Microbial aetiology, outcomes, and costs of hospitalisation for community-acquired pneumonia; an observational analysis

BACKGROUND: The aim of this study was to investigate the clinical outcome and especially costs of hospitalisation for community-acquired pneumonia (CAP) in relation to microbial aetiology. This knowledge is indispensable to estimate cost-effectiveness of new strategies aiming to prevent and/or improve clinical outcome of CAP. METHODS: We performed our observational analysis in a cohort of 505 patients hospitalised with confirmed CAP between 2004 and 2010. Hospital administrative databases were extracted for all resource utilisation on a patient level. Resource items were grouped in seven categories: general ward nursing, nursing on ICU, clinical chemistry laboratory tests, microbiology exams, radiology exams, medication drugs, and other.linear regression analyses were conducted to identify variables predicting costs of hospitalisation for CAP. RESULTS: Streptococcus pneumoniae was the most identified causative pathogen (25%), followed by Coxiella burnetii (6%) and Haemophilus influenzae (5%). Overall median length of hospital stay was 8.5 days, in-hospital mortality rate was 4.8%. Total median hospital costs per patient were €3,899 (IQR 2,911-5,684). General ward nursing costs represented the largest share (57%), followed by nursing on the intensive care unit (16%) and diagnostic microbiological tests (9%). In multivariate regression analysis, class IV-V Pneumonia Severity Index (indicative for severe disease), Staphylococcus aureus, or Streptococcus pneumonia as causative pathogen, were independent cost driving factors. Coxiella burnetii was a cost-limiting factor. CONCLUSIONS: Median costs of hospitalisation for CAP are almost €4,000 per patient. Nursing costs are the main cause of these costs.. Apart from prevention, low-cost interventions aimed at reducing length of hospital stay therefore will most likely be cost-effective

Latent class analysis-based subgroups and response to corticosteroids in hospitalised community-acquired pneumonia patients: a validation study

In patients with community-acquired pneumonia, LCA can identify robust prognostic subgroups based on clinical and inflammatory parameters. Yet, these subgroups have not proven robust in predicting response to adjunctive dexamethasone treatment. https://bit.ly/3O5eaxz

Prior outpatient antibiotic use as predictor for microbial aetiology of community-acquired pneumonia: hospital-based study

Objective: The causative micro-organism in community-acquired pneumonia (CAP) is often difficult to predict. Different studies have examined chronic morbidity and clinical symptoms as predictors for microbial aetiology of pneumonia. The aim of our study was to assess whether prior outpatient antimicrobial treatment is predictive for determining the microbial aetiology of CAP. Methods: This was a hospital-based prospective observational study including all patients admitted with CAP between 1 October 2004 and 1 August 2006. Microbial investigations included sputum, blood culture, sputum PCR, antigen testing and serology. Exposure to antimicrobial drugs prior to hospital admission was ascertained through community pharmacy dispensing records. Multivariate logistic regression analysis was conducted to assess whether prior outpatient antimicrobial treatment is a predictor of microbial aetiology. Patient demographics, co-morbidities and pneumonia severity were considered to be other potential predictors. Results: Overall, 201 patients were included in the study. The microbial aetiology was determined in 64% of the patients. The five most prevalent pathogens were Streptococcus pneumoniae, Heamophilus influenzae, Legionella spp., Mycoplasma pneumoniae and Influenza virus A+B. Forty-seven of the patients (23%) had received initial antimicrobial treatment as outpatients. Multivariate analyses revealed that initial outpatient beta-lactam treatment was associated with a threefold increased chance of finding atypical pathogens and a threefold decreased probability of pneumococcal infection; the corresponding odds ratios were 3.51 (95% CI 1.25-9.99) and 0.30 (95% CI 0.10-0.90), respectively. Patients who received macrolides prior to hospitalisation had an increased probability of viral pneumonia. Conclusion: Prior outpatient antimicrobial therapy has a predictive value in the diagnostic workup aimed at identifying the causative pathogen and planning corresponding antimicrobial treatment in patients hospitalised for pneumonia

Optimizing and implementing a community-based group fall prevention program: a mixed methods study

BackgroundFalls and fall-related injuries among older adults are associated with decreased health and increased costs. Therefore, fall prevention programs (FPPs) have become increasingly important and shown effective. However, the translation of such complex programs into clinical practice is difficult and still lacks insight into factors that influence implementation. This can hamper the implementation and effectiveness of such programs in daily practice. Therefore, the aim of this study was to conduct a process evaluation among participants, therapists and stakeholders of a widely used group-based FPP in the Netherlands, to optimize and further implement such a program. MethodsIn Balance is a 14-week group-based FPP, combining counselling and exercise sessions. For the process evaluation, we used a mixed methods design. FPP participants and therapists filled out a questionnaire about their experiences with the FPP. Moreover, five focus groups were conducted; three focus groups with FPP participants, one with therapists, and one with other stakeholders. Data was analysed according to the thematic analysis approach of Braun and Clarke. ResultsOverall, 93% of the 104 FPP participants who completed the questionnaire was satisfied with the FPP. Of the therapists, 86% (n=12) would recommend the FPP to older adults with balance or mobility difficulties. Within the qualitative data we identified six themes that are important for sustainable and further and lasting implementation: (1) Recruiting and motivating older adults to participate, (2) Structure and content of the program, (3) Awareness, confidence and physical effects, (4) Training with peers, (5) Funding and costs, and (6) Long-term continuation. Conclusions This study resulted in practical recommendations to optimize and further implement FPPs in practice. For successful implementation, FPPs should include recruitment via a personal approach, doing exercises with a focus on activities of daily living and situations in practice, and having exercise opportunities that follow-up on the FPP. Trial registration: Netherlands Trial Register: NL9248 (registered February 13 2021, URL: https://www.trialregister.nl/trial/9248)Keywords Accidental falls, health program, focus group, experiences, preventive intervention<br/

Unexpected findings after surgery for suspected appendicitis rarely change treatment in pediatric patients; Results from a cohort study

Background: To determine if non-operative treatment is safe in children with acute appendicitis, we evaluated the incidence of unexpected findings after an appendectomy in children, and the influence they have on subsequent treatment. Methods: A historical cohort study (January 2004-December 2014) was performed including children, aged 0-17 years, who underwent an appendectomy for the suspicion of acute appendicitis. Patients were divided based upon histopathological examination. Unexpected findings were reviewed, as well as the subsequent treatment plan. Results: In total 484 patients were included in this study. In the overall group, unexpected findings were noted in 10 (2.1%) patients of which two patients intra-operatively with a non-inflamed appendix (Ileitis terminalis N = 1 and ovarian torsion N = 1) and in 8 patients on histopathological examination. The latter group consisted of 4 patients with concomitant simple appendicitis (parasitic infection N = 3 and Walthard cell rest N = 1), two with concomitant complex appendicitis (carcinoid N = 1 and parasitic infection N = 1) and two patients with a noninflamed appendix (endometriosis N = 1 and parasitic infection N = 1). Treatment was changed in 4 patients ( <1%). Conclusions: Results from this study corroborate the safety of non-operative strategy for acute simple appendicitis, as the occurrence of unexpected findings was low, with extremely few necessary changes of the treatment plan because of serious findings. Type of study: Prognosis study. (C) 2017 Elsevier Inc. All rights reserve