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The site is secure. When patients from whom at least one pathogen was detected were compared with patients from whom no pathogens were detected, we found the former group more commonly presented the following conditions: bronchiectasis, tracheostomy, at least one respiratory comorbidity, hypertension, HIV infection, pervious infections, previous healthcare exposure, severe CAP, ICU admission, mechanical ventilation and use of vasopressors table 2. Diaconescu Dragos. Over-testing was also identified as a cause of discordance with the ERS guidelines. Comparisons between groups were made with the Fisher exact test or the Kruskal—Wallis test, as appropriate.❿
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The new PMC design is here! Learn more about navigating our updated article layout. The PMC legacy view will also be available for a limited time. Federal government websites often end in. The site is secure. In total, patients were included. Testing was performed in patients, and included blood culture A pathogen was detected in Testing attitudes varied significantly according to geography and disease severity. Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity.
Community-acquired pneumonia CAP is a leading cause of hospitalisation worldwide. Diagnostic testing in CAP has the potential to improve individual patient management, reducing the risk of clinical failure and death, and to generate epidemiological data, informing the selection of appropriate empirical antibiotic therapy.
Unfortunately, these advantages are counterbalanced by high healthcare costs associated with diagnostic testing and low sensitivity of these tests to identify pathogens causing CAP [ 56 ].
Considering both the benefits and limitations of diagnostic testing, several international scientific societies have published guidelines on effective diagnostic testing strategies for hospitalised patients with CAP.
However, important differences exist between recommendations of different societies [ 7 windows update 1709 download manuella allen county. These recommendations are mainly based on expert opinion given the scarcity of published evidence. We performed a secondary analysis of an international, multicentre, observational, prospective cohort study using the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia GLIMP database [ 13 ].
Patients hospitalised with a diagnosis of hospital-acquired or ventilator-associated pneumonia were excluded. The coordinating centre received expedited windows update 1709 download manuella allen county approval by the institutional review board number HSCE. The review board waived the need for receipt of informed consent due to the nature of the study.
Institutional review board approval was obtained by the site investigators at each individual centre. A detailed description of the GLIMP organisation and methodologies has been previously published [ 13 ]. This study had also two secondary outcomes. The first was to evaluate the influence of geography and disease severity on testing practices.
ICU admission, invasive mechanical ventilation, vasopressors, and combined administration of vasopressors and invasive mechanical ventilation were used as measures of disease severity.
Similarly, diagnostic testing was defined as concordant with the ERS guidelines if recommended tests were performed and non-recommended tests were not performed. Over-testing was defined as a condition where tests not required were performed. Under-testing was defined as a condition where required tests were not performed. Continuous variables were presented as medians with interquartile range.
Categorical windows update 1709 download manuella allen county were presented as frequencies and percentages of the specified group. Comparisons between groups were made with the Fisher exact test or the Kruskal—Wallis test, as appropriate.
Among patients, Variables significantly associated with the performance of diagnostic testing are presented in http://replace.me/214.txt 2.
When patients from whom at least one pathogen was detected were compared with patients from whom no pathogens were detected, we found the former group more commonly presented the following conditions: bronchiectasis, tracheostomy, at least one respiratory comorbidity, hypertension, HIV infection, pervious infections, previous healthcare exposure, severe CAP, ICU admission, mechanical ventilation and use of vasopressors table 2.
Baseline characteristics of adult inpatients with community-acquired pneumonia by testing status and by pathogen detection. Of the patients hospitalised with CAP and included in this study, diagnostic testing was as follows: Blood, sputum, BAL cultures, pleural fluid cultures and viral testing were more frequently obtained among patients undergoing invasive mechanical ventilation compared to patients not receiving invasive mechanical ventilation. In contrast, when ICU admission, vasopressor administration, or combined vasopressor and invasive mechanical ventilation administration were used as measures of disease severity, only blood cultures, BAL cultures and viral testing were significantly more common among patients with a severe disease table 3.
Of the diagnostic tests performed, Specifically, Bacteria, viruses and fungi accounted for Microbiological tests performed among adult inpatients with community-acquired pneumonia by disease severity. ICU: intensive care unit. When the performance of diagnostic testing was compared among patients admitted at participating hospitals in North America, South America, Africa, Asia, Europe and Oceania, significant differences were identified table 4.
Performance of at least one test ranged from Acute-phase serology for Chlamydophila pneumoniaeMycoplasma pneumonia e and Legionella species was more common in Europe Microbiological tests performed among adult inpatients with community-acquired pneumonia by geographic area.
When the overall study population was analysed, over-testing and under-testing were reported in Over-testing and under-testing were documented in Among ERS-discordant patients, pneumococcal and Legionella urinary antigen tests performed without an indication accounted for the majority of over-testing, while under-testing was mainly due windows update 1709 download manuella allen county the lack of obtaining blood cultures when indicated. This international, multicentre, point-prevalence study provides a high-quality, real-life picture of diagnostic testing in patients soft aim fortnite download 2022 with CAP.
At least one microbiological test was performed in the vast majority of patients hospitalised with CAP and led to an aetiological diagnosis in one-third of patients tested. Geographic area and disease severity influenced testing frequency. Several crucial points could be raised by our findings. First, a pathogen was identified in one-third of adult inpatients with CAP.
This pathogen-detection yield is similar to previously reported investigations [ 14 — 21 ] and consistent with the EPIC Etiology of Pneumonia in the Community study [ 1 ]. The low pathogen-detection yield reported in this and other CAP studies highlights how limited our understanding is of CAP aetiologies among adult inpatients and how current empirical antimicrobial recommendations are based on weak evidence. Studies aimed at collecting as much data as possible to identify the aetiology using state-of-the-art diagnostic techniques and innovative pathogen-discovery approaches are urgently needed.
Furthermore, aetiological studies should use novel analytical techniques in order to incorporate evidence from multiple specimens to account for the imperfect sensitivity and specificity of the diagnostic windows update 1709 download manuella allen county used [ 22 ]. Once a more accurate estimate of the aetiological distribution windows update 1709 download manuella allen county CAP among adult inpatients is available, empirical antimicrobial recommendations should be updated.
As a consequence, pneumonia severity was also windows update 1709 download manuella allen county with an increased probability of pathogen detection. Exploring the true determinants of pathogen detection would have required a systematic and universal testing strategy and, for this reason, it was out of the scope of this study. Thirdly, our study confirmed the differing diagnostic yield of various diagnostic tests. Specifically, only 6.
In contrast, BAL cultures were characterised by a high diagnostic yield While impractical and potentially associated with complications, BAL cultures represent an effective diagnostic tool for patients with severe infections, who may benefit the most from a targeted antimicrobial regimen.
Indeed, a randomised trial by van der E erden et al. Fourthly, our analysis described a significant geographic variation in diagnostic testing strategies.
We could speculate that the economical restraints of African health systems accounted for the reduced number of blood cultures and viral tests performed in this setting. Laboratory infrastructure to support diagnostic microbiological testing is limited in most African countries: bacteriological culture or molecular techniques that form the mainstay of CAP diagnostics in well-resourced settings are often lacking in Africa [ 2526 ]. In contrast, the seasonality and the epidemiological relevance of respiratory viruses, such as avian-origin windows update 1709 download manuella allen county A and Middle East respiratory syndrome coronavirus, may have favoured the performance of viral testing in Asia [ 2728 ].
Fifthly, our study приведу ссылку among the first to evaluate the concordance of real-life diagnostic testing with international guidelines.
To the best of our knowledge, only J enkins et al. Discordance with ERS guidelines was mainly due to under-testing, as a result of the extensive testing approach recommended by these guidelines.
Over-testing was also identified as a cause of discordance with the ERS guidelines. This event was more frequently reported in Europe than in North America. Insurance and healthcare system-related factors may have shaped the diagnostic approach both of European and North American clinicians.
Finally, this study has important strengths and limitations. To our knowledge, GLIMP is the first study to enrol a large and diverse group of adult windows update 1709 download manuella allen county hospitalised with CAP across six continents, providing a detailed, real-world picture of CAP diagnostic testing around the world.
Windows server 2019 update 1809 to 2004 этом, incomplete data regarding presence of pleural effusions and clinical and epidemiological determinants of Legionella infection limited the accuracy our findings, probably leading to an inflation of our over-testing estimates. Finally, due to its cross-sectional design, our study did not provide CAP outcome data.
In conclusion, our understanding of the aetiologies of CAP among hospitalised adults is scarce, limiting the accuracy of empirical antimicrobial regimens. Disease severity and geography are associated with differences in testing approaches. GLIMP investigators: We would like to thank the following study contributors for their valuable collaboration. Dr Cazaux A. India: Mohit Bhatia, S. Mahesh and B. Ireland: Vera M. Villegas, Hospital Universitario, Monterrey, Mexico. The Netherlands: E.
UK: Devesh J. USA: Karen S. Dysart and Susan M. Kellie, Clement J. Holland and Stephen P. Soni, Julio Noda, Cecilia I. Hinojosa, Stephanie M. Levine, Luis F. Wunderink and Ray D.
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