BACKGROUND AND OBJECTIVE

COVID-19 contributes significantly to global morbidity and mortality. Age-related comorbidities elevate the risk of severe cases. Studies have recently demonstrated that widely available medications, including tocilizumab (TCZ), can manage severe symptoms. However, its effectiveness is unclear, particularly among the older population. Therefore, this review aimed to evaluate TCZ’s efficacy in managing severe pneumonia in individuals aged 50 and older.

We systematically search several databases and gray literature including Web of Science, CINAHL, Academic Search Complete, PsycINFO, PsycArticles, SocINDEX, CENTRAL/Cochrane Library, PubMed/MEDLINE for original research articles in English across several study designs published in the year 2020-2022. A narrative synthesis was conducted to summarize the evidence. We employed the NIH quality assessment tool for observational cohort studies to evaluate risk of bias. Additionally, we utilized GRADE to appraise the certainty of evidence.

Among 539 screened articles, only five studies met the selection criteria. Tocilizumab's impact on severe COVID-19 pneumonia revealed a diverse effect on mortality rate, with 29% in the TCZ group, and 40% in the controls died within 30 days of intubation (OR 0.61; 95% CI, 0.27-1.36). It is also reported that TCZ was not associated with mortality, despite faster decline in pulmonary function and prolonged fever. Hospital mortality in the TCZ group was significantly lower than in the controls, and age over 60 was the only significant risk factor. Moreover, administering TCZ reduced mechanical ventilation needs, with 82% extubated compared to 53% in controls. However, 45% in TCZ group was associated with a higher ventilator-associated pneumonia rate than in the untreated group which was 20% (P CONCLUSIONS

The effects of tocilizumab on reducing mortality risk and improving the survival rate of COVID-19 patients with pneumonia remained inconclusive. Yet, the majority of results suggested that giving tocilizumab leads to shorter hospital stays, lowers the requirement for mechanical ventilation, and decreases the likelihood of ICU transfer. Tocilizumab is linked to the incidence of secondary infections; hence, this medication should be closely monitored for side effects.

BACKGROUND AND OBJECTIVES

The etiology of pneumonia in the pediatric population varies by age group. Among patients one month to 59 months old, viral pathogens are the most common cause of lower respiratory infections. The study aims to determine the frequency distribution of antibiotic prescription among patients one month to 59 months old and to determine the adherence of primary care facilities to local guidelines with recommended antibiotics.

A descriptive retrospective study using electronic medical records was conducted at two primary care sites. Patients aged 1 month to 59 months old seeking consult via telemedicine or face-to-face diagnosed with community acquired pneumonia from April 2019-March 2020 in the rural facility and May 2019-April 2020 in the remote facility were included in the study. The primary outcome was to determine the patterns of antibiotic use in pneumonia in remote and rural areas and adherence to the recommended antibiotics by the 2016 Philippine Academy of Pediatric Pulmonologists pediatric community-acquired pneumonia clinical practice guidelines (CPG).

There were 30 pediatric patients diagnosed with pneumonia in the rural facility and 213 in the remote facility. Of these patients with pneumonia, 96.7% and 94.8% were prescribed antibiotics in the rural and remote sites, respectively. The most commonly prescribed antibiotic in the rural facility was co-amoxiclav (26.7%), while amoxicillin (51.6%) was the most common in the remote facility. Adherence to the CPG in the rural site was lower at 23.3% (n=8/30) compared to the remote site which was 55.9% (n=119/213).

Primary care physicians prescribed antibiotics in over 90% of the time upon the diagnosis of pneumonia in children aged one month to 59 months old, despite viral pneumonia being the more common in primary care setting. Adherence to recommended antibiotics was higher in the remote setting than in the rural setting. Use of EMR to monitor quality of care can improve patient outcomes and safety, pointing out the importance of improving the quality of documentation in the study sites.

INTRODUCTION

Respiratory infections are a leading cause of pediatric hospitalizations, particularly pneumonia. In Metro Manila, many cases lack identifiable causes, underscoring the need for advanced diagnostics. The RT-PCR Respiratory Panel 2.1 enables rapid pathogen detection, improving diagnosis and treatment. Examining demographic and clinical factors linked to severe outcomes provides valuable local insights.

This study aimed to identify and compare respiratory pathogens detected by the RT-PCR panel and determine demographic and clinical factors associated with severe outcomes in pediatric patients at a private tertiary hospital in the Philippines.

A retrospective cohort study was conducted, analyzing pediatric patients (0–18 years) admitted for respiratory infections from August 2023 to August 2024. Descriptive statistics summarized patient characteristics, while regression analyses identified factors linked to mechanical ventilation, oxygen use, and prolonged hospital stays.

Of 118 patients, 85.6% tested positive for respiratory pathogens, predominantly viral (RSV 23.7%, human rhinovirus/enterovirus 22.9%), with cases peaking in late 2023. Most patients had elevated WBC with neutrophilic redominance. Oxygen support was required in 22.9% of cases, primarily in infants under six months with RSV, who had a four-fold increased risk. Difficulty breathing was the strongest predictor of oxygen use, while the presence of neurological conditions (e.g., cerebral palsy, seizure disorders) were significantly associated with mechanical ventilation and prolonged hospital stays.

Seizure disorder, cerebral palsy, and younger age influenced severe outcomes. Pathogen specific trends in demographics, clinical findings, and oxygen support needs may help guide physicians in recognizing illnesses caused by the most common viral respiratory pathogens identified by the RT-PCR Respiratory Panel 2.1

Child ; Humans ; Granulomatous Disease, Chronic/complications* ; Pneumonia

Humans ; Aged ; Lung Diseases ; Pneumonia/drug therapy* ; Adrenal Cortex Hormones/therapeutic use* ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Administration, Inhalation ; Community-Acquired Infections/drug therapy*

BACKGROUND

Broad  Panel Respiratory Multiplex PCR (Pneumonia Panel) tests a panel of bacteria and viruses associated with community acquired pneumonia (CAP) which help streamline antimicrobial therapy. Recently, pneumonia panel aids clinicians in early streamlining of antimicrobials as opposed to waiting for bacterial culture results [2].

To determine whether the use of pneumonia panel improves the overall survival rate, length of hospital stay, and number of antibiotic free days among hospitalized CAP patients.

In this RCT, adult patients admitted for CAP were randomized to perform pneumonia panel and sputum culture (pneumonia panel group) versus sputum culture only (control group). The results were relayed to the medical team and were incorporated into the medical records. Length of hospital stay, antibiotic free days in day 28, and mortality rates were the primary outcomes measured.

Eighty participants completed the study. There was no significant difference in the length of hospital stay (p-value 0.073, 95% C.I.), duration of antibiotic therapy (p-value 0.332, 95% C.I.), and mortality rates (p-value 0.570, 95% C.I.) between the 2 groups.

Routine use of pneumonia panel does not significantly reduce length of hospital stay, duration of antibiotic therapy, and mortality rates among admitted patients with moderate to severe CAP. The benefit of pneumonia panel was seen on early detection of drug resistant pathogen resulting in early antibiotic escalation and shorter duration of antibiotic therapy. Further studies are necessary to show its benefit in the high risk population.

BACKGROUND

Pneumonia in children causes significant morbidity and mortality especially in those less than 5 years of age. Accuracy of multiplex diagnostic tests for rapid identification of microbial etiology is not well established. This study was undertaken to determine the diagnostic accuracy of a pneumonia panel multiplex RT-PCR assay in the detection of respiratory pathogens among pediatric patients with pneumonia.

This retrospective analytic cross-sectional study included children less than 19 years old diagnosed with pneumonia between June 2022 to June 2023 with respiratory samples for bacterial culture and pneumonia panel multiplex RT PCR assay.

A total of 211 pediatric patients were included in the study. Of these, 72% were diagnosed with community acquiredpneumonia, 95% of them had endotracheal aspirate specimens. Bacterial pathogens were detected in 131 patients (61%). Of the 172 patients who had positive detections, 51 (30%) had at least one antibiotic-resistant gene identified. There was moderate agreement between the two methods (72.51%, kappa = 0.4632). Pneumonia panel multiplex RT-PCR assay showed acceptable discriminative ability (0.74) with accuracy at 72.51% and high sensitivity (88.42%), but specificity was only 59.48%. Its useresulted to the escalation of antimicrobial therapy in 15% of patients.

The pneumonia panel multiplex RT PCR assay is a valid diagnostic aid in the detection of respiratory pathogens for children with pneumonia given its good discriminative ability, high accuracy, and sensitivity.

Objective: To describe the treatment outcomes of patients who underwent tube thoracostomy for pleural complications in patients with COVID-19 and determine the association between patient profile and treatment outcomes. Methods: A single-institution retrospective review of patients who underwent tube thoracostomy for complications of COVID-19 infection in the University of the Philippines - Philippine General Hospital (UP-PGH) from March 30, 2020, to March 31, 2021, was performed. These patients' demographic and clinical profiles were evaluated using median, frequencies, and percentages. The association between patient profile, and mortality and reintervention rates was assessed using univariable Cox proportional hazards regression analysis. Results: Thirty-four (34) of 3,397 patients (1.00%) admitted for COVID-19 pneumonia underwent tube thoracostomy. Of these, 34, 47.06% were male, 52.94% were female, the median age was 51.5 years old, 85.29% had comorbid conditions, and 29.41% had a previous or ongoing tuberculous infection. The most common indication for tube thoracostomy was pleural effusion (61.76%), followed by pneumothorax (29.41%), and pneumo-hydrothorax (8.82%). The mortality rate was 38.24%, and the reintervention rate was 14.71%. Intubated patients had 14.84 times higher mortality hazards than those on room air. For every unit increase in procalcitonin levels, the mortality hazards were increased by 1.06 times. Conclusion An increasing level of oxygen support on admission and a level of procalcitonin were directly related to mortality risk in COVID-19 patients who underwent tube thoracostomy for pleural complications. There is insufficient evidence to conclude that patient-related, COVID-19 pneumonia-related, and procedure-related factors included in this study were significantly associated with reintervention risk.
COVID-19 ; Pneumonia

Background: Studies on previous viral pandemics showed poorer outcomes of patients with concomitant bacterial infection. During the early period of COVID-19 pandemic, empiric antibiotic therapy is commonly given among COVID-19 patients despite lack of strong recommendations for its use. Objectives: We determined the prevalence of bacterial co-infection and of empiric use of antibiotics among COVID-19 admissions. We also determined association between COVID-19 severity, ICU admissions, length of hospital stay, and mortality outcomes of those with and without bacterial co-infection. Methods: A total of 159 patients hospitalized with COVID-19 from April 2020 to April 2021 were analyzed in this crosssectional chart review study. Data on empiric antibiotic administration and cultures taken within 3 days of admission were collected. Chi-square, Fischer-Exact, and T-tests were used to analyze the data. Results: Empiric antibiotics were given in 94.97% of COVID-19 admissions with azithromycin as the most common agent. The prevalence of bacterial co-infection among COVID-19 admitted patients was 10%. There were higher ICU admissions and longer hospital stay among those with bacterial co-infection although it did not reach statistical significance. No mortality was seen among patients with bacterial co-infection. Conclusion There was a high use of empiric antibiotic treatment in hospitalized COVID-19 patients despite the low prevalence of bacterial co-infection among these cases. This warrants development of strategies for antimicrobial stewardship programs especially during the COVID-19 pandemic.
COVID-19 ; Pneumonia

Background and Objective: COVID-19 contributes significantly to global morbidity and mortality. Age-related comorbidities elevate the risk of severe cases. Studies have recently demonstrated that widely available medications, including tocilizumab (TCZ), can manage severe symptoms. However, its effectiveness is unclear, particularly among the older population. Therefore, this review aimed to evaluate TCZ’s efficacy in managing severe pneumonia in individuals aged 50 and older. Methods: We systematically search several databases and gray literature including Web of Science, CINAHL, Academic Search Complete, PsycINFO, PsycArticles, SocINDEX, CENTRAL/Cochrane Library, PubMed/MEDLINE for original research articles in English across several study designs published in the year 2020-2022. A narrative synthesis was conducted to summarize the evidence. We employed the NIH quality assessment tool for observational cohort studies to evaluate risk of bias. Additionally, we utilized GRADE to appraise the certainty of evidence. Results: Among 539 screened articles, only five studies met the selection criteria. Tocilizumab's impact on severe COVID-19 pneumonia revealed a diverse effect on mortality rate, with 29% in the TCZ group, and 40% in the controls died within 30 days of intubation (OR 0.61; 95% CI, 0.27-1.36). It is also reported that TCZ was not associated with mortality, despite faster decline in pulmonary function and prolonged fever. Hospital mortality in the TCZ group was significantly lower than in the controls, and age over 60 was the only significant risk factor. Moreover, administering TCZ reduced mechanical ventilation needs, with 82% extubated compared to 53% in controls. However, 45% in TCZ group was associated with a higher ventilator-associated pneumonia rate than in the untreated group which was 20% (P < 0.001). Despite this, TCZ-treated patients had shorter hospital stays. Conclusions The effects of tocilizumab on reducing mortality risk and improving the survival rate of COVID-19 patients with pneumonia remained inconclusive. Yet, the majority of results suggested that giving tocilizumab leads to shorter hospital stays, lowers the requirement for mechanical ventilation, and decreases the likelihood of ICU transfer. Tocilizumab is linked to the incidence of secondary infections; hence, this medication should be closely monitored for side effects.
COVID-19 ; Pneumonia