Pneumonia Research in the East Midlands

Current Pneumonia Research

Below are pneumonia research studies and trials taking place in the East Midlands

September 18, 2017

Inspiratory muscle training (IMT) is a technique where you repeatedly breathe in hard and fast from a hand held device, which strenghthens the respiratory muscles.  It has been shown in previous studies in a variety of medical and respiratory conditions to reduce the f...

September 18, 2017

Following treatment for Community Acquired Pneumonia (CAP), the resolution of symptoms for CAP has been shown to lag behind clinical cure as assessed by the clinical team.  Return to pre-pneumonia levels of fitness and general health has been reported to take over 3 mo...

July 9, 2017

A Population based prospective cohort study of pneumococcal pneumonia in adults following the introduction of childhood pneumococcal vaccination in the UK.

This research is being currently carried out at Nottingham University Hospitals NHS Trust;

Chief Investigator: Inve...

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East Midlands Pneumonia Publications

Respiratory syncytial virus (RSV) causes a significant public health burden, and outbreaks among vulnerable patients in hospital settings are of particular concern. We reviewed published and unpublished literature from hospital settings to assess: (i) nosocomial RSV transmission risk (attack rate) during outbreaks, (ii) effectiveness of infection control measures. We searched the following databases: MEDLINE, EMBASE, CINAHL, Cochrane Library, together with key websites, journals and grey literature, to end of 2012. Risk of bias was assessed using the Cochrane risk of bias tool or Newcastle-Ottawa scale. A narrative synthesis was conducted. Forty studies were included (19 addressing research question one, 21 addressing question two). RSV transmission risk varied by hospital setting; 6-56% (median: 28·5%) in neonatal/paediatric settings (n = 14), 6-12% (median: 7%) in adult haematology and transplant units (n = 3), and 30-32% in other adult settings (n = 2). For question two, most studies (n = 13) employed multi-component interventions (e.g. cohort nursing, personal protective equipment (PPE), isolation), and these were largely reported to be effective in reducing nosocomial transmission. Four studies examined staff PPE; eye protection appeared more effective than gowns and masks. One study reported on RSV prophylaxis for patients (RSV-Ig/palivizumab); there was no statistical evidence of effectiveness although the sample size was small. Overall, risk of bias for included studies tended to be high. We conclude that RSV transmission risk varies widely during hospital outbreaks. Although multi-component control strategies appear broadly successful, further research is required to disaggregate the effectiveness of individual components including the potential role of palivizumab prophylaxis.

 

French CE1,2, McKenzie BC3, Coope C1,2,4, Rajanaidu S3, Paranthaman K4, Pebody R4, Nguyen-Van-Tam JS3; Noso-RSV Study GroupHiggins JP1,2, Beck CR1,2,4. Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review. Influenza Other Respir Viruses. 2016 Jul;10(4):268-90. doi: 10.1111/irv.12379. Epub 2016 Mar 24.  PMID: 26901358 PMCID:  PMC4910170  DOI: 10.1111/irv.12379

Current pneumococcal vaccines cover the 10 to 23 most common serotypes of the 92 presently described. However, with the increased usage of pneumococcal-serotype-based vaccines, the risk of serotype replacement and an increase in disease caused by nonvaccine serotypes remains. Serotype surveillance of pneumococcal infections relies heavily on culture techniques, which are known to be insensitive, particularly in cases of noninvasive disease. Pneumococcal-serotype-specific urine assays offer an alternative method of serotyping for both invasive and noninvasive disease. However, the assays described previously cover mainly conjugate vaccine serotypes, give little information about circulating nonvaccine serotypes, and are currently available only in one or two specialist laboratories. Our laboratory has developed a Luminex-based extended-range antigen capture assay to detect pneumococcal-serotype-specific antigens in urine samples. The assay targets 24 distinct serotypes/serogroups plus the cell wall polysaccharide (CWP) and some cross-reactive serotypes. We report that the assay is capable of detecting all the targeted serotypes and the CWP at 0.1 ng/ml, while some serotypes are detected at concentrations as low as 0.3 pg/ml. The analytical serotype specificity was determined to be 98.4% using a panel of polysaccharide-negative urine specimens spiked with nonpneumococcal bacterial antigens. We also report clinical sensitivities of 96.2% and specificities of 89.9% established using a panel of urine specimens from patients diagnosed with community-acquired pneumonia or pneumococcal disease. This assay can be extended for testing other clinical samples and has the potential to greatly improve serotype-specific surveillance in the many cases of pneumococcal disease in which a culture is never obtained.

Eletu SD1, Sheppard CL2, Thomas E1, Smith K3, Daniel P4, Litt DJ1, Lim WS4, Fry NK1. Development of an Extended-Specificity Multiplex Immunoassay for Detection of Streptococcus pneumoniae Serotype-Specific Antigen in Urine by Use of Human Monoclonal Antibodies. Clin Vaccine Immunol. 2017 Dec 5;24(12). pii: e00262-17. doi: 10.1128/CVI.00262-17. Print 2017 Dec.  PMID: 28978509 PMCID: PMC5717182 DOI: 10.1128/CVI.00262-17

Community-acquired pneumonia (CAP) is a leading cause of death in the UK. In this analysis of 23 315 cases from the British Thoracic Society national CAP audit, an overall reduction in 30-day inpatient mortality over 6 years was observed-2014 compared with 2009 adjusted OR 0.86 (95% CI 0.68 to 1.08, p for trend 0.004). Significant increases in the proportions of patients who had (a) a chest X-ray and (b) the first antibiotic dose within 4 hours of admission were also observed (3.7% and 11.5% increases respectively). Further reductions in mortality may follow the 2016 National Institute for Health and Care Excellence Pneumonia Quality Standard.

Daniel P1, Woodhead M2, Welham S3, Mckeever TM4, Lim WS1; British Thoracic Society. Mortality reduction in adult community-acquired pneumonia in the UK (2009-2014): results from the British Thoracic Society audit programme. Thorax. 2016 Nov;71(11):1061-1063. doi: 10.1136/thoraxjnl-2016-208937. Epub 2016 Aug 17.  PMID: 27534681 DOI: 10.1136/thoraxjnl-2016-208937

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