Objective A comparative study of in-hospital mortality and risk factors of ventilator-associated pneumonia (VAP) caused by carbapenem-resistant gram-negative bacteria (CRGNB) and non-carbapenem-resistant gram-negative bacteria (nCRGNB) in China was conducted to investigate whether there is a higher in-hospital mortality of VAP caused by CRGNB and its unique associated risk factors. Methods Relevant literatures published at home and abroad in PubMed, EMBASE, Cochrane library, Web of Science, CNKI and Wanfang databases were retrieved from the date of establishment to June 1, 2021, and the quality of the included literatures was evaluated using Newcastle-Ottawa scale. Meta-analysis of literatures meeting the criteria was performed using RevMan 5.3 software. Results A total of 5 literatures were included, all of which were case-control studies with a total of 574 cases, including 302 cases in the CRGNB group and 272 cases in the nCRGNB group. The results showed that the in-patient mortality of VAP caused by CRGNB infection was significantly increased compared with that of VAP caused by nCRGNB infection (OR=2.51, 95%CI 1.71 - 3.67, P<0.00001). Risk factor analysis of CRGNB infection showed that statistically significant risk factors included mechanical ventilation duration ≥7 days (OR=2.66, 95%CI 1.23 - 5.75, P=0.01), secondary intubation (OR=4.48, 95%CI 2.61 - 7.69], P<0.00001), combined with antibiotics (OR=2.83, 95%CI 1.76 - 4.54, P<0.0001), using carbapenem antibiotics (OR=2.78, 95%CI 1.76 - 4.40, P<0.0001). In addition, two studies showed that tigecycline was sensitive to CRGNB in vitro. Conclusions Compared with nCRGNB-induced VAP, CRGNB infection significantly increases the in-hospital mortality of VAP patients in China, indicating that the in-hospital mortality of CRGNB infection is related to drug resistance, and had little relationship with region and drug resistance mechanism. Among them, mechanical ventilation duration ≥7 days, secondary intubation, combined use of antibiotics and carbapenem antibiotics are risk factors for CRGNB infection in VAP patients. Tigecycline is sensitive to most CRGNB strains in China and is an important choice for the treatment of CRGNB in China.
Objective To elucidate the clinical features of patients with non-HIV-infected pulmonary cryptococcosis, and provide a basis for early clinical identification, standardized diagnosis and treatment. Methods Clinical data of 80 patients with non-HIV-infected pulmonary cryptococcosis diagnosed in Beijing Chest Hospital from January 2018 to July 2025 were retrospectively analyzed, including demographic characteristics, clinical manifestations, laboratory examinations, pulmonary imaging findings, treatment and prognosis. Results Among the 80 patients, males accounted for the majority (66.3%). Common clinical manifestations included cough (22.5%), expectoration (12.5%) and fever (10.0%). Laboratory tests showed that the positive rate of serum cryptococcal antigen was 32.8%, and the patients with blood type O had a higher infection rate (42.5%). Pulmonary function testing revealed abnormalities in a subset of patients (30%), primarily manifesting as small airway dysfunction. Pathologically, both Grocott's methenamine silver (GMS) and periodic acid-Schiff (PAS) stains were found to effectively demonstrate Cryptococcus organisms in this study. Imaging findings were mainly characterized by pulmonary nodules/masses (70.0%) and patchy infiltrates (20.0%). More than half of the patients presented with involvement of a unilateral lung or the lower lungs. Cavitary lesions were present in 32 patients (40%). Univariate logistic regression analysis indicated that pulmonary opacities, cryptococcal antigen positivity, and AB blood type were potentially associated with cavity formation (P<0.05). Subsequent multivariate analysis identified positive cryptococcal antigen (P=0.001) and AB blood type (P=0.024) as independent risk factors for pulmonary cavitation. The patients with cavitary lesions had longer hospital stays. The overall effective rate of fluconazole treatment in the non-HIV-infected pulmonary cryptococcosis patients was 93.2%, indicating a generally favorable prognosis. However, prolonged hospitalization was significantly associated with poorer pulmonary function (P=0.037) and the presence of pulmonary cavities (P=0.017). Significant differences were observed between patients who did and did not receive antifungal therapy in several clinical parameters: clinical symptoms (P<0.001), pulmonary opacities (P<0.001), serum cryptococcal capsular antigen titer (P=0.013), absolute CD4 count (P=0.031), absolute neutrophil count (P=0.040), and C-reactive protein level (P=0.001). The effective rate of fluconazole treatment was 93.2%, and most patients had a favorable prognosis. Conclusions Pulmonary cryptococcosis in non-HIV-infected patients lacks specific clinical manifestations and is radiographically characterized by nodular masses and cavitations. The presence of cavitary lesions and pulmonary dysfunction suggests a prolonged treatment course. While prognosis following fluconazole therapy is generally favorable, clinical symptoms, radiographic findings, cryptococcal antigen titers, absolute CD4 count, absolute neutrophil count, and C-reactive protein levels may influence the selection of antifungal therapy. Clinicians should raise awareness of this disease, especially distinguishing it from malignant tumors such as lung cancer.