Uploaded by yuliadevinasuci

hospitalization due to CAP in patient with COPD

advertisement
Clinical Microbiology and Infection xxx (xxxx) xxx
Contents lists available at ScienceDirect
Clinical Microbiology and Infection
journal homepage: www.clinicalmicrobiologyandinfection.com
Original article
Hospitalization due to community-acquired pneumonia in patients
with chronic obstructive pulmonary disease: incidence, epidemiology
and outcomes
J. Bordon 1, *, M. Slomka 2, R. Gupta 3, S. Furmanek 4, R. Cavallazzi 5, S. Sethi 6,
M. Niederman 7, J.A. Ramirez 4, on behalf of the University of Louisville Pneumonia Study
Group
1)
Providence Health Center, Section of Infectious Diseases, Washington, DC, USA
University of Maryland Medical Center, Division of Infectious Diseases, Baltimore, MD, USA
3)
Cleveland Clinic, Department of Medicine, Division of Hematology and Oncology, Cleveland, OH, USA
4)
University of Louisville, Department of Medicine, Division of Infectious Diseases, Louisville, KY, USA
5)
University of Louisville, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Disorders, Louisville, KY, USA
6)
University at Buffalo, Jacobs School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Buffalo, NY, USA
7)
Weill Cornell Medical College, Pulmonary and Critical Care Medicine, New York, NY, USA
2)
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 21 April 2019
Received in revised form
8 June 2019
Accepted 17 June 2019
Available online xxx
Objectives: Community-acquired pneumonia (CAP) is an important complication in patients with chronic
obstructive pulmonary disease (COPD). This study aimed to define incidence, and outcomes of COPD
patients hospitalized with pneumonia in the city of Louisville, and to estimate the burden of disease in
the US population.
Methods: This was a secondary analysis of a prospective population-based cohort study of residents in
Louisville, Kentucky, 40 years old and older, from 1 June 2014 to 31 May 2016. All adults hospitalized with
CAP were enrolled. The annual incidence of pneumonia in COPD patients in Louisville was calculated and
the total number of adults with COPD hospitalized in the United States was estimated. Clinical outcomes
included time to clinical stability (TCS), length of hospital stay (LOS) and mortality.
Results: From a Louisville population of 18 246 patients with COPD, 3419 pneumonia hospitalizations
were documented during the 2-year study. The annual incidence was 9369 patients with pneumonia per
100 000 COPD population, corresponding to an estimated 506 953 adults with COPD hospitalized due to
pneumonia in the United States. The incidence of CAP in patients without COPD was 509 (95% CI 485
e533) per 100 000. COPD patients had a median (interquartile range) TCS and LOS of 2 (1e4) and 5 (3e9)
days respectively. The mortality of COPD patients during hospitalization, at 30 days, 6 months and 1 year
was 193 of 3419 (5.6%), 400 of 3374 (11.9%), 816 of 3363 (24.3%) and 1104 of 3349 (33.0%), respectively.
Conclusions: There was an annual incidence of 9369 cases of hospitalized CAP per 100 000 COPD patients
in the city of Louisville. This was an approximately 18-fold greater incidence of CAP in COPD patients
than in those without COPD. J. Bordon, Clin Microbiol Infect 2019;▪:1
© 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All
rights reserved.
Editor: L. Leibovici
Keywords:
COPD
Epidemiology
Incidence
Mortality
Pneumonia
Introduction
Chronic obstructive pulmonary disease (COPD) is the third
leading cause of death in the United States and is considered the
* Corresponding author. J. Bordon, Providence Health System, Section of Infectious Diseases, 1150 Varnum St NE Suite # 203, Washington, DC 20017, USA.
E-mail address: [email protected] (J. Bordon).
third leading cause of death worldwide [1,2]. Patients with COPD
may die due to the progression of airflow limitation leading to
respiratory failure, due to deterioration of comorbidities or due to
infectious complications such as exacerbations and pneumonia
[3e6]. The literature indicates that patients with COPD are at high
risk of developing pneumonia [7e9], but the incidence, epidemiology and clinical outcomes of COPD patients hospitalized with
community-acquired pneumonia (CAP) are not well defined. The
https://doi.org/10.1016/j.cmi.2019.06.025
1198-743X/© 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Please cite this article as: Bordon J et al., Hospitalization due to community-acquired pneumonia in patients with chronic obstructive pulmonary
disease: incidence, epidemiology and outcomes, Clinical Microbiology and Infection, https://doi.org/10.1016/j.cmi.2019.06.025
2
J. Bordon et al. / Clinical Microbiology and Infection xxx (xxxx) xxx
primary objectives of this study were to compare the incidence and
clinical outcomes of CAP of hospitalized patients with COPD versus
without COPD in Louisville, Kentucky. The secondary objectives
were to define the geospatial epidemiology in Louisville and to
estimate the number of COPD patients hospitalized due to CAP in
the US and the cost of hospitalization.
Methods
Study design and participants
This was a secondary data analysis of the University of Louisville
Pneumonia Study, a prospective population-based cohort study of
all hospitalized adults with CAP who were residents in the city of
Louisville, Kentucky, from 1 June 2014 to 31 May 2016 [10]. All
hospitalized adult patients in Louisville underwent screening for
participation in the study.
Inclusion criteria
Study patients were 40 years old and older with the diagnosis of
COPD documented in medical records. Controls were patients
40 years and older without the diagnosis of COPD. Patients were
defined as having pneumonia when the following three criteria
were met: (1) presence of a new pulmonary infiltrate on chest
radiograph and/or chest computed tomography scan at the time of
hospitalization, defined by a board-certified radiologist's reading;
(2) at least one of the following (a) new cough or increased cough or
sputum production, (b) fever >37.8 C (100.0 F) or hypothermia
<35.6 C (96.0 F), (c) changes in leucocyte count (leucocytosis
>11 000 cells/mm3; left shift >10% band forms/mL; or leucopenia
<4000 cells/mm3); and (3) no alternative diagnosis at the time of
hospital discharge that justified the presence of criteria 1 and 2
[10].
number of COPD patients hospitalized due to CAP in the US and the
cost of hospitalization.
Incidence calculation
The annual pneumonia incidence rates per 100 000 COPD patients were estimated for unique patients. COPD prevalence in the
city of Louisville was derived using data from the 2014 Behavioral
Risk Factor Surveillance System (BRFSS) as well as from the 2014
National Health Interview Survey (NHIS) [10].
Time to clinical stability
Patients were evaluated daily to determine the day when clinical stability was reached. The following ATS criteria to define a
patient as clinically stable were followed: (1) improved cough and
shortness of breath, (2) lack of fever for at least 8 hr, (3) improving
leucocytosis (decreased at least 10% from the previous day) and (4)
tolerating oral intake with adequate gastrointestinal absorption
[11]. The day that the patient met criteria for clinical stability minus
the day of admission defined time to clinical stability (TCS).
Length of hospitalization
Length of hospital stay (LOS) was defined in days and calculated
for each patient as day of discharge minus the day of admission.
Mortality
All-cause mortality for all unique hospitalized COPD patients
with pneumonia was evaluated during hospitalization, and at
30 days, 6 months and 1 year after hospitalization. After discharge,
mortality was evaluated by reviewing medical records and data
from the Kentucky Department for Public Health Office of Vital
Statistics.
Exclusion criteria
Geospatial epidemiology
With the intent to enrol only hospitalized COPD patients with
pneumonia who lived in Louisville, KY, and who were counted in
the 2010 US Census, patients were excluded from analysis if they
(1) did not have a permanent or valid Louisville address based on
US Census Bureau data, (2) did not have a valid Social Security
Number (SSN) or (3) were in the correctional system.
The geomasked location of each COPD patient's home address
was obtained through the US Census Bureau website and a kernel
density heatmap was created to show distribution of COPD patients
in Louisville. Choropleth maps were created to compare census
tract-level demographics and the spatial distribution of CAP. A
complete description of the geospatial methods is available (please
see supplementary material).
Unique COPD patients hospitalized with pneumonia
A unique COPD patient hospitalized with pneumonia was
counted as the first hospitalization during each study year. A rehospitalization due to a new episode of pneumonia was identified
by a repeat of the same SSN of each patient in the same study year.
Chronic obstructive pulmonary disease (COPD) is the third
leading cause of death in the United States and is considered the
third leading cause of death worldwide [1,2]. Patients with COPD
may die due to the progression of airflow limitation leading to
respiratory failure, due to deterioration of comorbidities or due to
infectious complications such as exacerbations and pneumonia
[3e6]. The literature indicates that patients with COPD are at high
risk of developing pneumonia [7e9], but the incidence, epidemiology and clinical outcomes of COPD patients hospitalized with
community-acquired pneumonia (CAP) are not well defined. The
primary objectives of this study were to compare the incidence and
clinical outcomes of CAP of hospitalized patients with COPD versus
without COPD in Louisville, KY. The secondary objectives were to
define the geospatial epidemiology in Louisville and to estimate the
Number of COPD patients hospitalized due to CAP in the United
States
The estimated number of pneumonia hospitalizations in the US
population with COPD was calculated by multiplying the Louisville
incidence rate by the estimated 2014 US adult population with
COPD estimated from the US Bureau. Full methodological descriptions can be found in the supplementary material.
Statistical analysis
Descriptive statistics were performed, with medians and interquartile ranges (IQRs) describing continuous data, and frequencies
and percentages describing categorical data. Patient groups were
compared using ManneWhitney U tests, chi-square tests or the
Fisher exact test where appropriate. Clinical outcomes of TCS and
LOS were compared using Cox proportional hazards regressions,
and clinical outcomes of mortality were compared using logistic
regression. In all regression analysis, pneumonia severity index
Please cite this article as: Bordon J et al., Hospitalization due to community-acquired pneumonia in patients with chronic obstructive pulmonary
disease: incidence, epidemiology and outcomes, Clinical Microbiology and Infection, https://doi.org/10.1016/j.cmi.2019.06.025
J. Bordon et al. / Clinical Microbiology and Infection xxx (xxxx) xxx
3
Table 1
Baseline characteristics of patients
Variable
Patients; n
Demographics
Age, median (IQR)
Male sex, n (%)
Black race, n (%)
Social and medical history, n (%)
History of CHF
BMI >30
History of diabetes mellitus
History of renal failure
History of neoplastic disease
History of stroke
History of liver disease
History of HIV infection
Smoking history
Never
Former
Current
Vaccination history, n (%)
Pneumococcal vaccination
Flu vaccination
Cardiovascular risk factors and medications, n (%)
Family history of CAD
History of CAD
History of arterial hypertension
History of hyperlipidaemia
Prior myocardial infarction
Prior percutaneous transluminal coronary angioplasty
History of atrial fibrillation
Aspirin use
Beta-blockers use
ACE inhibitors use
Warfarin use
Heparin use
Antiplatelet use
Statin use
Exam and laboratory values, median (IQR)
Temperature, C
Respiratory rate, breaths/min
Heart rate, beats/min
Systolic blood pressure, mmHg
Diastolic blood pressure, mmHg
Bicarbonate, mEq/L
Blood urea nitrogen, mg/dL
Glucose, mg/dL
Haematocrit, %
Sodium, mEq/L
Severity of disease at admission
ICU admission, n (%)
Altered mental status, n (%)
Vasopressors, n (%)
Ventilatory support, n (%)
Pneumonia severity index (PSI), median (IQR)
PSI risk class 4 or 5, n (%)
Blood culture isolatesa, n (%)
Streptococcus pneumonia
Staphylococcus other
Methicillin-resistant Staphylococcus aureus
Methicillin-susceptible Staphylococcus aureus
Respiratory culture isolatesa, n (%)
Methicillin-resistant Staphylococcus aureus
Streptococcus pneumonia
Haemophilus influenza
Pseudomonas aeruginosa
Methicillin-susceptible Staphylococcus aureus
COPD treatments, n (%)
Oral steroids prior to admission
Home oxygen use
Group
COPD þ
COPDe
3419
3476
70 (60e79)
1520 (44)
609 (18)
70 (57e83)
1656 (48)
701 (20)
1225 (36)
1197 (35)
1166 (34)
996 (29)
486 (14)
433 (13)
254 (7)
40 (1)
861 (25)
1197 (34)
1192 (34)
1114 (32)
482 (14)
500 (14)
225 (6)
45 (1)
501 (15)
1540 (45)
1378 (40)
1647 (47)
1148 (33)
681 (20)
1596 (47)
1226 (36)
1308 (38)
1097 (32)
940 (28)
1266 (37)
2520 (74)
1627 (48)
513 (15)
670 (20)
769 (22)
1313 (38)
1391 (41)
998 (29)
419 (12)
56 (2)
268 (8)
1341 (39)
794 (23)
932 (27)
2486 (72)
1572 (45)
392 (11)
507 (15)
685 (20)
1172 (34)
1338 (39)
1005 (29)
416 (12)
66 (2)
201 (6)
1230 (35)
37 (37e38)
24 (20e28)
106 (92e119)
115 (99e134)
56 (48e66)
27 (24e31)
19 (13e29)
149 (118e206)
36 (32e40)
137 (134e140)
37 (37e38)
22 (20e26)
103 (89e117)
117 (99e136)
57 (49e68)
25 (23e28)
20 (14e32)
138 (113e190)
35 (31e39)
137 (134e140)
648 (19)
581 (17)
99 (3)
579 (17)
105 (81e133)
2210 (65)
534 (15)
757 (22)
95 (3)
349 (10)
105 (78e133)
2227 (64)
37
33
22
11
(23)
(21)
(14)
(7)
36
27
20
26
(17)
(13)
(10)
(13)
59
55
39
37
25
(19)
(18)
(13)
(12)
(8)
36
21
21
21
20
(21)
(12)
(12)
(12)
(11)
568 (17)
834 (24)
ACE, angiotensin converting enzyme; BMI, body mass index; CAD, Coronary artery disease; CHF, Congestive heart failure; COPD, chronic
obstructive pulmonary disease; HIV, human immunodeficiency virus.
a
Only isolates with above at least 10% of found isolate frequency for either group are included.
Please cite this article as: Bordon J et al., Hospitalization due to community-acquired pneumonia in patients with chronic obstructive pulmonary
disease: incidence, epidemiology and outcomes, Clinical Microbiology and Infection, https://doi.org/10.1016/j.cmi.2019.06.025
4
J. Bordon et al. / Clinical Microbiology and Infection xxx (xxxx) xxx
(PSI) risk class IV or V was used to adjust for severity of CAP. In
addition the following variables not included in the PSI were also
adjusted for regression analyses: smoking status, race, obesity, ICU
admission on day 0, and active coronary artery disease as defined in
the medical record. KaplaneMeier curves were also produced to for
clinical outcomes of TCS, LOS and mortality. Time to clinical stability and length of stay were right truncated at eight and 14 days,
respectively. In the event that patients died or left the hospital
before becoming clinically stable, they were given the worst
outcome (8 days). Patients that died before they left the hospital
were given the worst outcome (14 days).
Human subjects protection
The study was approved by the University of Louisville (UofL)
Institutional Review Board (IRB #11.0613) and by the research offices at each participating hospital. Study consents were waived.
Study coordinating centre
The study-coordinating centre, located at the UofL Division of
Infectious Diseases, directed all operational and data aspects of the
study [10].
Results
Study population
A total of 18 246 individuals aged 40 and older with COPD were
estimated to live in Louisville, KY. Our study revealed a total of 3419
COPD patients hospitalized due to CAP in Louisville, KY, during the
2-year study period. Characteristics of our study patients are shown
in Table 1. COPD patients, compared with non-COPD patients, had
more history of heart failure, more ICU admission and use of mechanical ventilation, yet had similar PSI score and 17% received oral
steroids prior to admission. They also had more pneumococcal
pneumonia, in spite of receiving pneumococcal vaccine significantly more often.
Incidence of CAP
The annual incidence of CAP was 9369 (95% CI 8925e9813) in
patients with COPD versus 509 (95% CI 486e533) in patients
without COPD per 100 000 population in the city of Louisville. The
incidence of CAP among COPD and non-COPD patients for ages
40e64 years and older than 65 years, by sex, are shown in Fig. 1.
Clinical outcomes
TCS and LOS were similar for patients with and without COPD
hospitalized due to CAP. Median TCS was 2 (IQR 1e4) days and
median LOS was 5 (IQR 3e8) days in both patient groups. The
mortality of patients with COPD and CAP during hospitalization
was 5.6%. Furthermore, the mortality of patients with COPD at
30 days, 6 months and 1 year was 11.9%, 24.3% and 33.0%, respectively versus 6.6%, 14.2%, 24.2% and 30.1% in non-COPD respectively.
KaplaneMeier curves are shown in Fig. 2. The adjusted model
outcomes are shown in Table 2.
Geospatial epidemiology
The kernel density heat map according to the home address of
each COPD patient hospitalized with CAP is shown in Fig. 3A.
Clusters of COPD patients hospitalized with CAP were identified in
the western northern area of the city of Louisville were individuals
with low-income and Black/African American are concentrated
(Fig. 3B and C). Clusters of COPD patients hospitalized with CAP did
not appear to be associated with areas with increased elderly
population as shown in Fig. 3D.
Number of COPD patients hospitalized due to CAP in the USA
The projected number of individuals with COPD hospitalized
due to CAP in United States was 506 953 (95% CI 482 923e530 983).
Discussion
This study revealed a CAP incidence of 9369 individuals per
100 000 population aged 40 years and older with COPD in the city
Fig. 1. Incidence of patients hospitalized for community-acquired pneumonia by age groups and gender per 100 000 population for patients with and without COPD (chronic
obstructive pulmonary disease).
Please cite this article as: Bordon J et al., Hospitalization due to community-acquired pneumonia in patients with chronic obstructive pulmonary
disease: incidence, epidemiology and outcomes, Clinical Microbiology and Infection, https://doi.org/10.1016/j.cmi.2019.06.025
J. Bordon et al. / Clinical Microbiology and Infection xxx (xxxx) xxx
5
Table 2
Adjusted model results for clinical outcomes of CAP patients hospitalized with and
without COPD
Outcome
Estimate
95% Confidence interval
p
Time to clinical stabilitya
Length of staya
Mortality, all causes
In-hospital mortalityb
30-day mortalityb
6-month mortalityb
1-year mortalityb
0.92
0.90
0.87e0.97
0.85e0.95
0.002
<0.001
0.86
0.85
1.08
1.25
0.69e1.07
0.73e1.00
0.95e1.22
1.11e1.41
0.165
0.052
0.262
<0.001
a
b
Fig. 2. KaplaneMeier curves for hospitalized community-acquired pneumonia patients with and without chronic obstructive pulmonary disease (COPD) according to
time to reach clinical stability, hospital discharge, and mortality.
of Louisville. These observations mean that nearly one in ten persons with COPD will be hospitalized annually due to CAP. This
translates into approximately 500 000 COPD patients hospitalized
with CAP every year in the United States, resulting in a substantial
Adjusted hazard ratio for negative outcome reported.
Adjusted odds ratio for negative outcome reported.
burden of approximately 5 billion US dollars in hospitalization
costs. Furthermore, our study showed that patients with COPD have
an approximately 18-fold greater incidence of CAP than non-COPD
patients.
Risk factors for this high incidence may include use of inhaled
corticosteroid (ICS), smoking and suboptimal immunization
[12e15]. The use of ICS has been associated with a 69% increase of
the rate of pneumonia [16]. The UPLIFT trial established that use of
ICS increases pneumonia events by 22% in COPD patients [17]. A
Cochrane review of 43 RCTs concluded that ICS were associated
with a 1.78-fold increase in the odds of pneumonia [18]. The high
rate of tobacco smoking of our COPD patients is expected to be a
major contributing factor to the high incidence of CAP [19,20]. The
tobacco smoking rate of our patient population was similar to that
reported by Mullerova et al. in the UK [21]. Modifiable factors
associated with CAP such us tobacco smoking and immunizations
should be health interventions to prevent the burden of CAP in
COPD patients. However, pneumococcal vaccination was used more
often in our COPD population than in other CAP patients, but
pneumococcal pneumonia still occurred at a numerically higher
rate.
In relation to underserved populations, our study showed a
substantial burden of CAP in COPD among African Americans and
those living in poverty. Other studies of CAP among patients with
COPD did not examine epidemiology factors such as race/ethnicity
and poverty level [19,22,23]. Health interventions to prevent CAP
should be maximized in underserved population as revealed by our
study.
No clinical differences were found among patients with versus
without COPD in regard to time to reach clinical improvement, time
of hospital discharge. Except for the 1-year mortality that was 25%
greater among COPD patients, the in-hospital mortality, 30-day
mortality and 6-month mortality did not have statistically significant differences between groups (Table 2). Though patients with
COPD would be expected to have poorer outcomes, others reported
similar results to ours [18,24e26]. In our study, the lower than
expected mortality among COPD patients could be due to multiple
factors including the aggressive medical management for COPD.
Factors contributing to the outcomes of CAP among COPD patients
are poorly characterized. Corticosteroid therapy may play a role in
the lack of poor outcomes of COPD patients [27,28]. Similar to the
immune response following vaccination, chronic bacterial lung
colonization may contribute to the priming of the host response
favouring the outcomes of CAP in COPD patients [29,30]. Even
though we did not find evidence of increased mortality at earlier
time points, we documented an increase in the odds of 1-year allcause mortality by 25% among our COPD patients compared to
those without COPD.
Our study has several limitations. Our study was not designed to
identify risk factors for the incidence of CAP among COPD patients.
Please cite this article as: Bordon J et al., Hospitalization due to community-acquired pneumonia in patients with chronic obstructive pulmonary
disease: incidence, epidemiology and outcomes, Clinical Microbiology and Infection, https://doi.org/10.1016/j.cmi.2019.06.025
6
J. Bordon et al. / Clinical Microbiology and Infection xxx (xxxx) xxx
Fig. 3. Heatmap representation of the home address of each chronic obstructive pulmonary disease (COPD) patient hospitalized with community-acquired pneumonia (CAP) in the
city of Louisville (A). Maps indicating the home address (dots) of COPD patients hospitalized with CAP superimposed on maps indicating poverty (B), Black/African American (C),
and population over 65 years of age (D) according to census tracts in the city of Louisville.
In this regard, our study does not include validation of corticosteroid therapy and of influenza and pneumococcal immunizations.
Our study also did not include the confirmation of COPD diagnosis
by lung function test. We also did not evaluate CAP in COPD patients that did not lead to hospitalization. Major strengths of our
study include the prospective population-based design, the inclusion of all adult hospitals of a major US city, and the identification of
patients hospitalized multiple times by using the patients' social
security numbers as a unique identifier.
In summary, our study revealed an incidence of 9369 cases of
CAP per 100 000 COPD patients resulting in an approximately 18fold greater incidence of CAP than those patients without COPD.
This substantial incidence of CAP among COPD patients results in a
high health and financial burden.
Acknowledgements
The authors would like to acknowledge the efforts of all
healthcare workers, administrators, and members of the research
offices at each of the participating facilities who made this study
possible. The authors appreciate the manuscript review by Jessica
Lynn Petrey, Clinical Librarian, Kornhauser Health Sciences Library,
University of Louisville.
Appendix A. Supplementary data
Supplementary data to this article can be found online at
https://doi.org/10.1016/j.cmi.2019.06.025.
References
Transparency declaration
This work was supported primarily by the Division of Infectious
Diseases, University of Louisville, Kentucky. Partial support was
given by Pfizer Inc. All authors do not report conflicts of interest. All
authors submitted the CMI form for disclosure of Potential Conflict
of Interest. Conflicts that the journal consider relevant to the content of the manuscript have been disclosed.
[1] Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global
and regional mortality from 235 causes of death for 20 age groups in 1990 and
2010: a systematic analysis for the Global Burden of Disease Study 2010.
Lancet 2012;380:2095e128.
[2] National Center for Health Statistics. Health, United States 2015 with special
feature on racial and ethnic health disparities. Hyattsville, MD: US Dept Health
and Human Services; 2016.
[3] Qureshi H, Sharafkhaneh A, Hanania NA. Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications. Ther Adv
Chronic Dis 2014;5:212e27.
Please cite this article as: Bordon J et al., Hospitalization due to community-acquired pneumonia in patients with chronic obstructive pulmonary
disease: incidence, epidemiology and outcomes, Clinical Microbiology and Infection, https://doi.org/10.1016/j.cmi.2019.06.025
J. Bordon et al. / Clinical Microbiology and Infection xxx (xxxx) xxx
[4] Abukhalaf J, Davidson R, Villalobos N, Meek P, Petersen H, Sood A, et al.
Chronic obstructive pulmonary disease mortality, a competing risk analysis.
Clin Respir J 2018;12:2598e605.
~ a JJ, Martínez-García MA, Roma
n Sa
nchez P, Salcedo E,
[5] Soler-Catalun
Navarro M, Ochando R. Severe acute exacerbations and mortality in patients
with chronic obstructive pulmonary disease. Thorax 2005;60:925e31.
[6] McGarvey LP, John M, Anderson JA, Zvarich M, Wise RA, TORCH Clinical
Endpoint Committee. Ascertainment of cause specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee. Thorax 2007;62:411e5.
[7] Lin SH, Perng DW, Chen CP, Chai WH, Yeh CS, Kor CT, et al. Increased risk of
community-acquired pneumonia in COPD patients with comorbid cardiovascular disease. Int J Chron Obstr Pulm Dis 2016;11:3051e8.
J, Ferna
ndez-Sabe
N, Dorca J, Verdaguer R, Manresa F,
[8] Garcia-Vidal C, Carratala
et al. Aetiology of, and risk factors for, recurrent community-acquired pneumonia. Clin Microbiol Infect 2009;15:1033e8.
[9] Molinos L, Clemente MG, Miranda B, Alvarez C, del Busto B, Cocina BR, et al.
Community-acquired pneumonia in patients with and without chronic
obstructive pulmonary disease. J Infect 2009;58:417e24.
[10] Ramirez JA, Wiemken TL, Peyrani P, Arnold FW, Kelley R, Mattingly WA, et al.
Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality. Clin Infect Dis 2017;65:1806e12.
[11] Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD,
et al. Guidelines for the management of adults with community-acquired
pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and
prevention. Am J Respir Crit Care Med 2001;163:1730e54.
[12] Singh S, Amin AV, Loke YK. Long-term use of inhaled corticosteroids and the
risk of pneumonia in chronic obstructive pulmonary disease. Arch Intern Med
2009;169:219e29.
[13] Kurashima K, Takaku Y, Nakamoto K, Kanauchi T, Takayanagi N, Yanagisawa T,
et al. Risk factors for pneumonia and the effect of the pneumococcal vaccine in
patients with chronic airflow obstruction. Chronic Obstr Pulm Dis 2016;3:
610e9.
[14] Walters JA, Tang JN, Poole P, Wood-Baker R. Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease. Cochrane
Database Syst Rev 2017;24. CD001390.
~ oz J, Ferna
ndez A, Hernandez M, et al.
[15] Alfageme I, Vazquez R, Reyes N, Mun
Clinical efficacy of anti-pneumococcal vaccination in patients with COPD.
Thorax 2006;61:189e95.
[16] Suissa S, Patenaude V, Lapi F, Ernst P. Inhaled corticosteroids in COPD and the
risk of serious pneumonia. Thorax 2013;68:1029e36.
[17] Morjaria JB, Rigby A, Morice AH. Inhaled corticosteroid use and the risk of
pneumonia and COPD exacerbations in the UPLIFT study. Lung 2017;195:
281e8.
7
[18] Kew KM, Seniukovich A. Inhaled steroids and risk of pneumonia for chronic
obstructive pulmonary disease. Cochrane Database Syst Rev 2014:CD010115.
[19] Braeken DC, Rohde GG, Franssen FM, Driessen JH, van Staa TP, Souverein PC,
et al. Risk of community-acquired pneumonia in chronic obstructive pulmonary disease stratified by smoking status: a population-based cohort study in
the United Kingdom. Int J Chron Obstr Pulm Dis 2017;12:2425e32.
[20] Bagaitkar J, Demuth DR, Scott DA. Tobacco use increases susceptibility to
bacterial infection. Tob Induced Dis 2008;4:12.
[21] Müllerova H, Chigbo C, Hagan GW, Woodhead MA, Miravitlles M, Davis KJ,
et al. The natural history of community-acquired pneumonia in COPD patients: a population database analysis. Respir Med 2012;106:1124e33.
[22] Williams NP, Coombs NA, Johnson MJ, Josephs LK, Rigge LA, Staples KJ, et al.
Seasonality, risk factors and burden of community-acquired pneumonia in
COPD patients: a population database study using linked health care records.
Int J Chron Obstruct Pulmon Dis 2017;12:313e22.
[23] Braeken D, Franssen F, Schütte H, Pletz Mathias W, Bals Robert, Martus Peter,
et al. Increased severity and mortality of CAP in COPD: results from the
German competence network, CAPNETZ. J COPD Found 2014;2:131e40.
[24] Snijders D, van der Eerden M, de Graaff C, Boersma W. The influence of COPD
on mortality and severity scoring in community-acquired pneumonia.
Respiration 2010;79:46e53.
niz C, Marcos MA, Mensa J, et al. Severity
[25] Liapikou A, Polverino E, Ewig S, Cillo
and outcomes of hospitalised community-acquired pneumonia in COPD patients. Eur Respir J 2012;39:855e61.
[26] Maurici R, Morello Gearhart A, Viríssimo Maciel V, Arnold F, Fernandez F,
Persaud AK, et al. The presence of COPD does not influence clinical outcomes
in hospitalized patients with community-acquired pneumonia. Univ Louisville
J Respir Infect 2017;1:36e42.
[27] Torres A, Sibila O, Ferrer M, Polverino E, Menendez R, Mensa J, et al. Effect of
corticosteroids on treatment failure among hospitalized patients with severe
community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA 2015;313:677e86.
[28] Siemieniuk RA, Meade MO, Alonso-Coello P, Briel M, Evaniew N, Meade M,
et al. Corticosteroid therapy for patients hospitalized with communityacquired pneumonia: a systematic review and meta-analysis. Ann Intern
Med 2015;163:519e28.
[29] Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic
obstructive pulmonary disease. N Engl J Med 2008;359:2355e65.
[30] Veeramachaneni SB, Sethi S. Pathogenesis of bacterial exacerbations of COPD.
COPD 2006;3:109e15.
Please cite this article as: Bordon J et al., Hospitalization due to community-acquired pneumonia in patients with chronic obstructive pulmonary
disease: incidence, epidemiology and outcomes, Clinical Microbiology and Infection, https://doi.org/10.1016/j.cmi.2019.06.025
Download
Random flashcards
Rekening Agen Resmi De Nature Indonesia

9 Cards denaturerumahsehat

Secuplik Kuliner Sepanjang Danau Babakan

2 Cards oauth2_google_2e219703-8a29-4353-9cf2-b8dae956302e

Card

2 Cards

English Training Melbourne

2 Cards Einstein College of Australia

Create flashcards