Prevention and Management of Community-Acquired Pneumonia in Adults

230 Pages·2015·3.07 MB·English

Prevention and Management of
Community-Acquired Pneumonia
in Adults
Henri van Werkhoven
Prevention and Management of Community-Acquired Pneumonia in Adults
PhD thesis, University of Utrecht, the Netherlands
ISBN/EAN 978-90-393-6383-6
Design & lay-out Henri van Werkhoven, Zeist, the Netherlands
Cover painting J. Voorhorst, www.voorhorstkunstenfotografie.nl
Printing Off Page, www.offpage.nl
Copyright 2015 © C.H. (Henri) van Werkhoven, Zeist, the Netherlands. All rights
reserved. No part of this thesis may be reproduced, stored or transmitted in any form or
by any means without the prior permission of the author. The copyright of the articles
that have been accepted for publication or that have been published, has been
transferred to the respective journals.
Julius Clinical and Pfizer Nederland are acknowledged for financially supporting printing
of this thesis.
Prevention and Management of
Community-Acquired Pneumonia in Adults
Preventie en behandeling van in de
gemeenschap opgelopen pneumonie bij volwassenen
(met een samenvatting in het Nederlands)
Proefschrift
ter verkrijging van de graad van doctor aan de Universiteit Utrecht
op gezag van de rector magnificus, prof. dr. G.J. van der Zwaan,
ingevolge het besluit van het college voor promoties in het openbaar
te verdedigen op dinsdag 6 oktober 2015 des middags te 2.30 uur
door
Cornelis Hendrinus van Werkhoven
geboren op 4 januari 1983 te Streefkerk
Promotor: Prof. dr. M.J.M. Bonten
Copromotor: Dr. J.J. Oosterheert
Voor Myrthe en Roos, mijn lieve dochters
Later zullen jullie er meer van begrijpen

7
Table of contents
GENERAL INTRODUCTION 9
PART I PREVENTION OF COMMUNITY-ACQUIRED PNEUMONIA IN ELDERLY 23
Chapter 1 The Community-Acquired Pneumonia immunization Trial in Adults 25
(CAPiTA)
Chapter 2 The prevention paradox of pneumococcal conjugate vaccination: 33
highest efficacy in elderly at lowest risk of community-acquired
pneumonia
Chapter 3 The impact of age on the efficacy of 13-valent pneumococcal 53
conjugate vaccine in elderly
Chapter 4 Herd effects of infant immunisation with pneumococcal conjugate 63
vaccines on non-invasive pneumococcal pneumonia in elderly: a
post-hoc analysis
Chapter 5 The scrutiny of identifying Community Acquired Pneumonia 79
episodes quantified bias in absolute effect estimation in a
population based pneumococcal vaccination trial
PART II MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS 97
Chapter 6 Antibiotic treatment of moderate-severe community-acquired 99
pneumonia: design and rationale of a multi-centre cluster-
randomized cross-over trial
Chapter 7 Antibiotic treatment strategies for community-acquired pneumonia 115
in adults
Chapter 8 Cost-effectiveness of antibiotic treatment strategies for community- 147
acquired pneumonia
Chapter 9 Do treatment restrictions influence empirical antibiotic therapy in 171
elderly patients hospitalized with community-acquired pneumonia?
Chapter 10 Predictors of bacteraemia in patients with suspected community- 185
acquired pneumonia
GENERAL DISCUSSION 203
Nederlandse samenvatting (Dutch summary) 221
Samenvatting in jip-en-janneketaal (child summary) 226
Dankwoord (acknowledgements) 227
About the author 229
8
9
I
General introduction
Adapted from:
New trends in the prevention and management of community-acquired
pneumonia
Douwe F. Postmaa, Cornelis H. van Werkhovena, Susanne M. Huijtsa, Marieke
Bolkenbaasa, Jan Jelrik Oosterheertb, and Marc J.M. Bontena,c
a. Julius Centre for Health Sciences and Primary Care
b. Department of Internal Medicine and Infectious Diseases
c. Department of Medical Microbiology
All at University Medical Centre Utrecht, the Netherlands
Reproduced with permission from: The Netherlands Journal of Medicine 2012
Oct;70(8):337-48. Copyright Van Zuiden Communications B.V.
10 | Introduction
Community-acquired pneumonia (CAP) is an important cause of morbidity and
mortality worldwide.1–3 Reported annual incidences differ between countries, probably
reflecting heterogeneity of diagnostics, reporting and socio-economic factors.4 A
universal finding, however, is that Streptococcus pneumoniae is the most commonly
identified bacterial pathogen for CAP in all age groups. The 30-day mortality of patients
hospitalized with CAP is approximately 10%.5,6 For those surviving the acute phase of
the CAP episode, the long term prognosis is still poor with 45-50% not surviving five
years.7 It is however difficult (if at all possible) to determine which of these deaths are
due to (sequelae of) the CAP episode and in which patients CAP is merely a marker of
poor prognosis. In this thesis, the role of pneumococcal vaccination in the prevention of
CAP in elderly and the effectiveness of different empirical antibiotic treatment strategies
for adults hospitalized with CAP are discussed. First, current state of the art in the field
of prevention and management of CAP is summarized, after which an introduction to
the following chapters is provided.