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Distribution of Pathogens in Elderly Chinese Patients With Pneumonia: A Systematic Review and Meta-Analysis.

ABSTRACT: Background: To summarize the distribution of pathogenic bacteria in elderly Chinese patients with pneumonia and provide guidance for the clinical application of antibiotics. Methods: The electronic databases of PubMed, Embase, Cochrane library, and China National Knowledge Infrastructure were searched. The primary outcomes included the prevalence of gram-positive cocci, gram-negative bacilli, and fungus. The summary prevalence and 95% confidence interval (CI) were calculated using the random-effects model. Results: A total of 17 retrospective studies reporting a total of 5,729 elderly patients with pneumonia were selected for final analysis. The summary prevalence of gram-positive cocci was 25% (95% CI: 20-30%; p < 0.001), whereas the prevalence of gram-negative bacilli was 56% (95% CI: 46-67%; p < 0.001). Moreover, the pooled prevalence of fungus in elderly patients with pneumonia was 11% (95% CI: 8-14%; p < 0.001). The most common gram-positive cocci were Staphylococcus aureus (ES: 8%; 95% CI: 6-11%; p <0.001), Streptococcus hemolyticus (ES: 7%; 95% CI: 6-8%; p < 0.001), and Streptococcus pneumoniae (ES: 5%; 95% CI: 3-7%; p < 0.001). Pseudomonas aeruginosa (ES: 18%; 95% CI: 14-22%; p <0.001) and Klebsiella pneumoniae (ES: 14%; 95% CI: 11-18%; p <0.001) were most common gram-negative bacilli. Furthermore, the pooled prevalence of Candida albicans in elderly patients with pneumonia was 6% (95% CI: 5-8%; p < 0.001). Conclusions: The findings demonstrated the comprehensive distribution of pathogenic bacteria in elderly Chinese patients with pneumonia, which could guide further antibiotic therapies.

SUBMITTER: Chen L

PROVIDER: S-EPMC8350134 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundPneumonia is a serious disease associated with mortality among patients with dementia. However, the reported frequency of pneumonia as a cause of death in patients with dementia varies, the reason for which has not been fully elucidated.MethodsWe conducted a systematic search in PubMed and the Cochrane Database of Systematic Reviews (inception to December 2016). Two authors independently determined the suitability of studies and potential bias and extracted the data. The primary outcome was frequency of pneumonia-associated death in patients with dementia. Stratified subgroup analysis was conducted among studies grouped according to type of mortality cause (immediate or underlying), information source of mortality cause (autopsy or death certificate), and study setting (clinic, hospital, or nursing home).ResultsWe included 7 studies reporting the cause of death among patients with dementia and 12 studies comparing the cause of death among patients with and without dementia. The frequency of pneumonia-associated death among 19 eligible studies was 29.69% (95% confidence interval [CI], 25.86-33.53). Those frequencies differed according to whether the source for information about cause of death was an autopsy confirmation (49.98%; 95% CI, 43.75-56.71) or death certificate (19.65%; 95% CI, 15.48-23.83) and according to whether the type of mortality cause was an indirect cause of death (13.96%; 95% CI, 9.42-18.51) or direct cause of death (44.45%; 95% CI, 29.81-50.10). The risk of pneumonia-associated death in patients with dementia was twice as high as among those without dementia (odds ratio, 2.15; 95% CI, 1.63-2.83; p < 0.001).ConclusionThe various frequencies of pneumonia-associated death in patients with dementia were associated with the information source, type of mortality cause, and study setting. Patients with dementia in the terminal stages urgently require careful clinical management of pneumonia, to maximize patient life expectancy and quality.

Project description:BackgroundSevere pneumonia has consistently been associated with high mortality. We sought to identify risk factors for the mortality of severe pneumonia to assist in reducing mortality for medical treatment.MethodsElectronic databases including PubMed, Web of Science, EMBASE, Cochrane Library, and Scopus were systematically searched till June 1, 2023. All human research were incorporated into the analysis, regardless of language, publication date, or geographical location. To pool the estimate, a mixed-effect model was used. The Newcastle-Ottawa Scale (NOS) was employed for assessing the quality of included studies that were included in the analysis.ResultsIn total, 22 studies with a total of 3655 severe pneumonia patients and 1107 cases (30.29%) of death were included in the current meta-analysis. Significant associations were found between age [5.76 years, 95% confidence interval [CI] (3.43, 8.09), P < 0.00001], male gender [odds ratio (OR) = 1.47, 95% CI (1.07, 2.02), P = 0.02], and risk of death from severe pneumonia. The comorbidity of neoplasm [OR = 3.37, 95% CI (1.07, 10.57), P = 0.04], besides the presence of complications such as diastolic hypotension [OR = 2.60, 95% CI (1.45, 4.67), P = 0.001], ALI/ARDS [OR = 3.63, 95% CI (1.78, 7.39), P = 0.0004], septic shock [OR = 9.43, 95% CI (4.39, 20.28), P < 0.00001], MOF [OR = 4.34, 95% CI (2.36, 7.95), P < 0.00001], acute kidney injury [OR = 2.45, 95% CI (1.14, 5.26), P = 0.02], and metabolic acidosis [OR = 5.88, 95% CI (1.51, 22.88), P = 0.01] were associated with significantly higher risk of death among patients with severe pneumonia. Those who died, compared with those who survived, differed on multiple biomarkers on admission including serum creatinine [Scr: + 67.77 mmol/L, 95% CI (47.21, 88.34), P < 0.00001], blood urea nitrogen [BUN: + 6.26 mmol/L, 95% CI (1.49, 11.03), P = 0.01], C-reactive protein [CRP: + 33.09 mg/L, 95% CI (3.01, 63.18), P = 0.03], leukopenia [OR = 2.63, 95% CI (1.34, 5.18), P = 0.005], sodium < 136 mEq/L [OR = 2.63, 95% CI (1.34, 5.18), P = 0.005], albumin [- 5.17 g/L, 95% CI (- 7.09, - 3.25), P < 0.00001], PaO2/FiO2 [- 55.05 mmHg, 95% CI (- 60.11, - 50.00), P < 0.00001], arterial blood PH [- 0.09, 95% CI (- 0.15, - 0.04), P = 0.0005], gram-negative microorganism [OR = 2.56, 95% CI (1.17, 5.62), P = 0.02], and multilobar or bilateral involvement [OR = 3.65, 95% CI (2.70, 4.93), P < 0.00001].ConclusionsOlder age and male gender might face a greater risk of death in severe pneumonia individuals. The mortality of severe pneumonia may also be significantly impacted by complications such diastolic hypotension, ALI/ARDS, septic shock, MOF, acute kidney injury, and metabolic acidosis, as well as the comorbidity of neoplasm, and laboratory indicators involving Scr, BUN, CRP, leukopenia, sodium, albumin, PaO2/FiO2, arterial blood PH, gram-negative microorganism, and multilobar or bilateral involvement.Systematic review registrationPROSPERO Protocol Number: CRD 42023430684.

Project description:Background: Pneumonia is a prevalent and complicated disease among adults, elderly people in particular, and the debate on the optimal Chinese herbal injections (CHIs) is ongoing. Our objective is to investigate the comparative effectiveness of various CHIs strategies for elderly patients with pneumonia. Methods: A comprehensive search strategy was executed to identify relevant randomized controlled trials (RCTs) by browsing through several databases from their inception to first, Feb 2020; All of the direct and indirect evidence included was rated by Network meta-analysis under a Bayesian framework. Results: We ultimately identified 34 eligible randomized controlled trials that involved 3,111 elderly participants and investigated 4 CHIs combined with Western medicine (WM) (Xiyanping injection [XYP]+WM, Yanhuning injection [YHN]+WM, Tanreqing injection [TRQ]+WM, Reduning injection [RDN]+WM), contributing 34 direct comparisons between CHIs. Seen from the outcome of Clinical effective rate and time for defervescence, patients taking medicine added with CHIs [Clinical effective rate, XYP + WM(Odd ratio (OR): 0.74, 95%Credible intervals (CrIs):0.55-0.98), YHN + WM(OR: 0.66, 95%CrI: 0.45-0.95), TRQ + WM(OR: 0.65, 95%CrI: 0.50-0.83), RDN + WM(OR: 0.60, 95%CrI: 0.40-0.89); Time for defervescence, YHN + WM(Mean difference (MD): -2.11, 95%CrI: -3.26 to -0.98), XYP + WM(MD: -2.06, 95%CrI: -3.08 to -1.09), RDN + WM(MD: -1.97, 95%CrI: -3.61 to -0.35), TRQ + WM(MD: -1.69, 95%CrI: -2.27 to -1.04)] showed statistically better effect compared with participants in the Control group (CG) who only took WM. Meanwhile, based on the time for disappearance of cough, 3 out of 4 CHIs [TRQ + WM(MD: -2.56, 95%CrI: -3.38 to -1.54), YHN + WM(MD: -2.36, 95%CrI: -3.86 to -1.00) and XYP + WM(MD: -2.21, 95%CrI: -3.72 to -1.10)] strategies indicated improvement of clinical symptoms. Only XYP + WM(MD -1.78, 95%CrI: -3.29 to -0.27) and TRQ + WM (MD: -1.71, 95%CrI: -2.71 to -0.73) could significantly shorten the time for disappearance of pulmonary rales. Conclusion: According to the statistical effect size (The surface under the cumulative ranking), we found that XYP + WM was presumably to be the preferable treatment for treating elderly patients with pneumonia compared with WM alone in terms of clinical effective rate. Our findings were based on very limited evidence and thus should be interpreted with caution. The application of the findings requires further research.

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Distribution of Pathogens in Elderly Chinese Patients With Pneumonia: A Systematic Review and Meta-Analysis.

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