- [Clinical characteristics and prognosis of long-term glucocorticoid users with community-acquired pneumonia]. [Journal Article]
- ZYZhonghua Yi Xue Za Zhi 2018 Mar 13; 98(10):738-743
- Objective: To explore the clinical features, etiological features and prognostic risk factors of long-term glucocorticoid users with community-acquired pneumonia (CAP).Methods:A r...
Objective: To explore the clinical features, etiological features and prognostic risk factors of long-term glucocorticoid users with community-acquired pneumonia (CAP).Methods:A retrospective study included 100 long-term glucocorticoid users with CAP (G-CAP group) from 11 hospitals of China between January 2014 and December 2014, while 100 non-immunocompromised patients with community-acquired pneumonia were enrolled as controls (nICH-CAP group). Characteristics including age, gender, underlying diseases, corticosteroids, symptoms, disease severity, imaging manifestations, etiology, respiratory failure, mechanical ventilation, whether the application of vasoactive drugs, antibiotics application, hospital mortality rate between the two groups were compared, and the prognostic factors of G-CAP were investigated using Logistic regression.Results:The peripheral blood lymphocytes[1.06(0.70, 1.68) vs 1.44 (0.87, 1.98)]in G-CAP group was less than nICH-CAP group (P<0.05). CT with pulmonary interstitial change (28.6% vs 9.9%), the proportion of patients with respiratory failure (25.0% vs 7.0%), mechanical ventilation (9.0% vs 2.0%), noninvasive mechanical ventilation (12.0% vs 2.0%), septic shock (9.0% vs 2.0%), and the hospital mortality rate (13.0% vs 3.0%) in G-CAP group were significantly higher than in nICH-CAP group (allP<0.05). Bacterial infection accounted for the highest proportion of infection (61.3%) in G-CAP group, but also virus infection (19.4%) and mixed infection (16.1%). Pseudomonas accounted for the highest proportion (47.4%) in bacterial infection of G-CAP. Logistic regression analysis showed that peripheral blood lymphocytes (OR=0.004, 95%CI:0.000-0.234;P<0.05) and respiratory failure (OR=17.766, 95%CI:4.933-131.0;P<0.05) were independent predictors of death in G-CAP group.Conclusions:The proportion of severe pneumonia and the mortality rate of patients with G-CAP are higher than the patients with nICH-CAP. Lymphopenia and respiratory failure are associated with poor outcome of patients with G-CAP.
- Comparison of patients with avian influenza A (H7N9) and influenza A (H1N1) complicated by acute respiratory distress syndrome. [Journal Article]
- MMedicine (Baltimore) 2018; 97(12):e0194
- The aim of this study was to compare the clinical features of patients with avian influenza A (H7N9) and influenza A (H1N1) complicated by acute respiratory distress syndrome (ARDS).The clinical data...
The aim of this study was to compare the clinical features of patients with avian influenza A (H7N9) and influenza A (H1N1) complicated by acute respiratory distress syndrome (ARDS).The clinical data of 18 cases of H7N9 and 26 cases of H1N1 with ARDS were collected and compared in the respiratory intensive care unit (RICU) of Fuzhou Pulmonary Hospital of Fujian from March 2014 to December 2016.Patients with H7N9 had a higher acute physiology and chronic health evaluation-II score (P < .05) and lung injury score (P < .05). The rates of coexisting diabetes mellitus, hyperpyrexia, and bloody sputum production were significantly higher in the H7N9 group than in the H1N1 group (P < .05). The H7N9 group had a longer duration of viral shedding from the onset of illness (P < .05) and from the initiation of antiviral therapy (P < .05) to a negative viral test result than the H1N1 group. Patients with H7N9 had higher rates of invasive mechanical ventilation; serious complications, including alimentary tract hemorrhage, pneumothorax or septum emphysema, hospital-acquired pneumonia (HAP) and multiple organ dysfunction syndrome (MODS); and hospital mortality (P < .05). At the 6th month of follow-up, the rates of bronchiectasia, reticular opacities, fibrous stripes, and patchy opacities on chest computed tomography (CT) were significantly higher in the H7N9 group than in the H1N1 group (P < .05). Based on multiple logistic regression analysis, H7N9 influenza viral infection was associated with a higher risk of the presence of severe ARDS than H1N1 influenza viral infection (odds ratio 8.29, 95% confidence interval [CI] 1.53-44.94; P < .05).Compared to patients with H1N1, patients with H7N9 complicated by ARDS had much more severe disease. During long-term follow-up, more changes in pulmonary fibrosis were observed in patients with H7N9 than in patients with H1N1 during the convalescent stage.
- Successful Tigecycline Use in Combined Therapy of Ventilator-Associated Hospital-Acquired Pneumonia: a Clinical Case. [Journal Article]
- AKAntibiot Khimioter 2016; 61(11-12):48-55
- In patients under artificial lung ventilation (ALV) there is often observed development of severe ventilator-associated pneumonia (VAP) due to polyresistant hospital pathogens. It should be noted tha...
In patients under artificial lung ventilation (ALV) there is often observed development of severe ventilator-associated pneumonia (VAP) due to polyresistant hospital pathogens. It should be noted that in the patient described here with the initial diagnosis of community-acquired pneumonia rapidly subjected to prolonged ALV the previous antibacterial therapy by broad spectrum drugs significantly increased the risk of contamination just by multiresistant nosocomial strains, which hampered the starting therapy of nosocomial pneumonia either when there were not available or sometimes there were available microbial cultures. When the treatment of severe pneumonias caused by multiresistant hospital flora resistant to carbapenems is actual, in the alternative therapy it could be used tigecycline, a tetracycline from the group of glycylcyclines. A case of successful treatment of nosocomial VAP by tigecycline based on the results of the bronchoalveolar lavage (BAL) culture is described. The case is of interest because tigecycline was used as off label.
- Inpatient management of community-acquired pneumonia at the European Gaza Hospital: a clinical audit. [Journal Article]
- LctLancet 2018 Feb 21; 391 Suppl 2:S40
- CONCLUSIONS: Clinicians were poorly adherent to current standards of care in severity assessment and management of community-acquired pneumonia. Moreover, the broad range of antibiotic regimes used, without microbiological guidance, was inappropriate and will have increased the risk of antibiotic resistance. A local evidence-based clinical practice guideline should be developed and implemented. Furthermore, the documentation system should be improved to enhance the continuity of care and clinical auditing.
- Role of viral and bacterial pathogens in causing pneumonia among Western Australian children: a case-control study protocol. [Journal Article]
- BOBMJ Open 2018 03 16; 8(3):e020646
- Pneumonia is the leading cause of childhood morbidity and mortality globally. Introduction of the conjugateHaemophilus influenzaeB and multivalent pneumococcal vaccines in developed countries includi...
Pneumonia is the leading cause of childhood morbidity and mortality globally. Introduction of the conjugateHaemophilus influenzaeB and multivalent pneumococcal vaccines in developed countries including Australia has significantly reduced the overall burden of bacterial pneumonia. With the availability of molecular diagnostics, viruses are frequently detected in children with pneumonia either as primary pathogens or predispose to secondary bacterial infection. Many respiratory pathogens that are known to cause pneumonia are also identified in asymptomatic children, so the true contribution of these pathogens to childhood community-acquired pneumonia (CAP) remains unclear. Since the introduction of pneumococcal vaccines, very few comprehensive studies from developed countries have attempted to determine the bacterial and viral aetiology of pneumonia. We aim to determine the contribution of bacteria and viruses to childhood CAP to inform further development of effective diagnosis, treatment and preventive strategies.
- Community-acquired necrotizing pneumonia with bacteremia caused by Pseudomonas aeruginosa in a patient with emphysema: An autopsy case report. [Journal Article]
- RIRespir Investig 2018; 56(2):189-194
- We report the case of a 47-year-old man with chronic obstructive pulmonary disease who was referred to our hospital for acute dyspnea. The radiologic findings revealed consolidation with a cavity in ...
We report the case of a 47-year-old man with chronic obstructive pulmonary disease who was referred to our hospital for acute dyspnea. The radiologic findings revealed consolidation with a cavity in the left upper lobe of the lung. Blood/sputum cultures detected Pseudomonas aeruginosa. Despite intensive care, the patient died from respiratory failure. Autopsy revealed multiple small necrotizing cavities that had coalesced. Although P. aeruginosa is a known causative pathogen of community-acquired pneumonia in patients with structural lung disease, the radiologic findings were non-specific. Irrespective of imaging findings, P. aeruginosa should be considered a cause of community-acquired pneumonia.
- Recent trends in practice patterns and impact of corticosteroid use on pediatric Mycoplasma pneumoniae-related respiratory infections. [Journal Article]
- RIRespir Investig 2018; 56(2):158-165
- CONCLUSIONS: Increasing trends in fluoroquinolone use and decreasing trends in macrolide use were observed. Our study did not prove the benefits of corticosteroid use. Further studies are required to confirm the clinical benefits of corticosteroid treatment.
- Multidimensional Prognostic Index (MPI) and Proadrenomedullin plasma levels in predicting one-month mortality risk in older patients hospitalized with community-acquired pneumonia (CAP): a prospective study. [Journal Article]
- PMPanminerva Med 2018 Mar 15
- CONCLUSIONS: ProADM may significantly improve the prognostic accuracy of the MPI at admission in hospitalized elderly patients with CAP.
- Acute Respiratory Distress Syndrome in Mechanically-Ventilated Patients with Community-Acquired Pneumonia. [Journal Article]
- EREur Respir J 2018 Mar 15
- Question:To assess the incidence, characteristics, aetiology, risk factors and mortality of acute respiratory distress syndrome (ARDS) in ICU patients with community-acquired pneu...
Question:To assess the incidence, characteristics, aetiology, risk factors and mortality of acute respiratory distress syndrome (ARDS) in ICU patients with community-acquired pneumonia (CAP) using the Berlin definition.Methods:We prospectively enrolled consecutive mechanically-ventilated ICU adults with CAP over 20 years, compared with mechanically-ventilated patients without ARDS. The main outcome was 30-day mortality.Results:Among 5,334 patients hospitalized with CAP, 930 (17%) were admitted to the ICU, and 432 required mechanical ventilation; 125 (29%) cases met the Berlin ARDS criteria. ARDS was present in 2% of hospitalized patients and 13% of ICU patients. Based on the baseline PaO2/FiO2, 60 (48%), 49 (40%), and 15 (12%) patients had mild, moderate, and severe ARDS, respectively.Streptococcus pneumoniaewas the most frequent pathogen, with no significant differences in aetiology between groups. Higher organ system dysfunction and previous antibiotic use were independent risk factors for ARDS in the multivariate analysis, while previous inhaled corticosteroids was independently associated with a lower risk. The 30-day mortality was similar between patients with and without ARDS (25% vs. 30%, p=0.25), confirmed by propensity-adjusted multivariate analysis.Conclusions:ARDS occurs as a complication of CAP in 29% of mechanically-ventilated patients, but is not related to the aetiology or mortality.
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- CURB-65 Score is Equal to NEWS for Identifying Mortality Risk of Pneumonia Patients: An Observational Study. [Journal Article]
- LUNGLung 2018 Mar 14
- CONCLUSIONS: CURB-65 was not demonstrated to be significantly statistically better than NEWS at identifying CAP patients at risk of 30-day mortality.