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 explore clinical effect of failure mode and effect analysis in improving the submission rate of pathogen examination in counterpart supported high-altitude county hospitals, and formulate practical measures and methods suitable for high-altitude county hospitals to improve the submission rate of pathogen examination. Methods Patients admitted to the People’s Hospital of Ganzi County between January and December 2024 were selected. The data of hospitalized patients between January and June 2024 were as the control group, and the data of hospitalized patients between July and December 2024 were as the intervention group. The study analyzed and compared the submission rate of pathogen testing and the pass rate of microbiological test specimens before antimicrobial treatment between the two groups. Results A total of 3 984 patients were included. Among them, there were 1 748 cases in the control group and 2 236 cases in the intervention group. A total of 10 risk factors and 2 high-risk points were identified. There were statistically significant differences in the submission rate of pathogen specimens before antibiotic treatment [36.21% (633/1 748) vs. 49.33% (1 103/2 236); χ2=68.646, P<0.001] and the qualified rate of microbiological test specimens [26.75% (122/456) vs. 36.45% (261/716); χ2=11.910, P=0.001] between the control group and the intervention group. Conclusions Failure mode and effect analysis can effectively find out the weak points in low pathogen examination submission rate in high-altitude county hospitals. According to the high-risk points to guide the formulation of relevant measures, the pathogen submission rate in the region can be effectively improved.
Objective To preliminarily understand the equipment configuration and information system function improvement of the microbiology laboratory for etiological submission before antibiotic treatment in Chinese medical institutions, and provide a scientific basis for further targeted action work on the rate of etiological submission before antibiotic treatment. Methods A network questionnaire was released in “Sentinel Hospital Information Reporting System of National Hospital Infection Management Professional Quality Control Center” between March 1 and June 21, 2022. The second-level and above hospitals were investigated. Results A total of 783 hospitals were included, of which 765 (97.7%) hospitals had been equipped with microbiology laboratory equipment to varying degrees, and the allocation rate of tertiary hospitals was higher than that of secondary hospitals (P<0.05). The top three items of common pathogenic test were aerobic (98.3%), bacterial smear (97.6%) and fungal smear (95.1%), and the last three items were streptococcus pneumoniae urine antigen (20.4%), silver hexamine staining (19.0%) and gene sequencing (8.9%). The comparison of relevant information system and function improvement among hospitals of different levels showed that tertiary hospitals were superior to secondary hospitals (P<0.05). In different regions, except for the allocation rate of nosocomial infection information monitoring system and rational drug use monitoring system (P>0.05), other relevant systems and functional improvement of hospitals in eastern, central and western regions, the differences were statistically significant (P<0.05). The number of hospitals that could obtain the indicators of “etiological submission rate of inpatients before antibiotic treatment”“etiological submission rate related to hospital infection diagnosis”“etiological submission rate before combined use of key drugs” were 698 (89.1%), 474 (60.5%) and 337 (43.0%), respectively. Among the factors affecting the implementation of special actions, 454 hospitals (58.0%) thought that the information system was not fully functional, 341 hospitals (43.6%) thought that the etiology testing project was not fully carried out, and 148 hospitals (18.9%) thought that the microbiology laboratory testing ability was insufficient. Conclusion All kinds of hospitals at all levels in China, especially specialized and secondary hospitals, need to further improve the configuration of equipment and information system functions in the microorganism laboratory related to aetiology inspection, strengthen the support for microbial inspection, and strengthen information management, monitoring and analysis.
Organ transplantation is a critical treatment for end-stage organ diseases, yet postoperative infections significantly affect patient outcomes. Traditional diagnostic methods for infections often fall short in meeting the demands of precise prevention and treatment due to limitations in sensitivity, specificity, and speed. Targeted nanopore pathogen sequencing technology, characterized by its long-read capability, real-time detection, and adaptability, has shown unique potential in pathogen identification, structural variation analysis, and antimicrobial resistance gene profiling. This offers new insights into the prevention and management of postoperative infections. This expert consensus focuses on the standardized application of this technology in managing infections following organ transplantation, addressing its principles, clinical recommendations, and diagnostic workflows. By exploring its features and value in infectious disease diagnosis, the expert consensus provides standardized guidance on sample processing and result interpretation. The development of this consensus aims to promote the rational use of nanopore sequencing in diagnosing and treating post-transplant infections, enhance diagnostic accuracy and efficiency, improve patient outcomes, and facilitate the widespread adoption of this technology.
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 analyze the clinical features and etiologic of community-acquired pneumonia (CAP) among the elderly aged 80 and over, and provide evidence for clinical diagnosis and treatment. Methods The clinical characteristics and etiology of the elderly CAP (≥80 years old) were analyzed by collecting and comparing the clinical characteristics and etiology between the very elderly CAP group (≥80 years old, 94 cases) and control group (65 to 79 years old, 100 cases). Results On clinical symptoms, there were statistical differences in dyspnea and gastrointestinal symptoms, systemic symptoms, and mental status (P<0.05) between the two groups. There was no statistically significant difference in upper respiratory tract symptoms, fever, cough, sputum, hemoptysis and chest pain between the two groups (P>0.05). On the complications, the very elderly CAP group was more prone to respiratory failure, sepsis, urinary tract infection and electrolyte metabolism than the control group (P<0.05). On the experimental indicators, anemia and abnormal renal function in the elderly CAP group were high (P<0.05). There was no statistical difference between the two groups of inflammation indicators (white blood count, procalcitonin, C-reactive protein, erythrocyte sedimentation rate, neutrophil alkaline phosphatase score). The pneumonia severity index score and CURB-65 score of the very elderly CAP group were significantly higher than those of the control group (P<0.001). On pathogen analysis, in the very elderly CAP group the number of bacterial infections (23/94), viral infections (21/94) and bacterial mixed virus infections (21/94) were probably equivalent, and the proportion of bacterial infections of two or more types accounted for 17.0% (16/94); The bacteria detection rate was Streptococcus pneumoniae (22.4%), Pseudomonas aeruginosa (19.4%), Stenotrophomonas maltophilia (16.4%), Staphylococcus aureus (14.9%). Viral infection mainly focused on influenza A virus (23/94) and human cytomegalovirus (21/94). Bacterial mixed virus infection was mainly caused by Streptococcus pneumoniae and influenza A virus infection. Comparing the two groups, the most common bacterial pathogen both of them was Streptococcus pneumoniae, but the overall proportion was dominated by gram-negative bacteria, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Acinetobacter baumannii and Klebsiella pneumoniae were more common; the gram-positive bacteria in the two groups were mainly Streptococcus pneumoniae and Staphylococcus aureus. There was no significant difference in the detection rate of above Gram-positive bacteria between the two groups (P>0.05). The two groups of virus infections were mainly influenza A virus, and the difference was not statistically significant (P>0.05). The two groups of single bacteria rate, single virus infection rate, double virus infection rate and bacterial mixed virus infection rate were similar, the difference had not been found (P>0.05). Conclusions The elderly (aged 80 and over) CAP group is prone to dyspnea, often presents with extrapulmonary atypical symptoms such as digestive tract symptoms, systemic symptoms and psychiatric symptoms, and usually accompanied with many complications. The etiological treatment mainly covers gram-negative bacteria, and we must pay attention to the possibility of combined virus infection.
Objective To investigate the distribution and antibiotic resistance of pathogens isolated fromlower respiratory tract in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) . Methods The patients with AECOPD, who were hospitalized in RICU from January 2008 to November 2009, were divided into a community infection group and a nosocomial infection group. Lower respiratory tract isolates were collected by bronchoscopic protected specimen brush for bacterial identification and susceptibility test. Results 134 cases were enrolled in the study, with 75 cases in thecommunity infection group and 59 cases in the nosocomial infection group. The positive detection rate in the nosocomial infection group was significantly higher than that in the community infection group [ 81. 4%( 48/59) vs. 54. 7% ( 41/75) ] . In the community infection group, 49 strains were isolated, in which gramnegativebacteria, gram-positive bacteria, and fungi accounted for 55. 1% , 28. 6% , and 16. 3% , respectively.In the nosocomial infection group, 55 strains were isolated, in which gram-negative bacteria, gram-positive bacteria, and fungi accounted for 61. 8% , 21. 8% , and 16. 4%, respectively. There was no significant difference in the microbial distribution between the two groups ( P gt; 0. 05) . The detection rate of ESBLs producing strains in the nosocomial infection group was significantly higher than that in the community infection group ( 58. 8% vs. 37% ) . The resistance rates in the nosocomial groups were higher than those in the community infection group. Conclusions Antibiotic resistance is serious in mechanically ventilated patients with AECOPD, especially in the nosocomial infection patients. The increased fungi infection and drug resistance warrant clinicians to pay more attention to rational use of antibiotics, and take effective control measures.
Objective To analyze the etiology, risk factors, and prognosis of late-onset hospitalacquired pneumonia ( L-HAP) in respiratory ICU. Methods In this retrospective case control study, 30 L-HAP patients and 30 patients without HAP in respiratory ICU were enrolled to investigate the features and risk factors of L-HAP. Stratification was made according to the onset time of L-HAP. The etiology and pathogen distribution at each stage were described and analyzed. Results Univariate analysis revealed thatunconsciousness, aspiration, mechanical ventilation, hypoalbuminemia, and long-term use of proton pump inhibitor were significantly associated with L-HAP. Logistic regression analysis revealed that mechanical ventilation( OR = 8. 7) and hypoalbuminemia ( OR = 20. 4) were independent risk factors for L-HAP. The L-HAP patients had longer stay in hospital, long-termantibiotic use, and higher mortality compared with the patients without HAP. For the patients whose L-HAP onset time within 6-14 days, the dominated pathogens were Acinetobacter baumannii and Klebsiella pneumonia. For those within 15-28 days, the dominated pathogens were Pseudomonas aeruginosa, Acinetobacter baumanni, and Staphylococcus aureus. For those beyond 29 days, the dominated pathogens were Pseudomonas aeruginosa and Stenotrophomonas maltophilia. Conclusions Mechanical ventilation and hypoalbuminemia are independent risk factors for L-HAP. The pathogen features of L-HAP are quite different at different inhospital stage.
Objective To investigate the etiology, symptoms, diagnosis, surgical treatment, and outcomes of acute necrotizing mediastinitis (ANM) in order to guide future diagnosis and treatment of ANM. Methods The clinical data of patients with ANM referred to West China Hospital, Sichuan University from March 2012 to April 2021 were retrospectively analyzed. The etiology, clinical manifestations, demographic characteristics, bacterial culture results, surgical approach and prognostic factors of these patients were summarized. ResultsA total of 176 patients were enrolled in this study. The median age was 60 ( 0-84) years. There were 124 (70.5%) males and 52 (29.5%) females. The most common origin of infection was neck (n=66, 37.5%). The most common symptom was fever (n=85, 48.3%). Streptococcus constellatus represented the most common pathogens in secretion culture. Surgical treatment was administered to 119 (67.6%) patients through different approaches, including 54 (30.7%) patients of cervical approach, 9 (5.1%) patients of thoracotomy, 18 (10.2%) patients of video-assisted thoracoscopic surgery (VATS), 7 (4.0%) patients of cervical combined with thoracotomy, 30 (17.0%) patients of cervical combined with VATS, and 1 (0.6%) patient of subxiphoid approach. Among this cohort, 144 (81.8%) patients were cured, while 32 (18.1%) patients died. Age-adjusted Charlson comorbidity index (OR=2.95, P=0.022), perioperative sepsis (OR=2.84, P=0.024), and non-surgical treatment (OR=2.41, P=0.043) were identified as independent predictors of poor outcomes. Conclusion For patients with corresponding history and manifestations of ANM, it is crucial to go through imaging examination to confirm the presence of an abscess and guide the selection of surgical approach. Once the diagnosis of ANM is made, it is imperative to promptly perform surgical intervention for effective drainage. Our study highlights the significance of age-adjusted Charlson comorbidity index, perioperative sepsis and surgical treatment in predicting patients’ outcomes.
Objective To investigate the epidemical status of influenza in Mianyang during 2010-2011, so as to provide evidence for formulating prevention and control strategies. Methods Surveillance data, ILI etiological results, outbreak and epidemic situation of the influenza-like illnesses (ILI) in Mianyang during 2010-2011 were collected for analysis. Results There were 12 100 ILI cases reported in 2010, accounted for 2.72% of the total outpatients. While 8 364 ILI cases accounted for 1.83% of the total outpatients were reported in 2011, reduced by 32.47% compared with 2010. The temporal distribution of doctor-visiting ratio in those two years was in an increased bimodal pattern. Most cases were children aged 0-5 years, accounted for 46.24%. Most ILI cases were treated in the department of fever, accounted for 88.56%. A total of 788 ILI specimens were collected for the detection of Real time RT-PCR, of which 34 specimens showed positive strains (4.31%) including 5 influenza A/H1N1 (0.63%), 8 influenza A (1.02%), 1 seasonal influenza A/H3 (0.13%) and 20 influenza B (2.54%). No outbreak and epidemic situation in Mianyang during 2010-2011. Conclusion The influenza activity is relatively stable without large-scale outbreak in Mianyang during 2010-2011. The reporting quality of surveillance hospitals should be improved and the lab of flu surveillance network should actively prepare to do the isolation and identification of influenza virus. It is necessary to enhance flu surveillance so as to prevent and control influenza prevalence．