Clinical Outcomes for Patients with Community-Acquired Pneumonia are Worse in Those with a History of Stroke

Background: Stroke is one of the most prevalent neurological diseases in the United States. Community-acquired pneumonia (CAP) is the leading cause of infections in survivors of stroke. There is limited research evaluating the clinical outcomes of CAP in patients with stroke. The objective of this study was to evaluate the clinical characteristics and outcomes of hospitalized patients with CAP and a history of stroke. Methods: This was a secondary analysis of the University of Louisville Pneumonia Study database. Patients were divided into two groups based on the presence or absence of a history of stroke. Clinical outcomes were length of stay, time to clinical stability, and one-year mortality, which were assessed via stratified Cox proportional hazards regression. Differences in risk of clinical outcomes were reported as adjusted hazard ratios. Results: We found no significant differences in time to clinical stability between the two groups. The median length of stay for patients with a history of stroke hospitalized with CAP was six days and for patients without stroke was five days (P=0.01). We observed a 16% higher risk of mortality in stroke patients with CAP than in the non-stroke population (P=0.001). Conclusions: This study indicates that hospitalized patients with CAP have a longer hospital stay and higher mortality than those without stroke

Outcomes of Patients Hospitalized with Community-Acquired Pneumonia with Liver Disease or Cirrhosis.

Introduction: Liver disease and cirrhosis are common causes of mortality worldwide. Community-acquired pneumonia is recognized as a significant cause of morbidity and mortality in this population of adults. There is a lack of data regarding outcomes or prognosis in patients with liver dysfunction who develop CAP. The objective of this study was to evaluate the clinical characteristics, incidence, and outcomes of hospitalized patients with CAP and liver disease. Methods: This was a secondary analysis of the University of Louisville Pneumonia Study, which was a prospective population-based cohort study of adults hospitalized with community-acquired pneumonia. All patients were divided into three groups: 1) patients without liver disease, 2) patients with liver disease, and 3) patients with cirrhosis. Short and long-term outcomes were analyzed. Results: Among 9,201 patients, 8,566 patients did not have liver disease, 515 patients had liver disease, and 120 patients had cirrhosis. The median age of patients with liver disease or cirrhosis was approximately 10 years younger than the median age of overall population, and a higher proportion was admitted directly to the ICU. Compared to patients without liver disease, we found no significant difference in time to clinical stability for patients with liver diseases (adjusted hazard ratio [aHR] 1.01 [95% CI 0.92–1.12]; P=0.790) or cirrhosis (aHR 0.85 [95% CI 0.69–1.05]; P=0.127). There were also no differences in median length of stay (LOS) between any two groups. Patients with cirrhosis had a 35% higher risk of death at any time compared to patients with no liver disease (aHR 1.35 [95% CI 1.00–1.82]; P=0.049) but did not have significantly increased risk compared to patients with liver disease (aHR 1.37 [95% CI 0.97–1.93], P=0.070). Conclusion: In this study of hospitalized adults with CAP, patients with cirrhosis had a significantly higher risk of death compared to patients without liver disease

Implementing a Clinical Research Program in Long Term Care Facilities: Experiences from the University of Louisville Center Excellence for Research in Infectious Diseases [CERID]

Background: According to the US Census Bureau International Report, in 2015, almost nine percent of the world’s population was aged 65 and over. As the worldwide population ages, there is a need to understand how to best care for those individuals. Developing clinical research programs focusing on long term care (LTC) will be critical to defining best practice. Objectives: The objectives of this manuscript are to: 1) outline the challenges identified in performing clinical research in long term care facilities (LTCF), and 2) offer solutions for future clinical research in the LTC environment based upon our experiences. Methods: A research feasibility study was performed in 14 LTCFs in Louisville, Kentucky during 2018. Research questions involving identification of LTCF residents experiencing diarrhea were used as the basis for determining challenges and abilities to perform research in the LTC environment. Results: Challenges to performing clinical research involving an infectious disease were gathered throughout the twenty-week feasibility assessment period and organized into eight distinct yet inter-related areas. These included: 1) facility recruitment; 2) engagement of facility leadership; 3) engagement of facility personnel; 4) identification of research candidates; 5) consenting processes; 6) management of clinical samples; 7) navigating the medical record systems; and 8) study team workflow. Conclusions: This feasibility assessment found that conducting research in LTCFs was very different in almost every aspect from research conducted in the hospital setting. Results from this feasibility assessment will be used as a basis to determine a more comprehensive population-based incidence of C. difficile infection through the City of Louisville Diarrhea (CLOUD) study