Factors associated with hospitalization for community-acquired pneumonia in home health care patients in Taiwan.
- 作者列表："Lin CJ","Chang YC","Tsou MT","Chan HL","Chen YJ","Hwang LC
BACKGROUND:Pneumonia is a leading cause of hospitalization and death worldwide. However, studies focusing on risk factors of community-acquired pneumonia (CAP) in the home health care (HHC) population remain scarce. AIMS:This study aimed to evaluate risk factors associated with hospitalization for CAP among HHC patients in Taiwan. METHODS:This retrospective cross-sectional study extracted data from patients' electronic medical records between 1 January 2017 and 31 December 2017. Multiple logistic regression analyses were performed to explore factors associated with hospitalization for CAP. RESULTS:In total, 598 patients (men/women: 236/362) were included. One hundred ninety-nine patients (33.28%) were hospitalized for pneumonia. Inpatients showed a higher proportion of the following: male sex, functional impairment, hypoalbuminemia, anemia, nasogastric tube use, excessive polypharmacy, stroke, dementia, heart failure, chronic respiratory disease, and chronic liver disease. Furthermore, nasogastric tube use (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.88-4.82), anemia (OR 2.37, 95% CI 1.48-3.80), male sex (OR 2.14, 95% CI 1.43-3.20), chronic respiratory disease (OR 2.09, 95% CI 1.33-3.30), dementia (OR 1.94, 95% CI 1.27-2.97), heart failure (OR 1.69, 95% CI 1.11-2.56), and hypoalbuminemia (OR 1.57, 95% CI 1.03-2.40) significantly increased the risk of hospitalization for CAP. CONCLUSIONS:Our results revealed risk factors associated with hospitalization for CAP in HHC patients. In addition to chronic diseases, malnutrition is an important risk factor. Caregivers should make prompt assessments and take preventive measures for such patients.
背景: 肺炎是世界范围内导致住院和死亡的主要原因。然而，针对家庭保健 (HHC) 人群中社区获得性肺炎 (CAP) 危险因素的研究仍然很少。 目的: 本研究旨在评估台湾HHC患者中与CAP住院相关的危险因素。 方法: 这项回顾性横断面研究从 2017 年 1 月 1 日至 20 17 年 12 月 31 日的患者电子病历中提取数据。进行多元logistic回归分析以探索与CAP住院相关的因素。 结果: 共纳入 598 例患者 (男性/女性: 236/362)。33.28% 例患者 () 因肺炎住院。住院患者显示以下比例较高: 男性，功能障碍，低白蛋白血症，贫血，鼻胃管使用，过度多药，中风，痴呆，心力衰竭，慢性呼吸系统疾病，和慢性肝病。此外，使用鼻胃管 (比值比 [OR] 3.01，95% 置信区间 [CI] 1.88-4.82)，贫血 (OR 2.37，95% CI 1.48-3.80)，男性 (OR 2.14，95% CI 1.43-3.20)，慢性呼吸系统疾病 (OR 2.09，95% CI 1.33-3.30)，痴呆 (OR 1.94，95% CI 1.27-2.97)，心力衰竭 (OR 1.69，95% CI 1.11-2.56) 和低白蛋白血症 (OR 1.57，95% CI 1.03-2.40) 显著增加CAP住院的风险。 结论: 我们的结果揭示了与HHC患者CAP住院相关的危险因素。除了慢性疾病，营养不良是一个重要的危险因素。护理人员应对此类患者进行及时评估并采取预防措施。
METHODS::The antimicrobial functions of neutrophils are facilitated by a defensive armamentarium of proteins stored in granules, and by the formation of neutrophil extracellular traps (NETs). However, the toxic nature of these structures poses a threat to highly vascularized tissues, such as the lungs. Here, we identified a cell-intrinsic program that modified the neutrophil proteome in the circulation and caused the progressive loss of granule content and reduction of the NET-forming capacity. This program was driven by the receptor CXCR2 and by regulators of circadian cycles. As a consequence, lungs were protected from inflammatory injury at times of day or in mouse mutants in which granule content was low. Changes in the proteome, granule content and NET formation also occurred in human neutrophils, and correlated with the incidence and severity of respiratory distress in pneumonia patients. Our findings unveil a 'disarming' strategy of neutrophils that depletes protein stores to reduce the magnitude of inflammation.
METHODS::Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan-Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population.
METHODS:OBJECTIVE:To describe the treatment of community-acquired pneumonia (CAP) in children under five years in Tanzania. METHODS:Between January and December 2017, children aged 2-59 months with chest radiography-confirmed CAP were enrolled. The parents were interviewed to collect information on the patients and home-based medication. Clinical information was derived from the patient files. Nasopharyngeal swab and blood samples were collected for isolation of the causative pathogens. Swab samples were analysed by quantitative PCR whereas blood samples were tested using BacT/Alert 3D. RESULTS:Overall, 109 children with CAP were included in this analysis. Provision of care to most children was delayed (median = 4.6 days). A quarter (26.6%) were given unprescribed/leftover antibiotics at home. Only one child had positive bacterial culture. Referrals were associated with nasopharyngeal carriage of Streptococcus pneumoniae (p = 0.003) and Haemophilus influenzae (p = 0.004). Of all admitted children, more than a quarter (n = 29) did not need to be hospitalised and inappropriately received injectable instead of oral antibiotics. CONCLUSION:We found high rates of home treatment, particularly with antibiotics. Appropriate health care was delayed for most children because of home treatment. Efforts are needed at the community level to improve awareness of antimicrobial resistance.