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Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai

BACKGROUND: Despite the release of a national guideline in 2016, the actual practices with respect to adult community-acquired pneumonia (CAP) remain unknown in China. We aimed to investigate CAP patient management practices in Shanghai to identify potential problems and provide evidence for policy...

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Autores principales: Hu, Wei-Ping, Zhang, Feng-Ying, Zhang, Jing, Hang, Jing-Qing, Zeng, Ying-Ying, Du, Chun-Ling, Jie, Zhi-Jun, Jin, Xiao-Yan, Zheng, Cui-Xia, Luo, Xu-Ming, Huang, Yi, Cheng, Qi-Jian, Qu, Jie-Ming
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212141/
https://www.ncbi.nlm.nih.gov/pubmed/32395279
http://dx.doi.org/10.21037/jtd.2020.03.02
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author Hu, Wei-Ping
Zhang, Feng-Ying
Zhang, Jing
Hang, Jing-Qing
Zeng, Ying-Ying
Du, Chun-Ling
Jie, Zhi-Jun
Jin, Xiao-Yan
Zheng, Cui-Xia
Luo, Xu-Ming
Huang, Yi
Cheng, Qi-Jian
Qu, Jie-Ming
author_facet Hu, Wei-Ping
Zhang, Feng-Ying
Zhang, Jing
Hang, Jing-Qing
Zeng, Ying-Ying
Du, Chun-Ling
Jie, Zhi-Jun
Jin, Xiao-Yan
Zheng, Cui-Xia
Luo, Xu-Ming
Huang, Yi
Cheng, Qi-Jian
Qu, Jie-Ming
author_sort Hu, Wei-Ping
collection PubMed
description BACKGROUND: Despite the release of a national guideline in 2016, the actual practices with respect to adult community-acquired pneumonia (CAP) remain unknown in China. We aimed to investigate CAP patient management practices in Shanghai to identify potential problems and provide evidence for policy making. METHODS: A short-period, 5-day prospective cross-sectional study was performed with sampled pulmonologists from 36 hospitals, encompassing all the administrative districts of Shanghai, during January 8–12, 2018. The medical information was recorded and analyzed for the patients with the diagnosis of CAP who were cared for by 46 pulmonologists during the study period. RESULTS: Overall, 435 patients were included in the final analysis, and 94.3% had a low risk of death in terms of CRB-65 criteria (C: disturbance of consciousness, R: respiratory rate, B: blood pressure, 65: age). When diagnosed with CAP, 70.1% of patients were not evaluated using the CURB-65 score (CRB-65 + U: urea nitrogen), but most patients (95.4%) were evaluated using CRB-65. Time to achieve clinical stability was longer in patients with hypoxemia than in those without hypoxemia (8.42±6.36 vs. 5.53±4.12 days, P=0.004). Overall, 84.4% of patients with a CRB-65 score of 0 were administered antibiotics intravenously, and 19.4% were still hospitalized after excluding hypoxemia and comorbidities. The average duration of antibiotic treatment was 10.4±4.9 days. Overall, 72.6% of patients received antibiotics covering atypical pathogens whose time to clinical stability was significantly shortened compared with those without coverage, but the antibiotic duration was similar and not correspondingly shortened. CONCLUSIONS: CRB-65 seems to be more practical than CURB-65 for the initial evaluation of CAP in the context of local practice, and oxygenation assessment should be included in the evaluation of severity. Overtreatment may be relatively common in patients at low risk of death, including unreasonable hospitalization, intravenous administration, and antibiotic duration.
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spelling pubmed-72121412020-05-11 Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai Hu, Wei-Ping Zhang, Feng-Ying Zhang, Jing Hang, Jing-Qing Zeng, Ying-Ying Du, Chun-Ling Jie, Zhi-Jun Jin, Xiao-Yan Zheng, Cui-Xia Luo, Xu-Ming Huang, Yi Cheng, Qi-Jian Qu, Jie-Ming J Thorac Dis Original Article BACKGROUND: Despite the release of a national guideline in 2016, the actual practices with respect to adult community-acquired pneumonia (CAP) remain unknown in China. We aimed to investigate CAP patient management practices in Shanghai to identify potential problems and provide evidence for policy making. METHODS: A short-period, 5-day prospective cross-sectional study was performed with sampled pulmonologists from 36 hospitals, encompassing all the administrative districts of Shanghai, during January 8–12, 2018. The medical information was recorded and analyzed for the patients with the diagnosis of CAP who were cared for by 46 pulmonologists during the study period. RESULTS: Overall, 435 patients were included in the final analysis, and 94.3% had a low risk of death in terms of CRB-65 criteria (C: disturbance of consciousness, R: respiratory rate, B: blood pressure, 65: age). When diagnosed with CAP, 70.1% of patients were not evaluated using the CURB-65 score (CRB-65 + U: urea nitrogen), but most patients (95.4%) were evaluated using CRB-65. Time to achieve clinical stability was longer in patients with hypoxemia than in those without hypoxemia (8.42±6.36 vs. 5.53±4.12 days, P=0.004). Overall, 84.4% of patients with a CRB-65 score of 0 were administered antibiotics intravenously, and 19.4% were still hospitalized after excluding hypoxemia and comorbidities. The average duration of antibiotic treatment was 10.4±4.9 days. Overall, 72.6% of patients received antibiotics covering atypical pathogens whose time to clinical stability was significantly shortened compared with those without coverage, but the antibiotic duration was similar and not correspondingly shortened. CONCLUSIONS: CRB-65 seems to be more practical than CURB-65 for the initial evaluation of CAP in the context of local practice, and oxygenation assessment should be included in the evaluation of severity. Overtreatment may be relatively common in patients at low risk of death, including unreasonable hospitalization, intravenous administration, and antibiotic duration. AME Publishing Company 2020-04 /pmc/articles/PMC7212141/ /pubmed/32395279 http://dx.doi.org/10.21037/jtd.2020.03.02 Text en 2020 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Hu, Wei-Ping
Zhang, Feng-Ying
Zhang, Jing
Hang, Jing-Qing
Zeng, Ying-Ying
Du, Chun-Ling
Jie, Zhi-Jun
Jin, Xiao-Yan
Zheng, Cui-Xia
Luo, Xu-Ming
Huang, Yi
Cheng, Qi-Jian
Qu, Jie-Ming
Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai
title Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai
title_full Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai
title_fullStr Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai
title_full_unstemmed Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai
title_short Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai
title_sort initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in shanghai
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212141/
https://www.ncbi.nlm.nih.gov/pubmed/32395279
http://dx.doi.org/10.21037/jtd.2020.03.02
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