ObjectiveTo investigate the distribution and drug resistance of the pathogens isolated from hospitalized pediatric patients with respiratory tract infections, and to provide guidance for empiric therapy. MethodsRespiratory tract specimens from hospitalized pediatric patients with respiratory tract infections from 2011 to 2015 were collected, and the strains were identified and the drug susceptibility was tested. ResultsA total of 1995 strains of pathogens, 1281 (64.21%) from boys and 714 (35.79%) from girls, were isolated from 6236 specimens and the detection rate was 31.99%. The mean age of the hospitalized pediatric patients was (1.22±2.05) years (ranged from 1 day to 14 years). 1393 (69.82%) pediatric patients were younger than 1 year. Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Candida albicans and Acinetobacter baumannii ranked the top five species, accounting for 29.82%, 15.09%, 13.18%, 12.73% and 5.91%, respectively. 1995 strains included gram-negative bacteria (50.93%), gram-positive bacteria (35.29%), and fungi (13.78%). The resistance rate of Staphylococcus aureus to oxacillin was 31.76%, but it was 100% sensitive to vancomycin and linezolid. The resistant rate of gram-negative bacteria to imipenem was ranged from 1.52% to 5.93%. The resistant rate of gram-negative bacteria to ceftazidime, cefepime, piperacillin tazobactam and tobramycin was less than 30.00%. ConclusionsThe infants whose age are younger than 1 year comprise the majority of the hospitalized pediatric patients with respiratory tract infections. The proportion of male is more than that of female. Staphylococcus aureus and enterobacteriaceae were the main isolated pathogens. There is difference in drug resistance between different pathogens, so antibiotics should be chosen according to the results of drug sensitivity testing.
ObjectiveTo investigate the risk factors, prognostic factors and prognosis of Multidrug-Resistant Acinetobacter Baumannii (MDR-AB) infection of lower respiratory tract in Intensive Care Unit (ICU) of the Second Affiliated Hospital of Anhui Medical University. MethodsUsing retrospective analysis, we reviewed and compared clinical data of 77 AB infections in lower respiratory tract cases in ICU from January 2013 to March 2015. According to the resistance, patients were divided into a MDR-AB group and a NMDR-AB group. Then the risk factors, prognostic factors and prognosis of MDR-AB infection were analyzed. ResultsA total of 58 cases in the MDR-AB group, 19 cases in the NMDR-AB group were included. The result showed that, the MDR-AB infection in lower respiratory tract could significantly prolong the length of ICU stay (18.5±16.0 vs. 10.6±9.3 days, P<0.05) and increase the mortality (44.8% vs. 11.1%, P<0.01). Logistic regression analysis showed that the independent risk factors for MDR-AB infection in lower respiratory tract included Acute Physiology and Chronic Health Evaluation Ⅱ (Apache Ⅱ) score >15 (OR=0.138, 95%CI 0.03 to 0.625, P=0.01) and use of carbapenems (OR=0.066, 95%CI 0.012 to 0.0346, P=0.001). The independent prognostic factors included placement of drainage tube (OR=8.743, 95%CI 1.528 to 50.018, P=0.015) and use of vasoactive drugs (OR=12.227, 95%CI 2.817 to 53.074, P=0.001). ConclusionThe MDR-AB infection in lower respiratory tract can significantly prolong the length of ICU stay and increase the mortality. The Apache Ⅱ score >15 and use of carbapenems are the risk factors, and the placement of drainage tube and use of vasoactive drugs can increase the mortality of MDR-AB infection of lower respiratory tract in ICU.
Objective To understand the changing patterns and characteristics of the number of patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) before, during, and in the post-epidemic period of the COVID-19 pandemic and the Association between acute respiratory infections and hospitalization of patients with AECOPD. Methods A retrospective analysis was conducted to count the patients hospitalized for AECOPD in the Department of Respiratory Medicine of the Third Affiliated Hospital of Chongqing Medical University from July 2017 to June 2024. The pattern of change in the number of AECOPD hospitalizations and the associations with patients with respiratory tract infections in outpatient emergency departments were analyzed. Results During the COVID-19 epidemic, the number of hospitalizations of patients with AECOPD did not increase compared with the pre-epidemic period. Instead, it significantly decreased, especially in the winter and spring peaks (P<0.05). The only exception was a peak AECOPD hospitalization in the summer of 2022. COPD inpatient mortality and non-medical discharge rates tended to increase during the epidemic compared with the pre-epidemic period. Analysis of the curve of change in the number of patients with respiratory infections in our outpatient emergency departments during the same period revealed a downward trend in the number of patients with respiratory infections during the epidemic and an explosive increase in the number of patients with respiratory infections in the post epidemic period, whose average monthly number was more than twice as high as that during the epidemic. Correlation analysis of the number of patients with respiratory infections between AECOPD hospitalizations and outpatient emergency departments showed that there was a good correlation between the two in the pre-epidemic and post-epidemic periods, and the correlation between the two in the post-epidemic period was more significant in particular (r=0.84-0.91, P<0.001).In contrast, there was no significant correlation in 2021 and 2022 during the epidemic (r=0.24 and 0.50, P>0.05 ). The most common respiratory infection pathogens among AECOPD hospitalized patients during the post-epidemic period were influenza virus, COVID-19 virus, and human rhinovirus, respectively. Conclusions The pandemic period of COVID-19 infection did not show an increase in the number of AECOPD hospitalizations but rather a trend towards fewer hospitalizations. Respiratory infections were strongly associated with the number of AECOPD hospitalizations in the pre- and post-pandemic periods, while the correlation between the two was poorer during the pandemic period. Influenza virus was the most important respiratory infection pathogen for AECOPD during the post-epidemic period.
Objective To investigate the causal relationship between 91 circulating inflammatory proteins and respiratory tract infection by bidirectional Mendelian randomization. Methods single nucleotide polymorphisms (SNPs) for 91 inflammatory circulating proteins were derived from GWAS data from a genome-wide association study of 14 824 subjects of European ancestry on the Olink Target platform, and SNPs for acute bronchitis, acute bronchiolitis, and acute laryngitis and tracheitis were derived from GWAS pooled data in the FinnGen database. Inverse variance weighting method was used as the main research method to conduct bidirectional Mendelian randomization analysis, and Cochran’ IVW Q test, MR-Egger regression method and one by one elimination method were used to conduct sensitivity tests to evaluate heterogeneity and horizontal pleiotropy. In order to reduce the incidence of Class I errors and improve the feasibility of the study, Bonferroni correction was performed.ResultsLevels of C hemokine C-X-C motif ligand 6 (CXCL6), matrix metalloproteinase-1 (MMP-1), hepatocyte growth factor (HGF), interleukin-10 (IL-10), chemokine C-X3-C motif ligand 1 (CX3CL1), and TNF-related activation-induced cytokine (TRANCE) were causally associated with acute bronchitis. MMP-1 level [OR: 1.239 0, 95%CI: 1.111 6-1.382 2, P<0.000 5] had a significant causal relationship with acute bronchitiss and played a promoting role. Levels of macrophage inflammatory protein-1α (MIP-1α), signaling lymphocyte activating molecules, and FMS-associated tyrosine kinase 3 ligand (FIt3L) were potentially causally associated with acute bronchiolitis. There was a potential causal relationship between C-X-C motif chemokine 5 (CXCL5), T cell surface glycoprotein CD6 subtype (CD6), fibroblast growth factor 19 (FGF-19), C-C motif chemokine 23 (CCL23), monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor ligand superfamily member 12 (TNFSF12) levels and acute laryngitis and tracheitis. In reverse Mendelian randomization analysis, there were no positive results between acute bronchitis, acute bronchiolitis and 91 inflammatory factors. Acute laryngitis and tracheitis [OR: 1.076 3,95%CI: 1.012 9-1.143 7, P=0.017 6] were potentially causally associated with FGF-19 levels. Conclusions MMP-1 level have a significant causal relationship with acute bronchitis. The levels of other inflammatory factors such as CXCL6, HGF, MIP-1 alpha, FIt3L, CXCL5, FGF-19 are potentially causally associated with respiratory tract infections. MMP-1 may be an important target for the prediction or treatment of acute bronchitis.
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 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.
【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。
Objective To investigate the relations between the human beta defensin-2 (HBD-2) and systemic inflammatory responses in patients with lower respiratory tract infection（LRTI）. Methods Eighty-one patients with confirmed LRTI including community-acquired pneumonia，acute exacerbation of chronic obstructive pulmonary disease or concurrent lung infection，and bronchiectasis concurrent infection were enrolled，and twenty healthy volunteers were included as control. Plasma concentrations of HBD-2，IL-1β，and IL-8 were assayed with ELISA method in all patients and controls. Furthermore the patients were divided into three groups according to the onset of disease:,ie.group A （shorter than 7 days），group B （7 to 14 days），and group C （more than 14 days）. The differences between these groups were compared. Correlation between HBD-2 and IL-1β or IL-8 concentrations was analyzed. Results HBD-2，IL-1β，white blood cell （WBC） of the peripheral blood in the patients with LRTI were all significantly higher than those in the healthy controls. HBD-2 and IL-1β increased in group A and group B，and decreased in group C comparing to the control group （Plt;0.05 respectively）. There was no significant difference of IL-8 in group A，B and C. HBD-2 showed a positive linear correlation with IL-1β （r=0.313，P=0.030） and no correlation with IL-8（Pgt;0.05）. Conclusions The plasma HBD-2 concentration is increased in LRTI patients，which may be a biomarker of systemic inflammation in the early or relative early course of LRTI.
Objective To evaluate the clinical efficacy and safety of pazufloxacin for the treatment of moderate and severe acute bacterial respiratory infections.Methods A multicenter randomized controlled trial was conducted to compare the efficacy and safety of pazufloxacin versus levofloxacin. Patients in the pazufloxacin group were treated with pazufloxacin (500 mg twice daily for 7 to 10 days), and patients in the levofloxacin group were treated with levofloxacin (300 mg twice daily for 7 to 10 days). Results A total of 134 patients were enrolled in the study, 68 cases in pazufloxacin group and 66 cases in levofloxacin group were assessable for clinical efficacy by full analysis set(FAS). At the end of the treatment, in FAS analysis the total cure rates and effective rates were 52.9% and 86.7% in pazufloxacin group, 57.6% and 87.9% in levofloxacin group, in PPS analysis the total cure rats and effective rates were 57.1% and 93.7% in pazufloxacin group respectively, 61.3% and 93.6% in levofloxacin group. The bacterial clearance rates were 92.5% and 94.3% respectively. There were no statistically significant differences between the two groups. Adverse reactions were observed in 16.2% of patients in the pazufloxacin group and in 16.7% of patients in the levofloxacin group. These reactions were mainly local stimulation, nausea and diarrhea. No serious adverse event was reported in either group. Conclusion Pazufloxacin is as effective and safe as levofloxacin for the treatment of moderate to severe acute respiratory infections.
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.