CHEST Physician

Key clinical point: Serum IL-17 levels show a positive correlation with the severity and poor prognostic outcomes in patients with community-acquired pneumonia (CAP).

Main finding: In patients with CAP, serum IL-17 levels at admission increased in parallel with CAP severity scores, such as pneumonia severity index, and, after adjusting for confounding factors, showed a positive correlation with intensive care unit (ICU) admission (adjusted odds ratio [aOR] 1.01; P = .01), mechanical ventilation (aOR 1.10; P = .02), death (aOR, 1.05; P < .01), and hospital stay of 14 days or more (aOR 1.21; P = .01).

Study details: This was a prospective cohort study including 239 patients who were hospitalized for CAP.

Disclosures: The National Natural Science Foundation of China, Anhui Provincial Natural Science Foundation, National Natural Science Foundation Incubation Program of the Second Affiliated Hospital of Anhui Medical University, and Scientific Research of Health Commission in Anhui Province sponsored the study. None of the authors declared any conflict of interests.

Source: Feng CM et al. BMC Pulm Med. 2021;21:393 (Dec 2). Doi: 10.1186/s12890-021-01770-6.

Key clinical point: Serum IL-17 levels show a positive correlation with the severity and poor prognostic outcomes in patients with community-acquired pneumonia (CAP).

Main finding: In patients with CAP, serum IL-17 levels at admission increased in parallel with CAP severity scores, such as pneumonia severity index, and, after adjusting for confounding factors, showed a positive correlation with intensive care unit (ICU) admission (adjusted odds ratio [aOR] 1.01; P = .01), mechanical ventilation (aOR 1.10; P = .02), death (aOR, 1.05; P < .01), and hospital stay of 14 days or more (aOR 1.21; P = .01).

Study details: This was a prospective cohort study including 239 patients who were hospitalized for CAP.

Disclosures: The National Natural Science Foundation of China, Anhui Provincial Natural Science Foundation, National Natural Science Foundation Incubation Program of the Second Affiliated Hospital of Anhui Medical University, and Scientific Research of Health Commission in Anhui Province sponsored the study. None of the authors declared any conflict of interests.

Source: Feng CM et al. BMC Pulm Med. 2021;21:393 (Dec 2). Doi: 10.1186/s12890-021-01770-6.

Key clinical point: Serum IL-17 levels show a positive correlation with the severity and poor prognostic outcomes in patients with community-acquired pneumonia (CAP).

Main finding: In patients with CAP, serum IL-17 levels at admission increased in parallel with CAP severity scores, such as pneumonia severity index, and, after adjusting for confounding factors, showed a positive correlation with intensive care unit (ICU) admission (adjusted odds ratio [aOR] 1.01; P = .01), mechanical ventilation (aOR 1.10; P = .02), death (aOR, 1.05; P < .01), and hospital stay of 14 days or more (aOR 1.21; P = .01).

Study details: This was a prospective cohort study including 239 patients who were hospitalized for CAP.

Disclosures: The National Natural Science Foundation of China, Anhui Provincial Natural Science Foundation, National Natural Science Foundation Incubation Program of the Second Affiliated Hospital of Anhui Medical University, and Scientific Research of Health Commission in Anhui Province sponsored the study. None of the authors declared any conflict of interests.

Source: Feng CM et al. BMC Pulm Med. 2021;21:393 (Dec 2). Doi: 10.1186/s12890-021-01770-6.

Key clinical point: In patients hospitalized for community-acquired pneumonia (CAP), the least risk of acute kidney injury (AKI) can be achieved by empiric treatment with a third-generation cephalosporin ± macrolide or a respiratory fluoroquinolone.

Main finding: Barring fluoroquinolones (adjusted odds ratio [aOR] 1.06; 95% CI 0.98-1.14), all regimens offered a higher risk for AKI than a third-generation cephalosporin ± macrolide, with piperacillin/tazobactam + vancomycin being associated with the highest AKI odds (aOR 1.89; 95% CI 1.73-2.06).

Study details: Findings are from a retrospective cohort study consisting of 449,535 adult patients hospitalized for CAP, of whom 3.1% developed AKI.

Disclosures: The study was sponsored by the Agency for Healthcare Research and Quality. The authors declared no conflict of interests.

Source: Le P et al. Curr Med Res Opin. 2021 (Nov 15). Doi: 10.1080/03007995.2021.2000716.

Key clinical point: In patients hospitalized for community-acquired pneumonia (CAP), the least risk of acute kidney injury (AKI) can be achieved by empiric treatment with a third-generation cephalosporin ± macrolide or a respiratory fluoroquinolone.

Main finding: Barring fluoroquinolones (adjusted odds ratio [aOR] 1.06; 95% CI 0.98-1.14), all regimens offered a higher risk for AKI than a third-generation cephalosporin ± macrolide, with piperacillin/tazobactam + vancomycin being associated with the highest AKI odds (aOR 1.89; 95% CI 1.73-2.06).

Study details: Findings are from a retrospective cohort study consisting of 449,535 adult patients hospitalized for CAP, of whom 3.1% developed AKI.

Disclosures: The study was sponsored by the Agency for Healthcare Research and Quality. The authors declared no conflict of interests.

Source: Le P et al. Curr Med Res Opin. 2021 (Nov 15). Doi: 10.1080/03007995.2021.2000716.

Key clinical point: In patients hospitalized for community-acquired pneumonia (CAP), the least risk of acute kidney injury (AKI) can be achieved by empiric treatment with a third-generation cephalosporin ± macrolide or a respiratory fluoroquinolone.

Main finding: Barring fluoroquinolones (adjusted odds ratio [aOR] 1.06; 95% CI 0.98-1.14), all regimens offered a higher risk for AKI than a third-generation cephalosporin ± macrolide, with piperacillin/tazobactam + vancomycin being associated with the highest AKI odds (aOR 1.89; 95% CI 1.73-2.06).

Study details: Findings are from a retrospective cohort study consisting of 449,535 adult patients hospitalized for CAP, of whom 3.1% developed AKI.

Disclosures: The study was sponsored by the Agency for Healthcare Research and Quality. The authors declared no conflict of interests.

Source: Le P et al. Curr Med Res Opin. 2021 (Nov 15). Doi: 10.1080/03007995.2021.2000716.

Key clinical point: Quick sequential (sepsis-related) organ failure assessment (qSOFA) is better than the Infectious Disease Society of America/American Thoracic Society minor criteria and worse than confusion, urea, respiratory rate, blood pressure, and age ≥ 65 years (CURB-65) in predicting mortality in community-acquired pneumonia (CAP).

Main finding: The predictive validity of qSOFA for mortality (area under the receiver operating characteristic curve [AUROC] 0.868; 95% CI 0.853-0.882) was higher than that of minor criteria (AUROC 0.824; P < .0001) and lower than that of CURB-65 (AUROC 0.919; P < .0001).

Study details: The data come from an observational prospective cohort study consisting of 2,116 adult patients with CAP.

Disclosures: The study was sponsored by the Medical Science and Technology Foundation of Guangdong Province, Planned Science and Technology Project of Shenzhen Municipality, and Nonprofit Scientific Research Project of Futian District. The authors declared no conflict of interests.

Source: Guo Q et al. Am J Emerg Med. 2022(Feb);52:1-7 (Nov 24). Doi: 10.1016/j.ajem.2021.11.029.

Key clinical point: Quick sequential (sepsis-related) organ failure assessment (qSOFA) is better than the Infectious Disease Society of America/American Thoracic Society minor criteria and worse than confusion, urea, respiratory rate, blood pressure, and age ≥ 65 years (CURB-65) in predicting mortality in community-acquired pneumonia (CAP).

Main finding: The predictive validity of qSOFA for mortality (area under the receiver operating characteristic curve [AUROC] 0.868; 95% CI 0.853-0.882) was higher than that of minor criteria (AUROC 0.824; P < .0001) and lower than that of CURB-65 (AUROC 0.919; P < .0001).

Study details: The data come from an observational prospective cohort study consisting of 2,116 adult patients with CAP.

Disclosures: The study was sponsored by the Medical Science and Technology Foundation of Guangdong Province, Planned Science and Technology Project of Shenzhen Municipality, and Nonprofit Scientific Research Project of Futian District. The authors declared no conflict of interests.

Source: Guo Q et al. Am J Emerg Med. 2022(Feb);52:1-7 (Nov 24). Doi: 10.1016/j.ajem.2021.11.029.

Key clinical point: Quick sequential (sepsis-related) organ failure assessment (qSOFA) is better than the Infectious Disease Society of America/American Thoracic Society minor criteria and worse than confusion, urea, respiratory rate, blood pressure, and age ≥ 65 years (CURB-65) in predicting mortality in community-acquired pneumonia (CAP).

Main finding: The predictive validity of qSOFA for mortality (area under the receiver operating characteristic curve [AUROC] 0.868; 95% CI 0.853-0.882) was higher than that of minor criteria (AUROC 0.824; P < .0001) and lower than that of CURB-65 (AUROC 0.919; P < .0001).

Study details: The data come from an observational prospective cohort study consisting of 2,116 adult patients with CAP.

Disclosures: The study was sponsored by the Medical Science and Technology Foundation of Guangdong Province, Planned Science and Technology Project of Shenzhen Municipality, and Nonprofit Scientific Research Project of Futian District. The authors declared no conflict of interests.

Source: Guo Q et al. Am J Emerg Med. 2022(Feb);52:1-7 (Nov 24). Doi: 10.1016/j.ajem.2021.11.029.

Key clinical point: A positive association exists between blood glucose levels at hospital admission for community-acquired pneumonia (CAP) and 28-day mortality, and the strength of this association decreases with age.

Main finding: After adjusting for confounding factors, all patients exhibited a significant association between blood glucose levels at hospitalization and 28-day mortality (hazard ratio [HR] 2.08; P < .01). After age stratification, this association was evidenced in both middle-aged (HR 4.48; P < .01) and elderly (HR 1.52; P = .05) patients, but was stronger in the former (P = .01).

Study details: This was a retrospective observational study including 1,656 patients aged ≥45 years who were hospitalized for CAP, of which 592 were middle-aged (45-64 years) and 1,064 were elderly (>65 years).

Disclosures: The authors declared no conflict of interests.

Source: Shen Y et al. Int J Gen Med. 2021;14:7775-7781 (Nov 6). Doi: 10.2147/IJGM.S331082.

Key clinical point: A positive association exists between blood glucose levels at hospital admission for community-acquired pneumonia (CAP) and 28-day mortality, and the strength of this association decreases with age.

Main finding: After adjusting for confounding factors, all patients exhibited a significant association between blood glucose levels at hospitalization and 28-day mortality (hazard ratio [HR] 2.08; P < .01). After age stratification, this association was evidenced in both middle-aged (HR 4.48; P < .01) and elderly (HR 1.52; P = .05) patients, but was stronger in the former (P = .01).

Study details: This was a retrospective observational study including 1,656 patients aged ≥45 years who were hospitalized for CAP, of which 592 were middle-aged (45-64 years) and 1,064 were elderly (>65 years).

Disclosures: The authors declared no conflict of interests.

Source: Shen Y et al. Int J Gen Med. 2021;14:7775-7781 (Nov 6). Doi: 10.2147/IJGM.S331082.

Key clinical point: A positive association exists between blood glucose levels at hospital admission for community-acquired pneumonia (CAP) and 28-day mortality, and the strength of this association decreases with age.

Main finding: After adjusting for confounding factors, all patients exhibited a significant association between blood glucose levels at hospitalization and 28-day mortality (hazard ratio [HR] 2.08; P < .01). After age stratification, this association was evidenced in both middle-aged (HR 4.48; P < .01) and elderly (HR 1.52; P = .05) patients, but was stronger in the former (P = .01).

Study details: This was a retrospective observational study including 1,656 patients aged ≥45 years who were hospitalized for CAP, of which 592 were middle-aged (45-64 years) and 1,064 were elderly (>65 years).

Disclosures: The authors declared no conflict of interests.

Source: Shen Y et al. Int J Gen Med. 2021;14:7775-7781 (Nov 6). Doi: 10.2147/IJGM.S331082.

Key clinical point: Lefamulin is suitable as monotherapy against common community-acquired bacterial pneumonia (CABP)-causing pathogens, both typical and atypical, including drug-resistant strains and those causing polymicrobial infections.

Main finding: Lefamulin was as effective as moxifloxacin in the microbiological intent-to-treat (microITT) population, exhibiting a similar early clinical response rate (89.3% vs. 93.0%; difference ‒3.7; 95% CI ‒7.9 to 0.5) and investigator assessment of clinical response success rate (83.2% vs. 86.7%; difference ‒3.3; 95% CI ‒8.6 to 2.0).

Study details: The study analyzed pooled data from the phase 3 noninferiority Lefamulin Evaluation Against Pneumonia 1 and 2 trials, including a total of 1,289 adult patients with CABP (Pneumonia Outcomes Research Team risk classes II-V) who were randomly assigned to receive lefamulin or moxifloxacin. Of these, a baseline CABP pathogen was detected in 709 patients (microITT population).

Disclosures: Nabriva Therapeutics plc (Fort Washington, PA, USA) sponsored the study. Some of the authors, including the lead author, are former or current employees of or stockholders in Nabriva Therapeutics. A few others received research grants/consultation fees from various sources including Nabriva Therapeutics.

Source: Paukner S et al. J Glob Antimicrob Resist. 2021 (Nov 14). Doi: 10.1016/j.jgar.2021.10.021.

Key clinical point: Lefamulin is suitable as monotherapy against common community-acquired bacterial pneumonia (CABP)-causing pathogens, both typical and atypical, including drug-resistant strains and those causing polymicrobial infections.

Main finding: Lefamulin was as effective as moxifloxacin in the microbiological intent-to-treat (microITT) population, exhibiting a similar early clinical response rate (89.3% vs. 93.0%; difference ‒3.7; 95% CI ‒7.9 to 0.5) and investigator assessment of clinical response success rate (83.2% vs. 86.7%; difference ‒3.3; 95% CI ‒8.6 to 2.0).

Study details: The study analyzed pooled data from the phase 3 noninferiority Lefamulin Evaluation Against Pneumonia 1 and 2 trials, including a total of 1,289 adult patients with CABP (Pneumonia Outcomes Research Team risk classes II-V) who were randomly assigned to receive lefamulin or moxifloxacin. Of these, a baseline CABP pathogen was detected in 709 patients (microITT population).

Disclosures: Nabriva Therapeutics plc (Fort Washington, PA, USA) sponsored the study. Some of the authors, including the lead author, are former or current employees of or stockholders in Nabriva Therapeutics. A few others received research grants/consultation fees from various sources including Nabriva Therapeutics.

Source: Paukner S et al. J Glob Antimicrob Resist. 2021 (Nov 14). Doi: 10.1016/j.jgar.2021.10.021.

Key clinical point: Lefamulin is suitable as monotherapy against common community-acquired bacterial pneumonia (CABP)-causing pathogens, both typical and atypical, including drug-resistant strains and those causing polymicrobial infections.

Main finding: Lefamulin was as effective as moxifloxacin in the microbiological intent-to-treat (microITT) population, exhibiting a similar early clinical response rate (89.3% vs. 93.0%; difference ‒3.7; 95% CI ‒7.9 to 0.5) and investigator assessment of clinical response success rate (83.2% vs. 86.7%; difference ‒3.3; 95% CI ‒8.6 to 2.0).

Study details: The study analyzed pooled data from the phase 3 noninferiority Lefamulin Evaluation Against Pneumonia 1 and 2 trials, including a total of 1,289 adult patients with CABP (Pneumonia Outcomes Research Team risk classes II-V) who were randomly assigned to receive lefamulin or moxifloxacin. Of these, a baseline CABP pathogen was detected in 709 patients (microITT population).

Disclosures: Nabriva Therapeutics plc (Fort Washington, PA, USA) sponsored the study. Some of the authors, including the lead author, are former or current employees of or stockholders in Nabriva Therapeutics. A few others received research grants/consultation fees from various sources including Nabriva Therapeutics.

Source: Paukner S et al. J Glob Antimicrob Resist. 2021 (Nov 14). Doi: 10.1016/j.jgar.2021.10.021.

Key clinical point: Reinforcement of antibiotic stewardship by forming large multihospital collaboratives increases adherence to the appropriate 5-day therapy for uncomplicated community-acquired pneumonia (CAP) while decreasing adverse events.

Main finding: After adjusting for hospital clustering, the 20.9% predicted probability of patients receiving a 5-day antibiotic therapy increased to 45.9% (P < .001) over the study period, with the odds of this duration increasing (adjusted odds ratio [aOR] 1.10; 95% CI 1.07-1.14) and composite adverse events decreasing (aOR 0.98; 95% CI 0.96-0.99) with each successive quarter.

Study details: This study included 6,553 patients eligible for a 5-day therapy for uncomplicated CAP who were admitted to any of the 41 hospitals that participated in a state-wide collaborative quality initiative, Michigan Hospital Medicine Safety Consortium, for the entire 3-year study period.

Disclosures: The study was sponsored by Blue Cross Blue Shield of Michigan and a career development award from the Agency for Healthcare Research and Quality to the lead author who, along with other authors, also declared receiving salary, research grants, or speaker honoraria from additional sources.

Source: Vaughn VM et al. Clin Infect Dis. 2021:ciab950 (Nov 13). Doi: 10.1093/cid/ciab950.

Key clinical point: Reinforcement of antibiotic stewardship by forming large multihospital collaboratives increases adherence to the appropriate 5-day therapy for uncomplicated community-acquired pneumonia (CAP) while decreasing adverse events.

Main finding: After adjusting for hospital clustering, the 20.9% predicted probability of patients receiving a 5-day antibiotic therapy increased to 45.9% (P < .001) over the study period, with the odds of this duration increasing (adjusted odds ratio [aOR] 1.10; 95% CI 1.07-1.14) and composite adverse events decreasing (aOR 0.98; 95% CI 0.96-0.99) with each successive quarter.

Study details: This study included 6,553 patients eligible for a 5-day therapy for uncomplicated CAP who were admitted to any of the 41 hospitals that participated in a state-wide collaborative quality initiative, Michigan Hospital Medicine Safety Consortium, for the entire 3-year study period.

Disclosures: The study was sponsored by Blue Cross Blue Shield of Michigan and a career development award from the Agency for Healthcare Research and Quality to the lead author who, along with other authors, also declared receiving salary, research grants, or speaker honoraria from additional sources.

Source: Vaughn VM et al. Clin Infect Dis. 2021:ciab950 (Nov 13). Doi: 10.1093/cid/ciab950.

Key clinical point: Reinforcement of antibiotic stewardship by forming large multihospital collaboratives increases adherence to the appropriate 5-day therapy for uncomplicated community-acquired pneumonia (CAP) while decreasing adverse events.

Main finding: After adjusting for hospital clustering, the 20.9% predicted probability of patients receiving a 5-day antibiotic therapy increased to 45.9% (P < .001) over the study period, with the odds of this duration increasing (adjusted odds ratio [aOR] 1.10; 95% CI 1.07-1.14) and composite adverse events decreasing (aOR 0.98; 95% CI 0.96-0.99) with each successive quarter.

Study details: This study included 6,553 patients eligible for a 5-day therapy for uncomplicated CAP who were admitted to any of the 41 hospitals that participated in a state-wide collaborative quality initiative, Michigan Hospital Medicine Safety Consortium, for the entire 3-year study period.

Disclosures: The study was sponsored by Blue Cross Blue Shield of Michigan and a career development award from the Agency for Healthcare Research and Quality to the lead author who, along with other authors, also declared receiving salary, research grants, or speaker honoraria from additional sources.

Source: Vaughn VM et al. Clin Infect Dis. 2021:ciab950 (Nov 13). Doi: 10.1093/cid/ciab950.

Key clinical point: Patients with severe community-acquired pneumonia (SCAP) who also have type 2 diabetes mellitus (T2DM) have poorer clinical outcomes than those without T2DM.

Main finding: Compared with patients with SCAP but without T2DM, those with both exhibited higher rates of hospital mortality (35.2% vs. 31.0%; P = .009), 14-day mortality (15.0% vs. 10.8%; P < .001), 30-day mortality (25.7% vs. 22.7%; P = .046), and intensive care unit (ICU) mortality (30.8% vs. 26.5%; P = .005) along with a longer ICU length of stay (13 days vs. 12 days; P = .016).

Study details: Findings are from a retrospective, single-center, observational study including 3,786 adult patients admitted to an ICU for SCAP, among whom 1,262 patients with T2DM were matched to 2,524 patients without T2DM.

Disclosures: The study received funding from the National Natural Science Foundation of China, Science and Technology Department of Sichuan Province, and National Key Research and Development Program of China. The authors declared having no conflict of interests.

Source: Huang D et al. Crit Care. 2021;25:419 (Dec 7). Doi: 10.1186/s13054-021-03841-w.

Key clinical point: Patients with severe community-acquired pneumonia (SCAP) who also have type 2 diabetes mellitus (T2DM) have poorer clinical outcomes than those without T2DM.

Main finding: Compared with patients with SCAP but without T2DM, those with both exhibited higher rates of hospital mortality (35.2% vs. 31.0%; P = .009), 14-day mortality (15.0% vs. 10.8%; P < .001), 30-day mortality (25.7% vs. 22.7%; P = .046), and intensive care unit (ICU) mortality (30.8% vs. 26.5%; P = .005) along with a longer ICU length of stay (13 days vs. 12 days; P = .016).

Study details: Findings are from a retrospective, single-center, observational study including 3,786 adult patients admitted to an ICU for SCAP, among whom 1,262 patients with T2DM were matched to 2,524 patients without T2DM.

Disclosures: The study received funding from the National Natural Science Foundation of China, Science and Technology Department of Sichuan Province, and National Key Research and Development Program of China. The authors declared having no conflict of interests.

Source: Huang D et al. Crit Care. 2021;25:419 (Dec 7). Doi: 10.1186/s13054-021-03841-w.

Key clinical point: Patients with severe community-acquired pneumonia (SCAP) who also have type 2 diabetes mellitus (T2DM) have poorer clinical outcomes than those without T2DM.

Main finding: Compared with patients with SCAP but without T2DM, those with both exhibited higher rates of hospital mortality (35.2% vs. 31.0%; P = .009), 14-day mortality (15.0% vs. 10.8%; P < .001), 30-day mortality (25.7% vs. 22.7%; P = .046), and intensive care unit (ICU) mortality (30.8% vs. 26.5%; P = .005) along with a longer ICU length of stay (13 days vs. 12 days; P = .016).

Study details: Findings are from a retrospective, single-center, observational study including 3,786 adult patients admitted to an ICU for SCAP, among whom 1,262 patients with T2DM were matched to 2,524 patients without T2DM.

Disclosures: The study received funding from the National Natural Science Foundation of China, Science and Technology Department of Sichuan Province, and National Key Research and Development Program of China. The authors declared having no conflict of interests.

Source: Huang D et al. Crit Care. 2021;25:419 (Dec 7). Doi: 10.1186/s13054-021-03841-w.

Key clinical point: Owing to a similar clinical efficacy and safety profile to piperacillin-tazobactam (PIP-TAZ), cefoperazone-sulbactam (CFP-SUL) could be used as an alternative for treating severe community-acquired pneumonia (SCAP) in elderly patients.

Main finding: The odds for clinical cure (adjusted odds ratio [aOR] 1.10; 95% CI 0.71-1.70), clinical effectiveness (aOR 0.99; 95% CI 0.62-1.59), all-cause mortality (aOR 0.95; 95% CI 0.60-1.48), and pneumonia-related mortality (aOR 0.88; 95% CI 0.51-1.53) were similar between patients with SCAP receiving CFP-SUL and those receiving PIP-TAZ. Both drug combinations were equally well tolerated.

Study details: Based on the retrospective multicenter registry BATTLE, the study included 624 patients with SCAP among 317 others with hospital- or ventilator-acquired pneumonia who were aged ≥65 years when diagnosed with pneumonia.

Disclosures: The authors disclosed receiving no financial support for the study. None of the authors declared any conflict of interests.

Source: Huang CT et al. Int J Antimicrob Agents. 2021;106491 (Dec 4). Doi: 10.1016/j.ijantimicag.2021.106491.

Key clinical point: Owing to a similar clinical efficacy and safety profile to piperacillin-tazobactam (PIP-TAZ), cefoperazone-sulbactam (CFP-SUL) could be used as an alternative for treating severe community-acquired pneumonia (SCAP) in elderly patients.

Main finding: The odds for clinical cure (adjusted odds ratio [aOR] 1.10; 95% CI 0.71-1.70), clinical effectiveness (aOR 0.99; 95% CI 0.62-1.59), all-cause mortality (aOR 0.95; 95% CI 0.60-1.48), and pneumonia-related mortality (aOR 0.88; 95% CI 0.51-1.53) were similar between patients with SCAP receiving CFP-SUL and those receiving PIP-TAZ. Both drug combinations were equally well tolerated.

Study details: Based on the retrospective multicenter registry BATTLE, the study included 624 patients with SCAP among 317 others with hospital- or ventilator-acquired pneumonia who were aged ≥65 years when diagnosed with pneumonia.

Disclosures: The authors disclosed receiving no financial support for the study. None of the authors declared any conflict of interests.

Source: Huang CT et al. Int J Antimicrob Agents. 2021;106491 (Dec 4). Doi: 10.1016/j.ijantimicag.2021.106491.

Key clinical point: Owing to a similar clinical efficacy and safety profile to piperacillin-tazobactam (PIP-TAZ), cefoperazone-sulbactam (CFP-SUL) could be used as an alternative for treating severe community-acquired pneumonia (SCAP) in elderly patients.

Main finding: The odds for clinical cure (adjusted odds ratio [aOR] 1.10; 95% CI 0.71-1.70), clinical effectiveness (aOR 0.99; 95% CI 0.62-1.59), all-cause mortality (aOR 0.95; 95% CI 0.60-1.48), and pneumonia-related mortality (aOR 0.88; 95% CI 0.51-1.53) were similar between patients with SCAP receiving CFP-SUL and those receiving PIP-TAZ. Both drug combinations were equally well tolerated.

Study details: Based on the retrospective multicenter registry BATTLE, the study included 624 patients with SCAP among 317 others with hospital- or ventilator-acquired pneumonia who were aged ≥65 years when diagnosed with pneumonia.

Disclosures: The authors disclosed receiving no financial support for the study. None of the authors declared any conflict of interests.

Source: Huang CT et al. Int J Antimicrob Agents. 2021;106491 (Dec 4). Doi: 10.1016/j.ijantimicag.2021.106491.

Key clinical point: In patients with chronic obstructive pulmonary disease (COPD), the occurrence of SARS-CoV-2 community-acquired pneumonia (CAP) leads to poorer clinical outcomes than non-SARS-CoV-2 CAP.

Main finding: After adjustment for inverse propensity weighting (IPW) and pneumonia severity index, patients with COPD and SARS-CoV-2 CAP had higher odds of intensive care unit (ICU) admission during hospitalization (IPW-odds ratio [OR] 2.41), invasive mechanical ventilation requirement (IPW-OR 2.23), a cardiovascular event (IPW-OR 4.98), and in-hospital mortality (IPW-OR 7.31) and a longer length of hospital stay (all P < .001) than patients with COPD  who were non-SARS-CoV-2 CAP.

Study details: The analysis compared 96 hospitalized patients with COPD and SARS-CoV-2 CAP with 1,129 patients with COPD and non-SARS-CoV-2 CAP included in the Burden of COVID-19 study and the University of Louisville Pneumonia Study, 2 large observational retrospective and prospective studies, respectively.

Disclosures: The study was sponsored by the Division of Infectious Diseases, University of Louisville. None of the authors reported any conflict of interests.

Source: Sheikh D et al. Respir Med. 2021’191:106714 (Dec 8). Doi: 10.1016/j.rmed.2021.106714.

Key clinical point: In patients with chronic obstructive pulmonary disease (COPD), the occurrence of SARS-CoV-2 community-acquired pneumonia (CAP) leads to poorer clinical outcomes than non-SARS-CoV-2 CAP.

Main finding: After adjustment for inverse propensity weighting (IPW) and pneumonia severity index, patients with COPD and SARS-CoV-2 CAP had higher odds of intensive care unit (ICU) admission during hospitalization (IPW-odds ratio [OR] 2.41), invasive mechanical ventilation requirement (IPW-OR 2.23), a cardiovascular event (IPW-OR 4.98), and in-hospital mortality (IPW-OR 7.31) and a longer length of hospital stay (all P < .001) than patients with COPD  who were non-SARS-CoV-2 CAP.

Study details: The analysis compared 96 hospitalized patients with COPD and SARS-CoV-2 CAP with 1,129 patients with COPD and non-SARS-CoV-2 CAP included in the Burden of COVID-19 study and the University of Louisville Pneumonia Study, 2 large observational retrospective and prospective studies, respectively.

Disclosures: The study was sponsored by the Division of Infectious Diseases, University of Louisville. None of the authors reported any conflict of interests.

Source: Sheikh D et al. Respir Med. 2021’191:106714 (Dec 8). Doi: 10.1016/j.rmed.2021.106714.

Key clinical point: In patients with chronic obstructive pulmonary disease (COPD), the occurrence of SARS-CoV-2 community-acquired pneumonia (CAP) leads to poorer clinical outcomes than non-SARS-CoV-2 CAP.

Main finding: After adjustment for inverse propensity weighting (IPW) and pneumonia severity index, patients with COPD and SARS-CoV-2 CAP had higher odds of intensive care unit (ICU) admission during hospitalization (IPW-odds ratio [OR] 2.41), invasive mechanical ventilation requirement (IPW-OR 2.23), a cardiovascular event (IPW-OR 4.98), and in-hospital mortality (IPW-OR 7.31) and a longer length of hospital stay (all P < .001) than patients with COPD  who were non-SARS-CoV-2 CAP.

Study details: The analysis compared 96 hospitalized patients with COPD and SARS-CoV-2 CAP with 1,129 patients with COPD and non-SARS-CoV-2 CAP included in the Burden of COVID-19 study and the University of Louisville Pneumonia Study, 2 large observational retrospective and prospective studies, respectively.

Disclosures: The study was sponsored by the Division of Infectious Diseases, University of Louisville. None of the authors reported any conflict of interests.

Source: Sheikh D et al. Respir Med. 2021’191:106714 (Dec 8). Doi: 10.1016/j.rmed.2021.106714.

According to the Centers for Disease Control and Prevention, lung cancer is the third-most common cancer in the United States and the leading cause of cancer deaths in both men and women. Approximately, 150,000 Americans die every year from this disease.

For many years, no effective screening tests were available for lung cancer. This has changed with the advent of low-dose CT scanning as a screening method. In fact, it has been shown that low-dose CT scan screening can reduce lung cancer deaths by 20%-30% in high-risk populations.

In the United States, low-dose CT scan screening for lung cancer has largely become the norm. In July 2021, CHEST released new clinical guidelines. These guidelines cover 18 evidence-based recommendations as well as inclusion of further evidence regarding the benefits, risks, and use of CT screening.

In doing the risk assessment of low-dose CT scan as a method of lung cancer screening, meta-analyses were performed on evidence obtained through a literature search using PubMed, Embase, and the Cochrane Library. It was concluded that the benefits outweigh the risks as a method of lung cancer screening and can be utilized in reducing lung cancer deaths.

Low-dose CT scan screening was recommended for the following patients:

• Asymptomatic individuals aged 55-77 years with a history of smoking 30 or more pack-years. (This includes those who continue to smoke or who have quit in the previous 15 years. Annual screening is advised.)
• Asymptomatic individuals aged 55-80 years with a history of smoking 20-30 pack-years who either continue to smoke or have quit in the previous 15 years.
• For asymptomatic individuals who do not meet the above criteria but are predicted to benefit based on life-year gained calculations.

Don’t screen these patients

CT scan screening should not be performed on any person who does not meet any of the above three criteria.

Additionally, if a person has significant comorbidities that would limit their life expectancy, it is recommended not to do CT scan screening. Symptomatic patients should have appropriate diagnostic testing rather than screening.

Additional recommendations from the updated guidelines include developing appropriate counseling strategies as well as deciding what constitutes a positive test.

A positive test should be anything that warrants further evaluation rather than a return to annual screening. It was also advised that overtreatment strategies should be implemented. Additionally, smoking cessation treatment should be provided.

CHEST suggested undertaking a comprehensive approach involving multiple specialists including pulmonologists, radiologists, oncologists, etc. Strategies to ensure compliance with annual screening should also be devised, the guidelines say.
 

USPSTF’s updated guidelines

It should be noted that the U.S. Preventative Task Force released their own set of updated guidelines in March 2021. In these guidelines, the age at which lung cancer screening should be started was lowered from 55 years to 50 years.

Also, the USPSTF lowered the minimum required smoking history in order to be screened from 30 to 20 pack-years. Their purpose for doing this was to include more high-risk women as well as minorities.

With the changes, 14.5 million individuals living in the United States would be eligible for lung cancer screening by low-dose CT scan, an increase of 6.5 million people, compared with the previous guidelines.

While only small differences exist between the set of guidelines issued by CHEST and the ones issues by the USPSTF, lung cancer screening is still largely underutilized.

One of the barriers to screening may be patients’ lacking insurance coverage for it. As physicians, we need to advocate for these screening tools to be covered.

Other barriers include lack of patient knowledge regarding low-dose CT scans as a screening tool, patient time, and patient visits with their doctors being too short.
 

Key message

Part of the duties of physicians is to give our patients the best information. We can reduce lung cancer mortality in high risk patients by performing annual low-dose CT scans.

Whichever set of guidelines we chose to follow, we fail our patients if we don’t follow either set of them. The evidence is clear that a low-dose CT scan is a valuable screening tool to add to our practice of medicine.

Dr. Girgis practices family medicine in South River, N.J., and is a clinical assistant professor of family medicine at Robert Wood Johnson Medical School, New Brunswick, N.J. You can contact her at [email protected].

According to the Centers for Disease Control and Prevention, lung cancer is the third-most common cancer in the United States and the leading cause of cancer deaths in both men and women. Approximately, 150,000 Americans die every year from this disease.

For many years, no effective screening tests were available for lung cancer. This has changed with the advent of low-dose CT scanning as a screening method. In fact, it has been shown that low-dose CT scan screening can reduce lung cancer deaths by 20%-30% in high-risk populations.

In the United States, low-dose CT scan screening for lung cancer has largely become the norm. In July 2021, CHEST released new clinical guidelines. These guidelines cover 18 evidence-based recommendations as well as inclusion of further evidence regarding the benefits, risks, and use of CT screening.

In doing the risk assessment of low-dose CT scan as a method of lung cancer screening, meta-analyses were performed on evidence obtained through a literature search using PubMed, Embase, and the Cochrane Library. It was concluded that the benefits outweigh the risks as a method of lung cancer screening and can be utilized in reducing lung cancer deaths.

Low-dose CT scan screening was recommended for the following patients:

• Asymptomatic individuals aged 55-77 years with a history of smoking 30 or more pack-years. (This includes those who continue to smoke or who have quit in the previous 15 years. Annual screening is advised.)
• Asymptomatic individuals aged 55-80 years with a history of smoking 20-30 pack-years who either continue to smoke or have quit in the previous 15 years.
• For asymptomatic individuals who do not meet the above criteria but are predicted to benefit based on life-year gained calculations.

Don’t screen these patients

CT scan screening should not be performed on any person who does not meet any of the above three criteria.

Additionally, if a person has significant comorbidities that would limit their life expectancy, it is recommended not to do CT scan screening. Symptomatic patients should have appropriate diagnostic testing rather than screening.

Additional recommendations from the updated guidelines include developing appropriate counseling strategies as well as deciding what constitutes a positive test.

A positive test should be anything that warrants further evaluation rather than a return to annual screening. It was also advised that overtreatment strategies should be implemented. Additionally, smoking cessation treatment should be provided.

CHEST suggested undertaking a comprehensive approach involving multiple specialists including pulmonologists, radiologists, oncologists, etc. Strategies to ensure compliance with annual screening should also be devised, the guidelines say.
 

USPSTF’s updated guidelines

It should be noted that the U.S. Preventative Task Force released their own set of updated guidelines in March 2021. In these guidelines, the age at which lung cancer screening should be started was lowered from 55 years to 50 years.

Also, the USPSTF lowered the minimum required smoking history in order to be screened from 30 to 20 pack-years. Their purpose for doing this was to include more high-risk women as well as minorities.

With the changes, 14.5 million individuals living in the United States would be eligible for lung cancer screening by low-dose CT scan, an increase of 6.5 million people, compared with the previous guidelines.

While only small differences exist between the set of guidelines issued by CHEST and the ones issues by the USPSTF, lung cancer screening is still largely underutilized.

One of the barriers to screening may be patients’ lacking insurance coverage for it. As physicians, we need to advocate for these screening tools to be covered.

Other barriers include lack of patient knowledge regarding low-dose CT scans as a screening tool, patient time, and patient visits with their doctors being too short.
 

Key message

Part of the duties of physicians is to give our patients the best information. We can reduce lung cancer mortality in high risk patients by performing annual low-dose CT scans.

Whichever set of guidelines we chose to follow, we fail our patients if we don’t follow either set of them. The evidence is clear that a low-dose CT scan is a valuable screening tool to add to our practice of medicine.

Dr. Girgis practices family medicine in South River, N.J., and is a clinical assistant professor of family medicine at Robert Wood Johnson Medical School, New Brunswick, N.J. You can contact her at [email protected].

According to the Centers for Disease Control and Prevention, lung cancer is the third-most common cancer in the United States and the leading cause of cancer deaths in both men and women. Approximately, 150,000 Americans die every year from this disease.

For many years, no effective screening tests were available for lung cancer. This has changed with the advent of low-dose CT scanning as a screening method. In fact, it has been shown that low-dose CT scan screening can reduce lung cancer deaths by 20%-30% in high-risk populations.

In the United States, low-dose CT scan screening for lung cancer has largely become the norm. In July 2021, CHEST released new clinical guidelines. These guidelines cover 18 evidence-based recommendations as well as inclusion of further evidence regarding the benefits, risks, and use of CT screening.

In doing the risk assessment of low-dose CT scan as a method of lung cancer screening, meta-analyses were performed on evidence obtained through a literature search using PubMed, Embase, and the Cochrane Library. It was concluded that the benefits outweigh the risks as a method of lung cancer screening and can be utilized in reducing lung cancer deaths.

Low-dose CT scan screening was recommended for the following patients:

• Asymptomatic individuals aged 55-77 years with a history of smoking 30 or more pack-years. (This includes those who continue to smoke or who have quit in the previous 15 years. Annual screening is advised.)
• Asymptomatic individuals aged 55-80 years with a history of smoking 20-30 pack-years who either continue to smoke or have quit in the previous 15 years.
• For asymptomatic individuals who do not meet the above criteria but are predicted to benefit based on life-year gained calculations.

Don’t screen these patients

CT scan screening should not be performed on any person who does not meet any of the above three criteria.

Additionally, if a person has significant comorbidities that would limit their life expectancy, it is recommended not to do CT scan screening. Symptomatic patients should have appropriate diagnostic testing rather than screening.

Additional recommendations from the updated guidelines include developing appropriate counseling strategies as well as deciding what constitutes a positive test.

A positive test should be anything that warrants further evaluation rather than a return to annual screening. It was also advised that overtreatment strategies should be implemented. Additionally, smoking cessation treatment should be provided.

CHEST suggested undertaking a comprehensive approach involving multiple specialists including pulmonologists, radiologists, oncologists, etc. Strategies to ensure compliance with annual screening should also be devised, the guidelines say.
 

USPSTF’s updated guidelines

It should be noted that the U.S. Preventative Task Force released their own set of updated guidelines in March 2021. In these guidelines, the age at which lung cancer screening should be started was lowered from 55 years to 50 years.

Also, the USPSTF lowered the minimum required smoking history in order to be screened from 30 to 20 pack-years. Their purpose for doing this was to include more high-risk women as well as minorities.

With the changes, 14.5 million individuals living in the United States would be eligible for lung cancer screening by low-dose CT scan, an increase of 6.5 million people, compared with the previous guidelines.

While only small differences exist between the set of guidelines issued by CHEST and the ones issues by the USPSTF, lung cancer screening is still largely underutilized.

One of the barriers to screening may be patients’ lacking insurance coverage for it. As physicians, we need to advocate for these screening tools to be covered.

Other barriers include lack of patient knowledge regarding low-dose CT scans as a screening tool, patient time, and patient visits with their doctors being too short.
 

Key message

Part of the duties of physicians is to give our patients the best information. We can reduce lung cancer mortality in high risk patients by performing annual low-dose CT scans.

Whichever set of guidelines we chose to follow, we fail our patients if we don’t follow either set of them. The evidence is clear that a low-dose CT scan is a valuable screening tool to add to our practice of medicine.

Dr. Girgis practices family medicine in South River, N.J., and is a clinical assistant professor of family medicine at Robert Wood Johnson Medical School, New Brunswick, N.J. You can contact her at [email protected].