Objective To observe the gamma-glutamyltransferase ( GGT) activity and total antioxidant capacity ( T-AOC) in serum and platelet during the course of community-acquired pneumonia ( CAP) . Methods Ninety cases of hospitalized CAP were recruited from the respiratory wards in the Affiliated Hospital of XuzhouMedical College fromSeptember 2010 to September 2011, and 30 healthy cases who underwent physical examination in the same hospital were enrolled as control. GGT activity and T-AOC were compared between the CAP patients and the control subjects, and also between the CAP patients who developed reactive thrombocytosis ( platelet count gt;300 ×109 /L) and those without thrombocytosis ( platelet count ≤300 ×109 /L) . Results Compared with the control subjects, serumand platelet GGT activity of the CAP patients were significantly higher [ ( 45. 6 ±25. 4) U/L vs. ( 17. 9 ±3. 7 ) U/L, ( 179. 9 ±41. 3) mU/109plt vs. ( 49. 5 ±8. 0) mU/109plt, P lt; 0. 05] , serum T-AOC at admission was significantly lower [ ( 12. 6 ±1. 6) U/mL vs. ( 17. 7 ±2. 1) U/mL, P lt; 0. 05] , and platelet T-AOC at admission was significantly higher [ ( 61. 6 ±18. 3) mU/109plt vs. ( 48. 6 ±9. 9) mU/109 plt, P lt; 0. 05] . Platelet T-AOC of the CAP patients at discharge was significantly lower than that of the CAP patients at admission and the control subjects. Compared with the CAP patients without thrombocytosis, serum T-AOC and serum GGT activity of the CAP patients who developed reactive thrombocytosis were significantly higher( P lt;0. 05) , and platelet T-AOC and platelet GGT activity were both significantly lower ( P lt; 0. 05) . There were negative correlations of the platelet count with platelet T-AOC and GGT activity in the CAP patietns( r = - 0. 316,P =0.003; r = - 0. 318, P =0. 002) . Conclusions There is a correlation between the oxidative stress and the platelet function in the inflammatory process of CAP. There might be an indicative role of platelets in resolving the inflammatory process and in maintaining the oxidative-antioxidative balance.
Objective To establish a model for prognosis analysis of severe community-acquired pneumonia in order to find the independent risk factors for mortality. Methods The data of 88 patients with severe community-acquired pneumonia enrolled from 533 community-acquired pneumonia patients in Fujian Provincial Hospital from April 2012 to December 2015 were analyzed, they were divided into a survival group and a death group according to prognosis. The clinical materials of basic data of the population, clinical manifestation, treatment and prognosis and pulmonary severity indexes were collected. Then univariate analysis was used to screen risk factors of death before logistic multivaritae regression was applied to explore independent risk factors. Results The different pathogen groups including viral, bacterial, mixed infection, negative and other groups were compared and no differences were found in mortality (all P>0.05). Univariate analysis revealed antibiotics treatment before admission, higher APACHEⅡ score, higher Chalison's score, septicopyemia, and higher level of procalcitonin, blood urea nitrogen (BUN), blood glucose, lactate could increase death risk for the patients. While antiviral treatment and no invasive mechanical ventilation were determined as protective factors. Logistic multivaritae regression showed three factors including higher lactate and higher serum BUN and higher heart rates were independent death risk factors [OR values were 4.704 (95%CI 0.966-22.907), 1.264 (95%CI 0.994-1.606), and 1.081 (95%CI 1.003-1.165), respectively]. Whereas no invasive mechanical ventilation was protective factor (OR=0.033, 95%CI 0.001-0.764). Conclusion The patients with higher lactate and BUN, higher heart rate and accepting invasive mechanical ventilation have poor prognosis.
Objective To measure the expression level of Myc-interacting zinc finger protein-1 (MIZ1) in peripheral blood mononuclear cells (PBMC) of patients with severe and non-severe community-acquired pneumonia (CAP) and its relationship with inflammatory factors. Methods Thirty-six CAP patients from Beijing Chaoyang Hospital from April 2018 to June 2019 were enrolled in this study. MIZ1 mRNA level in PBMC were measured by reverse transcriptase-quantitative polymerase chain reaction. The levels of interleukin (IL)-6, IL-8, IL-10, and interferon-α in the serum of patients were measured by enzyme-linked immunosorbent assay. The levels of MIZ1 mRNA and inflammatory factors were compared between the severe CAP patients and the non-severe CAP patients. Results Compared with non-severe CAP patients, the MIZ1 mRNA level in the PBMC of severe CAP patients was lower (P<0.05) than non-severe group. Receiver operating characteristic (ROC) curve of the expression level of MIZ1 in PBMC was calculated according to whether CAP was severe or non-severe, and the area under ROC curve was 0.731 (P=0.018). Spearman correlation analysis showed that MIZ1 mRNA was negatively correlated with IL-10 level in the severe CAP patients (Spearman correlation co-efficient was –0.620, P<0.05). Conclusions MIZ1 may indicate the severity of CAP. MIZ1 may affect IL-10 so as to play a role in inflammation regulation.
ObjectiveTo explore the efficacy of community-acquired pneumonia (CAP) by tracheoscopy intervention altimeter and analyze and compare its financial burden.MethodsRetrospective analysis of 419 hospitalized patients with CAP was carried in respiratory medicine department of four hospitals from July 1, 2017 to August 31, 2018 (Changhai Hospital, Shanghai First People’s Hospital, Baoshan Branch of Shanghai First People’s Hospital, and Baoshan Integrated Traditional Chinese and Western Medicine Hospital). According to the time of tracheoscopy intervention treatment, they were divided into 3 groups: 127 patients treated with tracheoscopy intervention during the initial treatment period (within 72 h after obtaining imaging diagnosis) were included in an early intervention group, 158 patients treated with tracheoscopy intervention 72 h after obtaining imaging diagnosis were included in a medium-term intervention group, and 134 patients treated without tracheoscopy intervention were included in a non-intervention group. The total efficiency of treatment, improvement of clinical symptoms, imaging absorption, serum inflammation index level, sputum culture positive rate, change rate, efficiency after drug change, hospital stay and hospitalization cost were compared among three groups.ResultsThe total efficiency of treatment in the early intervention group was higher than that of the medium-term intervention group and the non-intervention group, with statistically significant difference (P<0.05), and the time of normality of body temperature, the time of disappearance of strong sputum and cough in the early intervention group, the absorption time of chest X-rays were shorter than that of the medium-term intervention group and the non-intervention group, and the difference was statistically significant (P<0.05); peripheral blood hemoglobin, serum calcitonin and hypersensitive C reactive protein levels were lower than those in the medium-term intervention group and the non-intervention group, with statistically significant differences (P<0.05), and the sputum-positive and drug-change rates in the early intervention group and the medium-term intervention group were higher than those in the non-intervention group, and the difference was statistically significant (P<0.05); the duration of hospital stay in the early intervention group was shorter than that of the medium-term intervention group and the non-intervention group, and the cost of hospitalization was less than that of the medium-term intervention group and the non-intervention group, and the difference was statistically significant (P<0.05).ConclusionTracheoscopy intervention treatment in the initial period of CAP not only significantly improves the efficacy, but also significantly reduces treatment costs and length of hospitalization, hence it is worth clinical promotion.
ObjectiveTo systematically review the efficacy and safety of respiratory fluoroquinolones monotherapy versus β-lactams plus macrolides combination therapy for non-ICU hospitalized community acquired pneumonia (CAP) patients. MethodsWe searched databases including PubMed, the Cochrane Library (Issue 3, 2015), EMbase, CNKI, WanFang Data, VIP and CBM to identify randomized controlled trials (RCTs) involving the comparison of fluoroquinolones monotherapy with β-lactams plus macrolides combination treatment for the non-ICU hospitalized patients with CAP up to April 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, assessed the risk bias of included studies, and then meta-analysis was performed using the RevMan 5.0 software. ResultsA total of 17 RCTs involving 5 423 patients were included. The results of meta-analysis showed that there was no significant difference between the two therapy groups on the mortality. For the clinical treatment success rates, no significant differences between the two groups were found based on the data of intention-to-treat (ITT) and per-protocol (PP) analyses. However, respiratory fluoroquinolones monotherapy was associated with higher clinical treatment success rates based on the data that it was unclear whether ITT or PP analysis was used (RR=1.08, 95% CI 1.01 to 1.18, P=0.02), especially in Asians (RR=1.10, 95%CI 1.02 to 1.18, P=0.01). Additionally, respiratory fluoroquinolones monotherapy was associated with less adverse events (RR=0.81, 95%CI 0.73 to 0.90, P<0.000 1), especially in Caucasians (RR=0.64, 95%CI 0.36 to 1.14, P=0.13). ConclusionCurrent evidence shows that the efficacy of respiratory fluoroquinolones monotherapy may be similar to β-lactams plus macrolides combination treatment for non-ICU hospitalized CAP patients. Since the limitation of quantity and quality of included studies, large-scale high-quality RCTs are needed to verify the above conclusion.
Objective To evaluate the predictive value of CURB-65 score combined with blood urea nitrogen to albumin ratio (B/A) for intensive care unit (ICU) admission and death in adults with community-acquired pneumonia (CAP). Methods A retrospective analysis was performed on 523 patients with CAP hospitalized in the Second Affiliated Hospital of Kunming Medical University from January 2018 to January 2022. According to whether the patients were admitted to ICU, they were divided into an ICU group (n=36) and a general ward group (n=487). The patients were divided into a death group (n=45) and a non-death group (n=478) according to the death situation during hospitalization. Basic data (age, gender, history of underlying diseases, etc.), hospital stay, antibiotic use days, CURB-65 score, white blood cell count (WBC), neutrophil count (NEUT), procalcitonin (PCT), C-reactive protein (CRP), serum albumin (Alb), blood urea nitrogen (BUN), and BUN to Alb ratio (B/A) of the two groups were compared respectively. Receiver operating characteristic (ROC) curve were plotted to evaluate the predictive value of CURB-65 score, B/A, and their combination for death during ICU admission and hospitalization in patients with CAP. Logistic regression was used to analyze risk factors for in-hospital death in the patients with CAP. Results The number of days in hospital, the number of days of antibiotic use, the number of deaths during hospitalization, the proportion of hypertension, diabetes, CURB-65 score, WBC, NEUT, PCT, CRP, BUN and B/A in the ICU group were significantly higher than those in the general ward group. Age, male, combined hypertension, diabetes, coronary heart disease, ICU admission, CURB-65 score, WBC, NEUT, PCT, CRP, BUN and B/A in the death group were significantly higher than those in the non-death group, and Alb in the ICU group and the death group were significantly lower (all P<0.05). Correlation analysis showed that B/A was positively correlated with PCT, CRP, WBC, NEUT and CURB-65 scores (correlation coefficient r values were 0.486, 0.291, 0.260, 0.310, 0.666, all P<0.001). The area under ROC curve of CURB-65 combined with B/A to predict ICU admission and death of CAP patients was 0.862 (95%CI 0.807 - 0.918, sensitivity 91.7%, specificity 66.4%) and 0.908 (95%CI 0.864 - 0.952, sensitivity 93.3%, specificity 75.7%), respectively. Multivariate logistic regression analysis showed that diabetes, high CURB-65 score, low Alb level and B/A≥4.755 mg/g were independent risk factors for death of CAP patients during hospitalization (P<0.05). Conclusions There is a significant correlation between elevated B/A and ICU demand and mortality in CAP patients. Combined use can improve the predictive value of CURB-65 score for ICU admission and mortality in CAP patients.
Objective To overview the systematic reviews about the efficacy and safety of respiratory fluoroquinolones for community-acquired pneumonia (CAP). Methods We electronically searched databases including China National Knowledge Internet, WanFang Data, VIP, PubMed, Embase and The Cochrane Library to collect systematic reviews or Meta-analyses about respiratory fluoroquinolones for CAP from inception to November 2, 2017. Two reviewers independently screened literatures, extracted data, and then AMSTAR tool was used to assess the methodological quality of included studies. Results A total of 18 systematic reviews/Meta-analyses were included. The results of quality assessment indicated the scores ranged from 5 to 10. Among the 11 items, the item 1 of " Was an ‘a priori’ design provided” and item 4 " Was the status of publication (i.e. grey literature) used as an inclusion criterion” appeared to be the most problematic. The results of overview suggested that: the efficacy of respiratory fluoroquinolones might be similar to β-lactams plus macrolides combination treatment for CAP. However, respiratory fluoroquinolones might be more safety. In addition, the efficacy of respiratory fluoroquinolones sequential therapy for CAP was similar to that of continuous intravenous therapy, but the adverse reactions of the former were fewer. Conclusions Respiratory fluoroquinolones might be similar in efficacy for CAP to other antibiotics recommended by the guidelines with less adverse reactions. However, it can increase multi-drug resistance and potential tuberculosis drug resistance, we should strictly follow the principle of rational use of antibiotics to avoid abuse.
ObjectiveTo analyze the clinical features of Legionella-associated cavitary pneumonia, and to explore the diagnosis, treatment planning, and clinical management of patients.MethodsThe data of a patient with severe Legionella-associated cavitary pneumonia were collected and analyzed. Databases including PubMed, Ovid, Wanfang, VIP and Chinese National Knowledge Infrastructure were searched for pertinent literatures, using the keyword "Legionella, lung abscess or cavitary pneumonia" in Chinese and English from Jan. 1990 to Jun. 2019. The related literature was reviewed.ResultsA 60-year-old male patient was admitted to hospital because of fever, cough, and expectoration for five days. On presentation, his temperature was 38.3 °C, and pulmonary auscultation revealed rales on the left side of the lungs. Culture of lower airway secretions obtained by bronchoscopy revealed Legionella pneumophila infection, and serotype 6. Chest computerized tomography showed a consolidation in the left lung and an abscess in the left upper lobe. The patient was discharged from the hospital after three months of anti-Legionella treatment (Mosfloxacin, Azithromycin, etc.). Fifteen manuscripts, including 18 cases, were retrieved from databases. With the addition of our case, a total of 19 cases were analyzed in detail. There were 15 males and four females, aged from 4 months to 73 years old. Most of them (14/19, 73.7%) were accompanied by multiple underlying diseases. Initial empiric antimicrobial therapy failed in 15 (78.9%) cases, and 7 (36.8%) patients required combination therapy. The courses of antimicrobial treatment were from 3 to 49 weeks. All except one patient were fully recovered and discharged from hospital.ConclusionsLegionella pneumonia with pulmonary abscess or cavity is rare and often presents with fever. Pulmonary imaging shows infiltration in the initial, but can be free of cavities or abscesses. Most patients have basic diseases. Severe patients often need to be treated in combination with antibiotics for long periods of time.
Community-acquired pneumonia (CAP) is still a common disease that seriously affects people’s health. It is of great clinical significance for proper anti-infective therapy to identify the characteristics and changes of the pathogens. Along with the accelerated process of aging population, increased use of immunosuppression agents, and increased morbidity of malignant tumor and underlying diseases, the pathogenic spectrum of patients with CAP varies as well. This article reviews the important pathogenic changes of CAP in recent years.