About: Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi

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An Entity of Type : schema:ScholarlyArticle, within Data Space : covidontheweb.inria.fr associated with source document(s)

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
title	Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi
Creator	Daire, Arthur Everett, Dean Faragher, Brian Greenwood, Simon Ho, Antonia Huwa, Jacqueline Ibitoye, Sarah Jary, Hannah Joekes, Elizabeth Mallewa, Jane Mitchell, Tamara Nyirenda, Mulinda Gordon, Stephen Aston, Stephen Heyderman, Robert Mwandumba, Henry
source	Medline; PMC
abstract	Rationale: In the context of rapid antiretroviral therapy rollout and an increasing burden of noncommunicable diseases, there are few contemporary data describing the etiology and outcome of community-acquired pneumonia (CAP) in sub-Saharan Africa. Objectives: To describe the current etiology of CAP in Malawi and identify risk factors for mortality. Methods: We conducted a prospective observational study of adults hospitalized with CAP to a teaching hospital in Blantyre, Malawi. Etiology was defined by blood culture, Streptococcus pneumoniae urinary antigen detection, sputum mycobacterial culture and Xpert MTB/RIF, and nasopharyngeal aspirate multiplex PCR. Measurements and Main Results: In 459 patients (285 [62.1%] males; median age, 34.7 [interquartile range, 29.4–41.9] yr), 30-day mortality was 14.6% (64/439) and associated with male sex (adjusted odds ratio, 2.60 [95% confidence interval, 1.17–5.78]), symptom duration greater than 7 days (2.78 [1.40–5.54]), tachycardia (2.99 [1.48–6.06]), hypoxemia (4.40 [2.03–9.51]), and inability to stand (3.59 [1.72–7.50]). HIV was common (355/453; 78.4%), frequently newly diagnosed (124/355; 34.9%), but not associated with mortality. S. pneumoniae (98/458; 21.4%) and Mycobacterium tuberculosis (75/326; 23.0%) were the most frequently identified pathogens. Viral infection occurred in 32.6% (148/454) with influenza (40/454; 8.8%) most common. Bacterial–viral coinfection occurred in 9.1% (28/307). Detection of M. tuberculosis was associated with mortality (adjusted odds ratio, 2.44 [1.19–5.01]). Conclusions: In the antiretroviral therapy era, CAP in Malawi remains predominantly HIV associated, with a large proportion attributable to potentially vaccine-preventable pathogens. Strategies to increase early detection and treatment of tuberculosis and improve supportive care, in particular the correction of hypoxemia, should be evaluated in clinical trials to address CAP-associated mortality.
has issue date	2019-08-01(xsd:dateTime)
bibo:doi	10.1164/rccm.201807-1333oc
bibo:pmid	30625278
has license	cc-by
sha1sum (hex)	045b111f0f2584890e9271399aa93c917a496662
schema:url	https://doi.org/10.1164/rccm.201807-1333oc
resource representing a document's title	Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi
has PubMed Central identifier	PMC6680311
has PubMed identifier	30625278
schema:publication	Am J Respir Crit Care Med
resource representing a document's body	covid:045b111f0f2584890e9271399aa93c917a496662#body_text
is schema:about of	named entity 'MALAWI' covid:arg/045b111f0f2584890e9271399aa93c917a496662 named entity 'RATIONALE' named entity 'NONCOMMUNICABLE DISEASES' named entity 'ANTIRETROVIRAL THERAPY' named entity 'DATA' named entity 'CONTEXT' named entity 'OUTCOME' named entity 'INCREASING' named entity 'COMMUNITY-ACQUIRED PNEUMONIA' named entity 'COHORT' named entity 'ADULT' named entity 'MORTALITY' named entity 'COMMUNITY-ACQUIRED PNEUMONIA' named entity 'BURDEN' named entity 'DESCRIBING' named entity 'SUB-SAHARAN AFRICA' named entity 'ETIOLOGY' named entity 'RISK FACTORS' named entity 'RAPID' named entity 'ETIOLOGY' named entity 'CAP' named entity 'Cohort' named entity 'Risk Factors' named entity 'pneumonia' named entity 'patient education' named entity 'sub-Saharan' named entity 'clinical case definition' named entity 'logistic regression' named entity 'vaccination' named entity 'CAP' named entity 'antimicrobial' named entity '1.26' named entity 'etiology' named entity 'CAP' named entity 'HIV-infected patients' named entity 'Xpert MTB/RIF' named entity 'organism' named entity 'pathogens' named entity 'pneumonia' named entity 'HIV status' named entity 'Xpert MTB/RIF' named entity 'poorly predicted' named entity 'sub-Saharan African' named entity 'HIV-infected patients' named entity 'respiratory infection' named entity 'observational study' named entity 'healthcare facilities' named entity 'infection' named entity 'expectorated' named entity 'bacterial pathogens' named entity 'HIV' named entity 'sub-Saharan' named entity 'fever' named entity 'diagnostic tests' named entity 'HIV status' named entity 'focal signs' named entity 'CD4 cell' named entity 'Lost to follow-up' named entity 'CAP' named entity 'blood culture' named entity 'pleural' named entity 'CAP' named entity 'CAP' named entity 'pulse oximetry' named entity 'pneumococcal'

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