Efficacy and Safety of Intravenous Moxifloxacin Versus Cefoperazone with Azithromycin in the Treatment of Community Acquired Pneumonia

Summary： To compare the efficacy, safety, and tolerability of intravenous moxifloxacin with those of a commonly used empirical antibiotic regimen, cefoperazone and azithromycin in the treatment of community acquired pneumonia （CAP） in adult patients requiring initial parenteral therapy, 40 patients with CAP were divided into two groups, a moxifloxacin group （n=20） and a control group （n=20）, which were treated for 7 to 14 days. The patients in the moxifloxacin group were intravenously given 400 mg of moxifloxacin （AveloxR） once a day. Patients in the control group were administered 2.0 g of cefoperazone twice a day and azithromycin 0.5 g once a day. Clinical, bacteriological, and laboratory examinations were performed before the treatment, and at the end of the treatment. Our results showed that there was no significant difference in the clinical efficacy rate between two treatment groups at end of therapy （90 % for moxifloxacin, 95 % for cefoperazone plus azithromycin） （P〉0.05）. The bacteriologic eradication rate at the end of treatment was 90 % in the moxifloxacin group and 80 % in the cefoperazone-plus-azithromycin group, whereas there was no significant difference between the two groups （P〉0.05）. In addition, both drugs were well-tolerated in this trial, with the number of drug-related adverse events being comparable. It is concluded that moxifloxacin is an effective and well-tolerated treatment for CAP and was equivalent to the com- monly used empirical treatment of cefoperazone plus azithromycin. Moxifloxacin is likely to offer clinicians an alternative for reliable empirical CAP treatment in the face of increasing antibiotic resistance.

Pseudomonas aeruginosa Community Acquired Pneumonia with Septicemia in a Previously Healthy Woman

A previously healthy 53-year-old woman was urgently hospitalized due to septic shock. She was diagnosed with bacterial pneumonia based on chest radiograph and computed tomography findings of right upper lobe consolidation. Sputum Gramstain at the time of admission showed gram-negative rods with phagocytosis. Intravenous meropenem was immediately initiated as empiric antibacterial therapy. Bacterial culture specimens from sputum and blood were positive for Pseudomonas aeruginosa. Following appropriate antibiotic therapies, the patient recovered from a shock state and gradually became well. There has been no evidence of recurrence at 6 months after discharge. P. aeruginosa community acquired pneumonia with septicemia is rapidly progressive and often fatal. The choice of initial empiric antibiotic treatment that is active against P. aeruginosa is critical in improving outcome.

Study on inflammatory factors and curative effect of Rhizoma Imperata on community acquired pneumonia based on TLR4/NF-κB signaling pathway

Objective:To investigate the curative effect of Rhizoma Imperata in the treatment of patients with community-acquired pneumonia and its influence on inflammatory factors related to TLR4/NF-κB signaling pathway,so as to seek new drugs for the treatment of community-acquired pneumonia.Methods:120 patients with community-acquired pneumonia who were treated in Department of respiratory medicine,the First Affiliated Hospital of Hainan Medical College from November 2019 to September 2020 were collected and randomly divided into control group and experimental group,with 60 patients in each group.The control group was given cefuroxime sodium injection,and the experimental group was given cefuroxime sodium injection+Baimao root decoction.The levels of high-sensitivity C-reactive protein(CRP)and the level of serum CRP in the two groups before and after treatment were compared Objective To observe the expression of procalcitonin(PCT),IL-6,IL-8,TNF-αand TLR4/NF-κB mRNA levels,and to observe the effect of Radix Imperata Rubra on community-acquired pneumonia.Results:The fever,cough,expectoration subsided time and chest CT inflammation absorption time of the experimental group were shorter than those of the control group,the difference was statistically significant(P<0.05);the total effective rate of the experimental group(96.67%)was higher than that of the control group(85%),the difference was statistically significant(P<0.05);after treatment,the serum CRP,PCT,IL-6,IL-8,TNF-αin the two groups were lower than before,and the experimental group was significantly lower than the control group,the difference was statistically significant(P<0.05),There was statistical significance(P<0.05);after treatment,TLR4/NF-κB mRNA of the two groups were decreased,and the experimental group was significantly lower than the control group,the difference was statistically significant(P<0.05).Conclusion:In the treatment of cap,Rhizoma Imperata can reduce the levels of CRP,PCT,IL-6,IL-8 and TNF-α.The mechanism is related to inhibiting the activation of TLR4/NF-κB signaling pathway,so as to reduce the release of inflammatory factors and improve clinical symptoms.

Effect of Elephantopus scaber Linn on community acquired pneumonia through TLR4/NF-κB signaling pathway

Objective:To observe the effect of Elephantopus scaber Linn on community-acquired pneumonia and its relationship with the expression of TLR4/NF-κB pathway and the downstream inflammatory cytokines IL-6,IL-8,TNF-α.and to explore its molecular mechanism for the treatment of community-acquired pneumonia,so as to provide new ideas and theoretical basis for the treatment of community-acquired pneumonia.Methods:140 patients with community-acquired pneumonia were randomly divided into observation group and control group,with 70 cases in each group.Observation group:Elephantopus scaber Linn+NS atomized inhalation+intravenous injection of ceftazidine;Control group:intravenous injection of ceftazidine;Meanwhile,70 healthy subjects were selected as the healthy control group.The expressions of TLR4,NF-kB,IL-6,IL-8 and TNF-αin serum of observation group,control group before and after treatment and healthy control group were detected by enzyme linked immunosorbent assay(ELISA),and the efficacy of Elephantopus scaber Linn in the treatment of community acquired pneumonia was observed.Results:Compared with the control group,the observation group was significantly better than the control group in recovery rate,total effective rate,number of days for the disappearance of symptoms such as fever,cough,expectoration,with statistical significance(P<0.05);Compared with the healthy control group,the serum TLR4,NF-κB,IL-6,IL-8,TNF-αwere significantly different(P<0.05)between the observation group and the control group;Serum TLR4,NF-κB,IL-6,IL-8,TNF-αwere significantly different(P<0.05)in the observation group before and after treatment with Elephantopus scaber Linn;Compared with the control group after treatment,there were significantly different(P<0.05)in serum TLR4,NF-κB,IL-6,IL-8 and TNF-αin the observation group after treatment.Conclusion:Serum TLR4,NF-κB,IL-6,IL-8,TNF-αwere highly expressed in patients with community-acquired pneumonia,Elephantopus scaber Linn can decreased the expression of TLR4 and NF-κB in blood,and its downstream inflammatory factors also decreased significantly.There were significantly different(P<0.05)in blood TLR4 and NF-κB between the observation group and the control group after treatment.It is suggested that Elephantopus scaber Linn may inhibit TLR4/NF-kB signal pathway to exert anti-inflammatory effect.Elephantopus scaber Linn has a definite effect and can significantly improve the clinical symptoms,and effectively shorten the treatment cycle.

Impact of the socioeconomic status on the severity and outcome of community-acquired pneumonia among Egyptian children: a cohort study

Background:Community-acquired pneumonia(CAP)is one of the five leading causes of death among children in developing countries,accounting for approximately three million deaths per year.Identification of the modifiable risk factors of CAP may help to reduce the burden of this disease.In this study,the impact of the socioeconomic status(SES)on the severity and outcome of CAP among Egyptian children was studied.Methods:This was a prospective longitudinal cohort study which included 1,470 children diagnosed with CAP,aged two to 15 years(median age 5.4 years).The diagnosis of CAP was based on clinical and radiological findings.A structured questionnaire and the patients’medical records were used for the data collection.The subjects were divided into two groups:mild and severe CAP.Social and demographic variables were compared,and a multivariate logistic regression analysis was performed.Results:The multivariate analysis showed that a low maternal education level(OR:3.8;95%CI:2.12-6.70;P=.0001),unavailability of adequate medical care(OR:3.1;95%CI:1.99-4.88;P=.0001),a low family income(OR:2.2;95%CI:0.99-4.78;P=.047),and parents’smoking habits(OR:2.0;95%CI:1.15-3.55;P=.014)were significant independent predictive risk factors for severe CAP among Egyptian children.Conclusion:Public health measures against these socio-demographic risk factors should be identified as priorities in order to help reduce the disease burden of deaths from severe CAP among Egyptian children.

Steroids in acute respiratory distress syndrome:A panacea or still a puzzle?

Acute respiratory distress syndrome(ARDS)is a unique entity marked by various etiologies and heterogenous pathophysiologies.There remain concerns regarding the efficacy of particular medications for each severity level apart from respiratory support.Among several pharmacotherapies which have been examined in the treatment of ARDS,corticosteroids,in particular,have demonstrated potential for improving the resolution of ARDS.Nevertheless,it is imperative to consider the potential adverse effects of hyperglycemia,susceptibility to hospital-acquired infections,and the development of intensive care unit acquired weakness when administering corticosteroids.Thus far,a multitude of trials spanning several decades have investigated the role of corticosteroids in ARDS.Further stringent trials are necessary to identify particular subgroups before implementing corticosteroids more widely in the treatment of ARDS.This review article provides a concise overview of the most recent evidence regarding the role and impact of corticosteroids in the management of ARDS.

Prevalence and clinical prognosis of heteroresistant vancomycin-intermediate Staphylococcus aureus in a tertiary care center in China

Background The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus （hVISA） is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of hVISA is rare in China. This study summarizes the prevalence and clinical features associated with hVISA infections at our institution and the local impact they have on clinical outcome. Methods A total of 122 methicillin-resistant Staphylococcus aureus （MRSA） isolates which were of the causative pathogens were collected. One hundred and two patients for whom we had full information of MRSA pneumonia were included. Isolates of MRSA were collected using PCR to detect the mecA gene. Both Etest and macro Etest were performed to screen for hVISA. The Staphylococcal chromosome cassette mec （SCCmec） types were determined by multiplex PCR strategy. Logistic regression analysis was used to determine the risk factors. Results Among the 122 MRSA isolates collected, 25 （20.5%） strains were identified as hVISA. There were 119 （97.5%） SCCmec III isolates, two （1.6%） SCCmec II isolates, and one （0.8%） SCCmec V isolate. The 30-day mortality of MRSA-hospital acquired pneumonia （HAP） was 37.3%, and 62.5% for hVISA-HAP. Vancomycin treatment was the independent risk factor of hVISA. Factors independently associated with 30-day mortality in all patients were acute physiology and Chronic Health Evaluation （APACHE） II score 〉20, multiple lobe lesions, and creatinine clearance rate （CCR） 〈15 ml/min. Conclusions The prevalence of hVISA is 20.5% at our institution, hVISA-HAP patients had a poor clinical outcome. Vancomycin treatment was the independent predictors for hVISA infection. Factors independently associated with 30-day mortality in all patients were APACHE II score 〉20, multiple lobe lesions and CCR 〈15 ml/min.

E test for studying in vitro activity of seven antimicrobial agents against penicillin-susceptible and penicillin-resistant pneumococci

To evaluate the comparative activity of seven oral antimicrobial agents against 100 strains of Streptococcus pneumoniae (S pneumoniae) Methods Total 100 strains of S pneumoniae were collected from general hospitals in Beijing from June 1996 to June 1997 E test method was used to detect the minimum inhibitory concentration (MIC) values of the following seven drugs against S pneumoniae : penicillin, amoxicillin/clavulanate, cefaclor, cefuroxime, ceftriaxone, azithromycin and ofloxacin The breakpoint of susceptibility categories was defined according to NCCLS Results 74% of isolates were susceptible (S, MIC 0 06?mg/L) to penicillin, and 5% were penicillin resistant (R, MIC 2?mg/L). The intermediately resistant (I, MIC 0 1-1?mg/L) rate to penicillin was 21% The total rates of R or I were 26% for penicillin, 6% for both amoxicillin/clavulanate and ceftriaxone, 9% for cefuroxime, 66% and 68% for azithromycin and ofloxacin respectively Overall 94%, 94% and 91% of the pneumococcal isolates were susceptible to amoxicillin/clavulanate, ceftriaxone and cefuroxime respectively S pneumoniae was highly resistant to azithromycin tested as a representative of macrolides (MIC 50 and MIC 90 both >256?mg/L, R rate 66%), and had a highly intermediately resistant rate to ofloxacin (I rate 62%) Conclusions Our data suggest that in vitro activity of oral amoxicillin/clavulanate was as good as ceftriaxone and cefuroxime It can be considered as an alternative compound in the treatment of community acquired pneumoniae and other respiratory tract infections caused by multiresistant S pneumoniae

COMPARISON OF RANITIDINE AND PANTOPRAZOLE FOR STRESS ULCER BLEEDING PROPHYLAXIS IN CRITICALLY ILL PATIENTS REQUIRING MECHANICAL VENTILATION

Objective To compare the efficacy of Ranitidine and Pantoprazole for the prevention of haemorrhage from stress ulcer among critical care patients. Methods A total of 121 critically ill patients were included in this retrospective study. The choice of pharmacologic stress ulcer prophylaxis were either Ranitidine or Pantoprazole. The primary outcome was the incidence of stress-related significant upper gastrointestinal bleeding, and the secondary outcome was the incidence of hospital acquired pneumonia (HAP). Results A total of 63 patients were given Ranitidine, and 58 patients were given Pantoprazole for stress ulcer bleeding prophylaxis. Nine patients (7.44%, 9/121) developed clinically-important upper gastrointestinal bleeding, including 5 (7.94%, 5/63) in the Ranitidine group, and 4 (6.90%,4/58) in the Pantoprazole group. The rate of HAP was 3.17% (2/63) in the Ranitidine group, and 15.52% (9/58) in the Pantoprazole group. Conclusion Ranitidine was associated with lower rates of HAP as compared with Pantoprazole, with no statistically significant difference in clinically-important gastrointestinal hemorrhage. Because of limited trial data, future well-designed and powerful randomized, clinical trials are warranted.

Evaluation value of lung ultrasound combined with CRP and PCT on the efficacy and prognosis of HAP

Objective To investigate the efficacy of lung ultrasound combined with serum C-reactive protein(CRP)and procalcitonin(PCT)in evaluating the efficacy and prognosis of hospital-acquired pneumonia(HAP).Methods A total of 308 HAP patients admitted to the emergency department and intensive care unit(ICU)of First Affiliated Hospital of Tsinghua University from January 2018 to December 2021 were selected and divided into effective group(n=276)and ineffective group(n=32)according to different treatment effects.The baseline data and the dynamic changes of lung ultrasound score(LUS),CRP and PCT were compared between the two groups before treatment,3 days and 7 days after treatment.Pearson correlation analysis was used to evaluate the correlation between LUS,CRP,PCT and Clinical Pulmonary Infection Score(CPIS)after 3 days and 7 days of treatment.Logistic regression equation was used to analyze the related influencing factors of curative effect.Receiver operating characteristic(ROC)curve and area under ROC(AUC)were used to analyze the efficacy of LUS,CPR,PCT and the combination of the three in predicting curative effect.Kaplan-Meier(K-M)survival curve was used to analyze the survival rate of patients with high-risk and low-risk LUS,CPR and PCT.Results In the effective group,the LUS,CPR and PCT after 3 days and 7 days of treatment were lower than those of the ineffective group.Pearson linear correlation analysis showed that LUS,CPR and PCT after 7 days of treatment were positively correlated with CPIS score(P<0.05),among which LUS after 7 days of treatment had the strongest correlation with CPIS(r=0.635).Logistic regression analysis showed that LUS,CPR and PCT were correlated with the efficacy of HAP after 3 days and 7 days of treatment(P<0.05).ROC curve analysis showed that the AUC of LUS,CPR and PCT predicting invalid HAP after 7 days of treatment was higher than that after 3 days of treatment.The AUC of LUS combined with CPR and PCT after 7 days of treatment to predict the efficacy is the largest(AUC=0.947).K-M curve analysis showed that there were statistically significant differences in LUS,CPR and PCT survival rates between high-risk and low-risk patients after 7 days of treatment(P<0.05).Conclusions There is a certain reference value for the dynamic monitoring of lung ultrasound combined with CPR and PCT in the evaluation of the efficacy and prognosis of HAP.