Usability and acceptability of two automated pneumonia diagnostic aids: Findings from Ethiopia and Nepal

By Malaria Consortium. Published October 2019.

 

The Acute Respiratory Infection Diagnostic Aid (ARIDA) project introduced two automated respiratory rate counting aids in Ethiopia and Nepal to support frontline health workers to classify fast breathing: a symptom of pneumonia. This research brief discusses the usability of the devices, as well as their acceptability to frontline health workers and caregivers.

Access article here.

0 Hits
0 Comments

Multiplex Polymerase Chain Reaction Panel for Suspected Pertussis What About a Positive Mycoplasma pneumoniae Result?

By Michaël  Desjardins, Paméla Doyon-Plourde, Sarah Mousseau, Daniela Iachimov, Fabien Rallu, Caroline Quach. Published in The Journal of Pediatric Infectious Diseases. Published October 1, 2019.  

 

The use of bacterial multiplex polymerase chain reaction (PCR) in children with suspected pertussis sometimes yields unexpected positive results for Mycoplasma pneumoniae. We aimed to evaluate the clinical significance of positive M. pneumoniae results in this population. Retrospective cohort of consecutive patients with suspected pertussis tested with a bacterial multiplex PCR (including Bordetella pertussis and M. pneumoniae) between June 2015 and March 2017. Medical records were reviewed to compare demographics, clinical presentations and outcomes of patients positive for M. pneumoniae with those positive for B. pertussis and those with negative results, using multivariable logistic regression. A total of 1244 patients were included as follows: 56 (4.5%) with M. pneumoniae, 116 (9.3%) with B. pertussis and 1029 (82.7%) with negative results. Mean age was respectively 4.8 years, 6.5 years and 2.8 years (P < 0.05). Children with M. pneumoniae were less likely to present with cardinal symptoms of pertussis such as paroxysmal cough [adjusted odds ratio (OR): 0.19, 95% confidence interval (CI): 0.08–0.40) but were more likely to have fever (adjusted OR: 10.53, 95% CI: 3.54–39.49) and other nonspecific respiratory symptoms compared with children with B. pertussis. Children with M. pneumoniae had very similar clinical presentations to those with a negative PCR, but were more likely to have radiologically confirmed pneumonia (adjusted OR: 5.48, 95% CI: 2.96–9.99) and were less likely to be diagnosed with a concomitant viral infection (adjusted OR: 0.32, 95% CI: 0.07–0.99). In children with suspected pertussis, the detection of M. pneumoniae is clinically relevant. However, the impact of this finding on patients’ outcome is still unclear.

Access article here.

20 Hits
0 Comments

Rapid Molecular Tests for Influenza, Respiratory Syncytial Virus, and Other Respiratory Viruses: A Systematic Review of Diagnostic Accuracy and Clinical Impact Studies

By Laura M Vos, Andrea H L Bruning, Johannes B Reitsma, Rob Schuurman, Annelies Riezebos-Brilman, Andy I M Hoepelman, Jan Jelrik Oosterheert

Clinical Infectious Diseases. October 1, 2019.

 

We systematically reviewed available evidence from Embase, Medline, and the Cochrane Library on diagnostic accuracy and clinical impact of commercially available rapid (results <3 hours) molecular diagnostics for respiratory viruses as compared to conventional molecular tests. Quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies criteria for diagnostic test accuracy (DTA) studies, and the Cochrane Risk of Bias Assessment and Risk of Bias in Nonrandomized Studies of Interventions criteria for randomized and observational impact studies, respectively. Sixty-three DTA reports (56 studies) were meta-analyzed with a pooled sensitivity of 90.9% (95% confidence interval [CI], 88.7%–93.1%) and specificity of 96.1% (95% CI, 94.2%–97.9%) for the detection of either influenza virus (n = 29), respiratory syncytial virus (RSV) (n = 1), influenza virus and RSV (n = 19), or a viral panel including influenza virus and RSV (n = 14). The 15 included impact studies (5 randomized) were very heterogeneous and results were therefore inconclusive. However, we suggest that implementation of rapid diagnostics in hospital care settings should be considered.

Access article here.

24 Hits
0 Comments

Things We Do For No Reason: Routine Blood Culture Acquisition for Children Hospitalized with Community-Acquired Pneumonia

By David P Johnson, Vivian Lee, Anand Gourishankar, Prabi Rajbhandari, Matthew Schefft, Marquita Genies. Published in Journal of Hospital Medicine. Published September 18, 2019.  

 

Inspired by the ABIM Foundation's Choosing Wisely® campaign, the "Things We Do for No Reason™" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.

Access article here.

15 Hits
0 Comments

Predictors of Bacteremia in Children Hospitalized With Community-Acquired Pneumonia

By Susan C. Lipsett, Matthew Hall, Lilliam Ambroggio, Sanyukta Desai, Samir S. Shah, Thomas V. Brogan, Adam L. Hersh, Derek J. Williams, Carlos G. Grijalva, Jeffrey S. Gerber, Anne J. Blaschke, Mark I. Neuman. Published in Hospital Pediatrics. September 13, 2019.

 

The yield of blood cultures in children hospitalized with community-acquired pneumonia (CAP) is low. Characteristics of children at increased risk of bacteremia remain largely unknown. We conducted a secondary analysis of a retrospective cohort study of children aged 3 months to 18 years hospitalized with CAP in 6 children’s hospitals from 2007 to 2011. We excluded children with complex chronic conditions and children without blood cultures performed at admission. Clinical, laboratory, microbiologic, and radiologic data were assessed to identify predictors of bacteremia. Among 7509 children hospitalized with CAP, 2568 (34.2%) had blood cultures performed on the first day of hospitalization. The median age was 3 years. Sixty-five children with blood cultures performed had bacteremia (2.5%), and 11 children (0.4%) had bacteremia with a penicillin-nonsusceptible pathogen. The prevalence of bacteremia was increased in children with a white blood cell count >20 × 103 cells per µL (5.4%; 95% confidence interval 3.5%–8.1%) and in children with definite radiographic pneumonia (3.3%; 95% confidence interval 2.4%–4.4%); however, the prevalence of penicillin-nonsusceptible bacteremia was below 1% even in the presence of individual predictors. Among children hospitalized outside of the ICU, the prevalence of contaminated blood cultures exceeded the prevalence of penicillin-nonsusceptible bacteremia. Although the prevalence of bacteremia is marginally higher among children with leukocytosis or radiographic pneumonia, the rates remain low, and penicillin-nonsusceptible bacteremia is rare even in the presence of these predictors. Blood cultures should not be obtained in children hospitalized with CAP in a non-ICU setting.

Access article here.

16 Hits
0 Comments