ObjectiveTo investigate the efficacy of macrolide antibiotics on patients with lower respiratory tract infection. MethodsA total of 146 patients with lower respiratory tract infections were selected from January 2011 to January 2014 in the Department of Respiratory Medicine of our hospital and divided into low risk and high risk group. Based on the clinical characteristics of the patients, low risk treatment plan was erythromycin capsule 0.25 g once, 3 times/day plus compound liquorice mixture, followed by clarithromycin 0.25 g once, 2-3 times/day plus compound liquorice mixture or clarithromycin 0.25 g once, 2-3 times/day plus compound liquorice mixture; high risk group treatment was macrolide antibiotics (erythromycin, clarithromycin) 0.25 g once, 3 times/day and second generation cephalosporins (cefaclor or cefuroxime) 0.25 g once, 3 times/day plus compound liquorice decoction. ResultsThe clinical seven-day curing rate was 54.1%, and the total effective rate was 93.1%. For low risk treatment regimen, the sevenday curing rate was 63.6%, and the total effective rate was 94.9%; for high risk treatment regimen, the seven-day curing rate was 34.0%, and the total effective rate was 89.4%. Acute bronchitis had high curing rate which was 70.1%. ConclusionMacrolide antibiotics (erythromycin, clarithromycin) oral administration in the treatment of lower respiratory tract infection is reliable and effective, which is worth promoting in clinical application.
至2002年6月,有關上呼吸道感染治療的臨床證據如下:①止痛劑/抗炎藥用于緩解癥狀:1個系統評價發現與安慰劑比較止痛劑或抗炎藥在1～5 d時顯著減輕咽喉炎癥狀;1個RCT發現在服用抗生素的急性鼻竇炎患者,激素鼻噴劑較安慰劑明顯改善癥狀,持續21 d.②抗生素用于預防β溶血鏈球菌咽炎的少見并發癥:1個系統評價發現抗生素可預防β溶血鏈球菌咽炎的非化膿性并發癥,但在工業化國家該并發癥少見.③抗生素能縮短流感嗜血桿菌、卡他莫拉菌或肺炎鏈球菌感染的康復時間,在少部分患者中其上呼吸道感染由流感嗜血桿菌,卡他莫拉菌或肺炎鏈球菌引起.1個RCT發現抗生素較安慰劑明顯增加這些患者在5 d時的康復.但目前尚無簡捷的方法將此亞組患者從眾多鼻咽培養陰性的患者中甄別出來.④抗生素縮短急性支氣管炎、咽喉炎和鼻竇炎的康復時間:系統評價發現抗生素能輕度改善癥狀.與安慰劑比較,使用抗生素常出現副作用(惡心、嘔吐、頭痛、皮疹、陰道炎).⑤抗生素在感冒患者中的作用:2個系統評價發現,在患感冒6～14 d時使用抗生素在治愈率或全身改善方面與安慰劑沒有差異.⑥抗組胺藥用于流涕和噴嚏:1個系統評價發現,使用抗組胺藥2 d后流涕和噴嚏明顯減輕,但臨床獲益較小.⑦β受體激動劑縮短成人支氣管高反應性、喘息或氣流受限患者咳嗽的持續時間:1個系統評價發現,與安慰劑或紅霉素比較,在7 d時β受體激動劑可減輕成人咳嗽癥狀,但亞組分析表明此種獲益僅限于伴有支氣管高反應性、喘息或氣流受限者.β受體激動劑明顯增加手抖、震顫和神經過敏的發生比例.兒童中進行的2個小樣本RCTs發現在7 d時咳嗽癥狀在β受體激動劑和安慰劑間沒有顯著差異.但是,這些RCTs規模太小,故不能檢出臨床上重要的差異.⑧減充血劑用于充血癥狀的長期緩解:1個系統評價發現,無證據支持數天中反復使用減充血劑.1個病例對照研究發現,有微弱證據支持去甲麻黃堿可能增加出血性中風的風險.⑨減充血劑用于充血癥狀的短期緩解:1個系統評價發現,與安慰劑比較單劑減充血劑顯著減輕鼻充血,持續3～10h.⑩紫錐花屬用于預防:1個系統評價發現與不干預比較,紫錐花屬顯著減少一次感染發作的人數,但與安慰劑比較,無有效證據支持紫錐花屬的作用.(11)紫錐花屬制劑:2個系統評價發現有限證據支持紫錐花屬的某些制劑在改善癥狀方面優于安慰劑,但我們未發現有效證據支持任何特定產品的療效.(12)蒸汽吸入:1個系統評價發現,無證據支持蒸汽吸入的作用.(13)維生素C:1個系統評價發現與安慰劑比較維生素C可輕度縮短感冒癥狀持續時間,但該作用較小且可能是發表偏倚.(14)鋅(鼻內鋅膠或錠劑):2個RCTs發現,與安慰劑比較鼻內鋅膠縮短感冒癥狀的平均持續時間,但僅有1個RCT發現差異有顯著性.2個系統評價發現,與安慰劑比較葡萄糖酸鋅或醋酸鹽鋅錠劑在7d時減輕癥狀的持續.
【摘要】 目的 分析ICU患者院內下呼吸道感染的細菌分布情況,為臨床用藥提供依據。方法 對成都市第六人民醫院2006年1月—2009年6月566例ICU院內下呼吸道感染患者的痰培養標本結果進行回顧性調查分析。結果 共分離出371株病原菌,其中革蘭陰性桿菌235株,占63.34%;革蘭陽性球菌62株,占16.71%;真菌74株,占19.95%。藥敏結果顯示,對常規青霉素類基本耐藥,亞胺培南—西司他丁、美羅培南耐藥菌株少見,對萬古霉素耐藥菌株尚未出現。結論 加強ICU呼吸道感染的病原菌監測極為必要,對臨床抗生素的合理使用具有指導意義。
ObjectiveTo investigate the clinical efficacy of CoughAssist for cleaning airway secretions in neuromuscular disease patients with respiratory insufficiency. MethodsForty-six cases of neuromuscular disease with respiratory insufficiency were recruited in the study,with Guillain-Barre syndrome in 24 cases,myasthenia gravis in 18 cases,and multiple myositis in 4 patients.Thirty-four patients underwent intubation and mechanical ventilation,and 12 patients underwent tracheotomy.They were randomly divided into group A using CoughAssist and group B using suction tube to clear airway secretions after mechanical vibration.The frequency of suction within 24 hours,oxygenation index,pulmonary static compliance,incidence of lung infections,lung auscultation and chest radiograph were recorded and compared between two groups. ResultsCoughAssist could more effectively clean respiratory secretions with higher oxygenation index and pulmonary static compliance in group A.Lung auscultation and chest radiograph significantly improved,and the incidence of lung infection significantly decreased in group A compared with group B.Furthermore,CoughAssist reduced nursing workload with lower frequency of suction within 24 hours. ConclusionCoughAssist can effectively clean up airway secretions,improve oxygenation,while reducing pulmonary infection and nursing workload for neuromuscular disease patients with respiratory insufficiency,so it is aworthy tool in clincal practice.
Objective To study the incidence and etiological distribution of lower respiratory tract infection (LRTI) after airway metal stent implantation in patients with malignant central airway obstruction (MCAO). Methods The clinical data of 149 patients with MCAO who underwent airway metal stent implantation in Department of Pulmonary and Critical Care Medicine of Hunan Provincial People's Hospital from April 2014 to April 2021 were selected for a retrospective study. The incidence of LRTI after treatment was counted. According to whether LRTI occurred after operation, they were divided into infected group and uninfected group. The clinical data of the two groups were compared and the influencing factors of LRTI were analyzed. Sputum samples and/or bronchoalveolar lavage fluid samples from patients infected with LRTI were collected for pathogen detection and drug susceptibility test, and the distribution and drug resistance of main pathogens were analyzed. Results A total of 149 patients who met the criteria were included in this study and the incidence of LRTI was 21.48%. People in the infected group was older than that in the uninfected one, and the proportion of people with a history of smoking, chemoradiotherapy, covered metal stents, and stent-related granulation tissue proliferation was higher, and the proportion of people with postoperative standardized aerosol inhalation was lower (P<0.05). Age, smoking history, chemoradiotherapy, covered metal stents, stent-related granulation tissue hyperplasia and postoperative standardized aerosol inhalation were all influencing factors of LRTI in these patients (P<0.05). A total of 38 pathogens were detected in 32 patients with LRTI. Gram negative bacteria, gram positive bacteria and fungi accounted for 68.42% (26/38), 21.05% (8/38) and 10.53% (4/38) respectively. Pseudomonas aeruginosa, the main Gram-negative bacteria, had no resistance to tobramycin, gentamicin and amikacin, but had high resistance to compound sulfamethoxazole, tigecycline and ampicillin; Klebsiella pneumoniae had low resistance to tobramycin, amikacin and tigecycline, and high resistance to cefotaxime, ciprofloxacin and cefepime; the main Gram-positive Staphylococcus aureus had no drug resistance to vancomycin, linezolid, compound sulfamethoxazole and quinuptin/dafuptin, but had high drug resistance to tetracycline, penicillin G, levofloxacin, oxacillin and ciprofloxacin; the main fungi Candida albicans showed no resistance to fluconazole, itraconazole, voriconazole, 5-fluorocytosine and amphotericin B. These results of pathogenic detection and drug susceptibility test contributed to the improvement of the rational application rate of antibiotics. Conclusions LRTI occurs in about a quarter of patients with MCAO after airway metal stent implantation. The pathogens are mainly Pseudomonas aeruginosa and Staphylococcus aureus. Antimicrobial treatment should be based on the results of etiological detection and drug susceptibility test.
Objective To investigate the viral etiology of acute lower respiratory tract infection in adult inpatients. Methods 192 adult inpatients suffering from community-acquired pneumonia, acute bronchitis, or acute exacerbation of chronic obstructive pulmonary disease, admitted from October 2007 to October 2008, were enrolled in the study. Swabs from the nasopharynxes were collected. Multiple polymerase chain reaction was employed to identify the 7 common species of respiratory virus ( including 11subspecies) . Serumspecific IgM against several viruses were detected by indirect immunofluorescence. 106 healthy volunteers were enrolled as control. Results Only 4 cases were found to be infected with virus in 106 healthy volunteers. Viruses were identified in 80 ( 41. 6% ) cases of 192 inpatients and 99 ( 51. 5% )viral strains were detected. The most common viruses identified in the inpatients were influenza virus A ( FluA) , rhinovirus ( RhV) , and parainfluenza virus 1 ( PIV1) . The ratio of the 3 virus strains to the all strains identified was 81. 8% ( 81/99) . Serumspecific IgM was positive in 61 ( 31. 7% ) inpatients and 73 ( 38. 0% ) viral strains were detected. The most common viruses identified in the inpatients were FluA, PIV1,and respiratory syncytial virus ( RSV) . When summing up the data from the swabs and serum, 91 ( 47. 3% )cases had viral infection in 192 inpatients and 110 ( 57. 2% ) viral strains were detected. Conclusion The rate of viral infection is relatively high in the adult inpatients with acute lower respiratory tract infection, and the most common species are FluA, RhV, and PIV1.
Objective To evaluate the efficacy and safety of domestic ambroxol hydrochloride injection in the treatment of lower respiratory tract infection. Methods A total of 120 patients with respiratory tract infections were included and randomized into the treatment group (ambroxol hydrochloride injection 30mg, iv, q12h) and the control group (mucosolvan ampoule 30mg, iv, q12h). The duration of treatment was 6 days. Results 118 patients completed the trial, 59 in each group. From Day 1 to Day 6, the severity scores of cough, sputum amount, difficulty in expectoration and rales were similar between the two groups (Pgt;0.05), but a significant difference was observed in the nature of sputum (Plt;0.05). The total effective rates of the treatment group and the control group were 96.6% (FAS analysis and PP analysis) or 93.3% (FAS analysis), and 94.9% (PP analysis), respectively. There was no significant difference between the two groups (Pgt;0.05). The incidence of adverse effects was comparable between the two groups (1.7% vs. 0%, Pgt;0.05), and no severe adverse effect was observed. Conclusion The efficacy of domestic ambroxol hydrochloride injection in the treatment of lower respiratory infection was equal to that of mucosolvan ampoule, and it can even further improve the nature of sputum. Ambroxol hydrochloride was as safe as mucosolvan ampoule.
ObjectiveTo systematically evaluate the efficacy and safety of teicoplanin versus vancomycin for lower respiratory tract infection with gram-positive bacteria in Chinese population. MethodsThe PubMed, EMbase, The Cochrane Library (Issue 3, 2016), CNKI, and WanFang Data databases were searched from their inception to March 20, 2016, to collect randomized controlled trials about teicoplanin versus vancomycin for lower respiratory tract infection with gram-positive bacteria in Chinese population. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 12 RCTs involving 921 patients were included. The results of meta-analysis suggested that there were no significant associations between the teicoplanin group and the vancomycin group in total effective rate (RR=0.99, 95%CI 0.93 to 1.05, P=0.69), clinical cure rate (RR=1.05, 95%CI 0.92 to 1.19, P=0.49), and bacteria clearance rate (RR=1.00, 95%CI 0.93 to 1.05, P=0.69). However, the teicoplanin group had lower incidences of the total adverse event (RR=0.65, 95%CI 0.47 to 0.90, P=0.008) and nephrotoxicity (RR=0.33, 95%CI 0.16 to 0.66, P=0.002), and shorter course of treatment (MD=-1.78, 95%CI -3.27 to -0.29, P=0.02) than that in the vancomycin group. ConclusionCurrent evidence indicates that teicoplanin is similar to vancomycin in therapeutic effects on treating lower respiratory tract infection with gram-positive bacteria in Chinese population, but teicoplanin is better in safety and has a shorter course of treatment than vancomycin. Due to limited quantity and quality of the included studies, more high-quality RCTs are needed to confirm the above conclusions.
Objective To investigate the differences in bacteria distribution and drug resistance of pathogens in patients with lower respiratory tract infection between respiratory general wards and respiratory intensive care unit ( RICU) .Methods All the clinical isolates fromsputumor secretion of lower respiratory tract from2007. 1-2010. 10 were analyzed retrospectively. Antibiotic susceptibility was tested by Kirby-Bauer method. Results The total number of isolated strains was 3202. Among 1254 strains isolated from respiratory general wards, Gram-positive bacteria accounted for 2. 63% , Gram-positive bacteria accounted for 42. 42% , and fungi accounted for 54. 95% . Streptococcus pneumoniae ranked first place among Gram-positive bacteria, accounting for 51. 52% . Haemophilus parainfluenzae bacillus ranked first place among Gramnegative bacteria, accounting for 21. 99% . Both were sensitive to the most commonly used antibiotics. Among 1948 strains isolated from RICU ward, Gram-positive bacteria accounted for 4. 52% , Gram-positive bacteria accounted for 37.73% , and fungi accounted for 57. 75% . Staphylococcus aureus ranked first place among Gram-positive bacteria, accounting for 52. 27% . Acinetobacter baumannii ranked first place in Gramnegative bacteria, accounting for 27. 35% . Both were resistant to most commonly used antibiotics. Pseudomonas aeruginosa had a higher rate of infection both in the general wards and RICU, and was resistant to most commonly used antibiotics.Conclusions In lower respiratory tract infection of respiratory general ward, Gram-positive bacteria with Streptococcus pneumoniae mainly and Gram-negative bacteria with Haemophilus parainfluenzae mainly are both sensitive to the most commonly used antibiotics. While in the RICU ward, Gram-positive bacteria infections with Staphylococcus aureus mainly and Gram-negative bacteria infections with Acinetobacter baumannii mainly are both resistant to most commonly used antibiotics.
呼吸道感染在感染性疾病中占有重要地位，細菌性肺炎是呼吸道感染中的主要代表性疾病，最重要的治療措施是抗菌治療，用藥選擇及方法正確與否直接影響治療的成敗。同時如何降低醫療費用也是臨床醫生需要考慮的棘手問題。據國外文獻報道在英國每年約有5億張以上的抗微生物藥物處方，其中住院處方中約40％為靜脈制劑，而我國住院靜脈制劑的處方比例則更高。醫療費用的增加部分與靜脈用藥過多有關。為尋求解決臨床治療與醫療費用之間的矛盾，選擇高效、低毒、廉價的抗菌藥物，1987年Quintiliani等[1]首先提出了抗生素序貫療法（sequential therapy）的概念，即在經過相對短療程（48～72 h）靜脈抗菌藥物治療，臨床癥狀基本穩定或改善后，改為口服抗菌藥物治療。口服的抗菌藥物可以是與前者完全相同的口服劑型，也可以是同一類或抗菌譜相似的同一級藥物，后也有人稱之為"轉換治療"（switch therapy）、"降級治療"（step-down therapy）。據國外文獻報道，住院的社區獲得性肺炎（CAP）應用序貫療法者因早期出院每位患者節約費用293~1393美元[2-4]。