investigate these issues. Methods We retrospectively investigated the rate of relapse and prognosis in 73 patients diagnosed as having CEP. Results Systemic corticosteroid therapy was administered at a prednisolone dose of 29.4±7.6 mg/day. During a median follow-up period of 1, 939 days, 27 patients suffered from relapse of CEP. Two patients developed steroid-induced diabetes mellitus, and 1 patient developed pulmonary nontuberculous mycobacteriosis. Five patients died; however, none died of CEP. A history of smoking was the only independent negative risk factor for relapse of CEP [hazard ratio, 0.37 (0.14-0.98)]. Conclusion Patients with CEP frequently relapse. During the follow-up, metabolic and infectious complications under prolonged corticosteroid therapy are problematic. A history of smoking was a negative factor for predicting the risk of CEP relapse

Etiology of pneumonia in the RA and non-RA patients.

<p>Etiology of pneumonia in the RA and non-RA patients.</p

Characteristics of the patients with and without RA.

<p>Characteristics of the patients with and without RA.</p