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.
Objective To determine the role of serum cystatin C in evaluating the severity and predicting in-hospital mortality in patients with community-acquired pneumonia (CAP). Methods The clinical data of 176 patients with CAP treated between January 2015 and October 2016 were collected in a retrospective way. The CURB-65 score was used to assess the severity. The serum levels of cystatin C and C-reactive protein (CRP) on admission were measured. The correlations between cystatin C and CURB-65 score and between cystatin C and CRP were calculated. Receiver operating characteristic curve was used to determine the ability of cystatin C in predicting in-hospital mortality. Results The serum level of cystatin C increased with the increasing CURB-65 score (P<0.001). The serum level of cystatin C was correlated positively with CRP level (rs=0.190, P<0.011). There were 22 patients died in hospital, the mean serum cystatin C level of non-survivor was significantly higher than that of survivors [(1.51±0.56)vs. (1.02±0.29) mg/L, P<0.001]. At a cut-off 1.18 mg/L, the sensitivity and specificity of cystatin C in predicting in-hospital mortality were 68.18% and 81.17%, respectively. The area under the receiver operating characteristic curve was 0.793. The combination of cystatin C and CRP increased the predictive accuracy for in-hospital mortality. Conclusion Cystatin C level increases with the increaseing severity of CAP, and it may be a clinical biomarker to evaluate the severity and prognosis of patients with CAP.
ObjectiveTo investigate the clinical efficacy of low molecular weight heparin on community-acquired pneumonia (CAP). MethodsA total of 78 patients with CAP admitted to hospital between January 2013 and March 2015 were randomly assigned into a conventional treatment group and a heparin treatment group. Both groups received anti-infection and symptomatic treatment, and the patients in heparin treatment group additionally received low molecular weight heparin by abdominal subcutaneous injection once daily for a course with seven days. The age, sex and severity of the disease were recorded. White blood cell (WBC) count and the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured on and during admission. ResultsThe baseline information including age and sex, severity of illness, CRP, ESR and WBC counts on admission and the first treatment day had no difference between two groups (P > 0.05). CRP and ESR on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significantly more decreased than those in the conventional treatment group (P < 0.05). For the moderate and severe CAP patients, the level of CRP on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significant lower than those in the conventional treatment group (P < 0.05). ConclusionCombination therapy of low molecular weight heparin may improve the clinical efficacy of CAP.
Objective To investigate the clinical characteristics and pathogen distribution of community-acquired pneumonia (CAP) combined with type 2 diabetes mellitus (T2DM), based on bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) test. Methods In this cross-sectional study, CAP patients with BALF mNGS test were screened from April 2023 to April 2024. The patients were divided into a single CAP group (CAP group) and a CAP combine with T2DM group (CAP+T2DM group). The data of demographics, underlying diseases, complications, and laboratory tests including blood routine, inflammatory parameters, liver and renal functions, random blood glucose (RGB), hemoglobin A1C (HbA1c), and BALF mNGS tests were collected and compared between the two groups. Results Ultimately, 86 patients were included, with 45 in the CAP group and 41 in the CAP+T2DM group. Compared with the CAP group, the CAP+T2DM group had higher platelet count [(272.44±128.57)×109/L vs. (215.00±100.06)×109/L], erythrocyte sedimentation rate [(75.63±35.19) vs. (59.69±34.47) mm/h], RGB [10.8 (9.1, 13.5) vs. 6.5 (5.8, 7.8) mmol/L], HbA1c [8.2% (7.3%, 8.5%) vs. 5.7% (5.5%, 6.1%)], and fungi infection rate (65.9% vs. 40.0%), and the differences were statistically significant between the two groups (P<0.05). Conclusion CAP patients with T2DM have increased levels of platelet and erythrocyte sedimentation rate, and are at higher risk for fungi infection, which potentially leads to worse outcome.
ObjectiveTo investigate the clinical characteristics and predicting factors for death in critically ill patients with severe community-acquired pneumonia (CAP). MethodA total of 143 hospitalized patients with severe CAP between January 2009 and December 2012 were included and their clinical data were retrospectively analyzed. According to the clinical outcome, patients were divided into survival group and death group, and their clinical features and laboratory test results were compared, and multivariate regression analysis was conducted to search for predicting factors for death. ResultsIn this study, a total of 118 patients survived and 25 patients died, and the mortality rate was 17.5%. The number of underlying diseases in the two groups were different, and death group had more patients with 3 kinds of diseases than the survival group[76.0% (19/25) vs. 22.8% (13/57), P<0.05]. The intubation rate in the death group was significantly higher than that in the survival group[84.0% (21/25) vs. 33.1% (39/118), P<0.05], and the arterial blood pH value (7.15±0.52 vs. 7.42±0.17, P<0.05), HCO3- concentration[(18.07±6.25) vs. (25.07±5.44) mmol/L, P<0.05], PaO2[(58.92±35.18) vs. (85.92±32.19) mm Hg (1 mm Hg=0.133 kPa), P<0.05] and PaO2/FiO2[(118.23±98.02) vs. (260.17±151.22) mm Hg, P<0.05)] in the death group were significantly lower than those in the survival group. And multivariate regression analysis indicated that the number of underlying diseases[OR=0.202, 95%CI (0.198, 0.421), P=0.003], PaO2[OR=1.203, 95%CI (1.193, 1.294), P=0.011] and PaO2/FiO2[OR=0.956, 95%CI (0.927, 0.971), P=0.008] were independent predictors of death in the patients with severe pneumonia. ConclusionsPatients who died of severe pneumonia often had severe illnesses before admission, and the number of underlying diseases and PaO2 have highly predictive value for death.
Objective To investigate the clinical efficacy of nutritional support with different proportion of fat on the prognosis of patients with severe community-acquired pneumonia (SCAP). Methods Ninety SCAP patients with nutritional risk treated between January 2014 and July 2015 were randomized into high, normal, and low-proportion fat groups with 30 patients in each. The patients in different groups underwent nutritional support with different fat proportion besides the same medication. Data of albumin, pre-albumin and transferrin were collected and analyzed before treatment and 10 days after treatment. The mortality rates were compared between groups. Results Albumin, pre-albumin and transferrin were similar in all groups before intervention (P>0.05); albumin, pre-albumin and transferrin increased significantly 10 days after treatment in each group (P<0.05). Patients in the normal-fat group acquired significantly more obvious improvements on each index (P<0.05). A shorter length of stay in hospital was observed in the normal-proportion fat group compared with the high and low-proportion fat groups, but there was no significant differences among groups (P>0.05). On the 10th day, the normal -proportion fat proportion group had a significantly higher cure rate and a significantly lower mortality rate than the other two groups (P<0.05). The improvement rate was similar in all groups (P>0.05). Conclusion Supportive treatment with normal fat proportion has a promising value in the improvement of albumin, pre-albumin and transferrin for SCAP patients with a shorter length of stay in hospital, which is worthy of clinical promotion.
ObjiectiveTo obtain reliable evidence of diagnosis and treatment through evaluating the validity of pneumonia severity index (PSI), CURB-65 and acute physiology and chronic health evaluationⅡ(APACHEⅡ) scores in predicting risk stratification, severity evaluation and prognosis in elderly community-acquired pneumonia (CAP) patients.MethodsClinical and demographic data were collected and retrospectively analyzed in 125 in-hospital patients with CAP admitted in Shanghai Dahua Hospital from January 2012 to April 2015. The severity of pneumonia was calculated with PSI, CURB-65 and APACHEⅡgroups during 1 to 3 days after admission. Mortality and intensive care unit (ICU) admission rates were evaluated among patients in each scores and was categorized into three classes, namely mild, moderate and severe groups during 1 to 3 days after admission. Mortality and ICU admission rates were evaluated among patients in each severity level. Through evaluating the sensitivity, specificity, the predicting values and the area under receiver operating characteristic (ROC) curve (AUC) among PSI, CURB-65 and APACHEⅡ, the validity and consistency of these three scoring systems were assessed.ResultsUsing PSI, CURB-65 and APACHEⅡ scoring systems, the patients were categorized into mild severity (48.8%, 64.0% and 52.8%, respectively), moderate severity (37.6%, 23.2% and 32.0%, respectively) and severe severity (13.6%, 12.8% and 15.2%, respectively). In PSI, CURB-65 and APACHEⅡ systems, the mortality in high risk groups was 41.3%, 62.5% and 47.4%, respectively; The ICU-admission rate in high risk groups was 88.3%, 100.0% and 94.7%, respectively. The sensitivity of PSI, CURB-65 and APACHEⅡ was 50.0%, 71.4% and 64.3% in predicting mortality, and was 46.8%, 50.0% and 59.3% in predicting ICU-admission, respectively. PSI, CURB-65 and APACHEⅡ showed similar specificity (approximately 90%) in predicting mortality and ICU admission. ROC was conducted to evaluate the sensitivity of PSI, APACHEⅡ and CURB-65 in predicting mortality and ICU admission. The AUC had no significant difference among these three scoring systems. The AUC of PSI, CURB-65 and APACHEⅡwas 0.893, 0.871, 0.880, respectively for predicting mortality, and was 0.949, 0.837, 0.949, respectively for predicting ICU admission. There was no significant difference among these three scoring in predicting mortality and ICU admission (all P>0.05).ConclusionsPSI, CURB-65 and APACHEⅡ performed similarly and achieved high predictive values in elderly patients with CAP. The three scoring systems are consistent in predicting mortality risk in elderly CAP patients. The CURB-65 is more sensitive in predicting the risk of death, and more early in identifing patients with high risk of death. The APACHEⅡ is more sensitive in predicting the risk of ICU admission, and has good value in identifying severe patients and choosing the right treatment sites.
Objective To investigate the relationship between the red blood cell distribution width (RDW) and the severity of community-acquired pneumonia (CAP). Methods The clinical data of 285 adult patients with CAP admitted from November 2014 to August of 2017 were analyzed retrospectively. The severity of CAP was evaluated by pneumonia severity index (PSI) score. Meanwhile, 60 cases with qualified medical examination were collected as a healthy control group. The distributions of PSI score, RDW, procalcitonin (PCT), C-reactive protein (CRP) and neutrophil percentage (NEU%) were described in the patients with different risk degree. The correlation analysis of various indicators were analyzed by Spearman correlation. The threshold of RDW(%) was calculated through the construction of the general linear regression equation. The risk factors of PSI score were analyzed with multiple linear regression. Results The higher the risk stratification, the higher the distribution of PSI scores, RDW, PCT, CRP and NEU% were. RDW was positively correlated with PCT, CRP, and NEU% (r values were 0.417, 0.252, 0.318, respectively, P<0.05). PSI score was positively correlated with RDW, PCT, CRP, and NEU% (r values were 0.537,0.598, 0.557, 0.482, respectively, P<0.05). RDW was positively correlated with PSI score (r=0.537, P<0.05). The thresholds of RDW(%) were 14.514 and 19.041. Multiple linear regression showed that RDW, PCT, CRP and NEU% were all influential factors of PSI scores and explained 46.9% of the total mutation rate. Conclusion RDW is correlated with the severity of CAP, and can predict the severity of CAP.
Community-acquired pneumonia refers to infectious pulmonary parenchyma inflammation that occurs outside the hospital, including pneumonia that occurs during the incubation period after admission of pathogens with a clear incubation period. Community-acquired pneumonia has a high incidence and mortality rate, imposing a heavy medical burden and posing a serious threat to social public health. In the diagnosis and treatment of community-acquired pneumonia, traditional Chinese medicine and Western medicine each have their own advantages. In order to strengthen the diagnosis and treatment of community-acquired pneumonia through the integration of traditional Chinese and Western medicine, and improve the prevention and treatment level of community-acquired lung disease, this guideline was developed by the Internal Medicine Professional Committee of the World Federation of Chinese Medicine Societies, led by Henan University of Chinese Medicine and the First Affiliated Hospital of Henan University of Chinese Medicine. This guideline refers to the development methods and processes of international clinical practice guidelines, based on the best existing evidence, combined with the characteristics of integrated traditional Chinese and Western medicine in the treatment of community-acquired pneumonia, weighing the pros and cons of intervention measures, and finally forming six recommended opinions, in order to provide references for the clinical practice of integrated traditional Chinese and Western medicine in the treatment of community-acquired pneumonia.
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.