Imaging of community-acquired pneumonia: Roles of imaging examinations, imaging diagnosis of specific pathogens and discrimination from noninfectious diseases

This article reviews roles of imaging examinations in the management of community-acquired pneumonia(CAP), imaging diagnosis of specific CAP and discrimination between CAP and noninfectious diseases. Chest radiography is usually enough to confirm the diagnosis of CAP, whereas computed tomography is required to suggest specific pathogens and to discriminate from noninfectious diseases. Mycoplasma pneumoniae pneumonia, tuberculosis, Pneumocystis jirovecii pneumonia and some cases of viral pneumonia sometimes show specific imaging findings. Peribronchial nodules, especially tree-in-bud appearance, are fairly specific for infection. Evidences of organization, such as concavity of the opacities, traction bronchiectasis, visualization of air bronchograms over the entire length of the bronchi, or mild parenchymal distortion are suggestive of organizing pneumonia. We will introduce tips to effectively make use of imaging examinations in the management of CAP.

Comparative efficacy of levofloxacin and ceftriaxone in the treatment of community acquired pneumonia in children

Pneumonia is a common cause of mortality and morbidity in under-5 children throughout the world. Globally an estimated 156 million new episodes of pneumonia occur each year in children and 2 million children die from pneumonia each year which is 20 percent of all deaths of children under five years old. Ceftriaxone is a commonly used drug for empiric treatment of community acquired pneumonia (CAP) in children. Levofloxacin may be an adequate option for empiric therapy in treatment of CAP in children because it gives the broad spectrum activity against both bacterial and atypical pathogens causing CAP and studies suggest that it can be safely used in children. This open labeled, randomized, comparative clinical trial was carried out in the Department of Pediatrics, Sylhet MAG Osmani Medical College Hospital, Bangladesh during January, 2011 & December, 2012 to compare the efficacy of levofloxacin and ceftriaxone in the treatment CAP in children. A total 70 cases of CAP were enrolled. 35 cases were allocated to levofloxacin group and another 35 cases to ceftriaxone group. At first the study cases were selected by systematic random sampling. Group allocation to either levofloxacin or ceftriaxone group was done by lottery method. Total duration for receiving study drugs was seven days. Dose of levofloxacin was 10 mg/kg/day children ≥5 years, where as it was 10 mg/kg 12 hourly in 6 months to <5 years age groups. Dose of ceftriaxone was 75 mg/kg/day. Response to treatment was assessed initially after 3 days and also after 7 days by clinical symptoms and signs. Clinical cure rate was determined by disappearance of the clinical signs and symptoms of pneumonia and resolution of radiological findings reported at admission. Clinical responses were categorized as cured and treatment failure. 91.43% cases were cured in levofloxacin group, whereas cure rate of ceftriaxone group was 68.57% which was statistically significant (p = 0.0168). Adverse effects of levofloxacin were found as skin rash in 1 case and vomiting in 2 cases whereas skin rash was found in 1 case in ceftriaxone group. So it can be concluded that levofloxacin is more effective than ceftriaxone in the treatment of CAP in children.

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.

Corticosteroids and ICU Course of Community Acquired Pneumonia in Egyptian Settings

Background: Pneumonia is the most common cause of community-acquired infection requiring ICU admission. 60-87% of patients with severe community acquired pneumonia (CAP) admitted to the ICU develops respiratory failure and require mechanical ventilation (MV). Objectives: To assess the efficacy and safety of adjunctive low dose hydrocortisone infusion treatment in Egyptian ICU patients with CAP. Methods: Hospitalized patients, clinically and radiologically diagnosed with CAP, were randomized to receive hydrocortisone 12.5 mg/h IV infusion for 7 days or placebo, along with antibiotics. The end-points of the study were improvement in PaO2:FIO2 (PaO2:FIO2 > 300 or ≥100 increase from study entry) and SOFA score by study day 8 and the development of delayed septic shock. Results: 80 patients were recruited, 40 of them received hydrocortisone and the remaining 40 received placebo. By study day 8, hydrocortisone treated patients showed a significant improvement in PaO2:FIO2 and chest radiograph score, and a significant reduction in C-reactive protein (CRP) levels, Sepsis-related Organ Failure Assessment (SOFA) score, and delayed septic shock compared to the control group. Hydrocortisone treatment was associated with a significant reduction in the duration of MV. However, hydrocortisone infusion did not show significant difference in the ICU mortality. Conclusions: adjunctive 7-day course of low dose hydrocortisone IV in patients with CAP hastens recovery of pneumonia and prevents the development of sepsis related complications with a significant reduction in duration of the mechanical ventilation.

B-type natriuretic peptide in predicting the severity of community-acquired pneumonia

BACKGROUND: Although pneumonia severity index(PSI) is widely used to evaluate the severity of community-acquired pneumonia(CAP), the calculation of PSI is very complicated. The present study aimed to evaluate the role of B-type natriuretic peptide(BNP) in predicting the severity of CAP.METHODS: For 202 patients with CAP admitted to the emergency department, BNP levels, cardiac load indexes, inf lammatory indexes including C-reactive protein(CRP), white blood cell count(WBC), and PSI were detected. The correlation between the indexes and PSI was investigated. BNP levels for survivor and non-survivor groups were compared, and a receiver operating characteristic(ROC) curve analysis was performed on the BNP levels versus PSI.RESULTS: The BNP levels increased with CAP severity(r=0.782, P<0.001). The BNP levels of the high-risk group(PSI classes IV and V) were signifi cantly higher than those of the low-risk group(PSI classes I–III)(P<0.001). The BNP levels were signifi cantly higher in the non-survivor group than in the survivor group(P<0.001). In addition, there were positive correlations between BNP levels and PSI scores(r=0.782, P<0.001). The BNP level was highly accurate in predicting the severity of CAP(AUC=0.952). The optimal cut-off point of BNP level for distinguishing high-risk patients from low-risk ones was 125.0 pg/m L, with a sensitivity of 0.891 and a specifi city of 0.946. Moreover, BNP level was accurate in predicting mortality(AUC=0.823). Its optimal cut-off point for predicting death was 299.0 pg/m L, with a sensitivity of 0.675 and a specifi city of 0.816. Its negative predictive cut-off value was 0.926, and the positive predictive cut-off value was 0.426.CONCLUSION: BNP level is positively correlated with the severity of CAP, and may be used as a biomarker for evaluating the severity of CAP.

Efficacy and safety of glucocorticoids in the treatment of community-acquired pneumonia: A meta-analysis of randomized controlled trials

BACKGROUND: Community-acquired pneumonia(CAP) is pneumonia acquired infectiously from normal social contact as opposed to being acquired during hospitalization. CAP is a leading cause of illness and death. This review aims to determine the efficacy and safety of glucocorticoids in the treatment of community-acquired pneumonia(CAP).DATA SOURCES: We searched randomized controlled trials(RCTs) from Pubmed, EMBASE, Cochrane Library, Chinese Journal Full-text Database, and Chinese Biomedical Literature Database to obtain the information by using steroids, glucocorticoids, cortisol, corticosteroids, community-acquired pneumonia and CAP as key words. The quality of RCTs was evaluated. A Meta-analysis was made using Rev Man 5.0 provided by the Cochrance Collaboration.RESULTS: Seven RCTs involving 944 patients were included in the meta-analysis. The mean length of hospital stay in glucocorticoids treatment group was significantly shorter than that in standard treatment group(WMD=–1.70, 95%CI 2.01–1.39, Z=10.81, P<0.00001). No statistically significant differences were found in the mortality rate(RR=0.77,95%CI 0.46–1.27, Z=1.03, P=0.30), the mean length of hospital stay in ICU(WMD=1.17, 95%CI 1.68–4.02, Z=0.81, P=0.42), the incidence of super infection(RR=1.32, 95%CI 0.66–2.63, Z=0.79, P=0.43), the incidence of hyperglycemia(RR=1.84, 95%CI 0.76–4.41, Z=1.36, P=0.17), the incidence of upper gastrointestinal bleeding(RR=1.98, 95%CI 0.37–10.59, Z=0.80, P=0.42) between the standard treatment group and the glucocorticoids treatment group.CONCLUSIONS: The use of glucocorticoids in patients with community-acquired pneumonia can significantly shorten the duration of illness and have a favorable safety profile. However, it could not reduce the overall mortality.

Community-acquired pneumonia complicated by rhabdomyolysis: A clinical analysis of 11 cases

BACKGROUND In clinical practice, community-acquired pneumonia(CAP) can be complicated by rhabdomyolysis(RM), and RM symptoms are mild and easily missed during diagnosis. Moreover, available data on RM induced by CAP are mainly from case reports. Due to the relatively low incidence of CAP-induced RM, more systematic studies are required to understand the characteristics of CAP-induced RM to improve its diagnosis and treatment.AIM To investigate the clinical characteristics of patients with CAP-induced RM.METHODS This was a retrospective study of 11 patients with CAP-induced RM. Baseline characteristics, diagnostic work-up, and laboratory test results were summarized and compared with those of 48 patients with exercise-induced RM admitted during the same period.RESULTS CAP-induced RM was more common in men, and affected older patients compared to those with exercise-induced RM. However, the average age of the patients in this study was lower than the age of peak incidence of CAP in adults in China. The major clinical manifestations were high fever and respiratory symptoms. RM symptoms were mild and often overlooked. Patients with CAP-induced RM had elevated inflammatory parameters, respiratory alkalosis,relatively low serum potassium levels and often had abnormalities in hepatic and renal function and cardiac enzymes. Compared with the exercise group, the pneumonia group had lower levels of creatine kinase and myoglobin, a higher incidence of acute kidney injury, and worse renal function and prognosis.Adverse events were mainly related to the severity of CAP.CONCLUSION CAP-induced RM has different clinical characteristics from those of exerciseinduced RM. Early detection and treatment could reduce complications and consequently shorten the treatment course.

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.

Atypical pathogens in community acquired pneumonia of Egyptian children

Objective:Diagnosis of atypical pathogens as an aetiology for community-acquired pneumonia(CAP) in children is a challenge world wide.The aim of this study was to detect the frequency of atypical pathogens as a cause of community-acquired pneumonia(CAP) in Egyptian children.Methods:From 50 children(with age ranged from 2 months to 12 years) hospitalized for community-acquired pneumonia;respiratory sputum samples were collected by induction or spontaneously.All samples were subjected to conventional cultures and Polymerase Chain Reaction(PCR) technique DNA extraction for identification of Mycoplasma,Chlamydia pneumoniae and Legionella pneumophila.Results;A definite pathogen was identified in 78%of the studied children;30% typical bacteria,8%Candida albicans and atypical bacteria in 40%of the pneumonic children.Chlamydia pneumoniae was isolated from 26%of the children while Mycoplasma pneumoniae was isolated from 14%, whereas Legionella pneumophilla was not isolated at all.Conclusion;Atypical pathogens are evident as a potential aetiology for community-acquired pneumonia in(13.3%) of young and(80%) of older Egyptian children.

Clinical Utility of Procalcitonin for Differentiating between Cryptogenic Organizing Pneumonia and Community-Acquired Pneumonia

Background: Differentiating cryptogenic organizing pneumonia (COP) from community-acquired pneumonia (CAP) can be difficult in some cases. Objective: To clarify the clinical utility of procalcitonin (PCT) levels for differentiating between COP and CAP. Methods: Blood PCT levels, leukocyte count, C-reactive protein concentration, number of segments involved on computed tomography (CT) images, and pneumonia severity assessment scale were retrospectively investigated from clinical charts and chest CT images of COP and CAP patients who were admitted to our hospital from 2012 to 2014. The clinical characteristics of COP patients were compared to those of CAP patients for whom causative organisms were not detected. Results: There were 16 COP and 94 CAP patients for whom causative organisms were not detected. Blood PCT levels of all COP patients were less than 0.16 ng/dL, and significantly lower than those of CAP patients (p = 0.0004), while the number of involved segments was significantly higher than that of CAP patients (p = 0.0001). Blood PCT levels and the number of involved segments remained independently significant for differentiating between COP and CAP by multivariate analysis. Receiver operating characteristics curve analysis revealed that 7 was the best cut-off number for involved segments to differentiate between COP and CAP patients with low PCT levels (sensitivity 85.7%, specificity 94.7%). Conclusion: A combination of PCT levels and number of involved segments on CT images is useful for differentiation between COP and CAP.

Clinical application of neutrophil/lymphocyte ratio combined with high sensitive C reactive protein in evaluation of community acquired pneumonia

Objective:To explore the application value of neutrophil/lymphocyte ratio (NLR) combined with high sensitive C reactive protein (hs-CRP) in the evaluation of community acquired pneumonia (CAP). Methods:From November 2015 to October 2016, 58 cases of CAP patients admitted in our department were selected as research objects and were divided into low risk group and high risk group according to the PSI score and CURB-65 standard for evaluation. They were divided into improved group (48 cases) and death group (10 cases) according to prognosis. Hs-CRP was determined by immunoturbidimetric assay, procalcitonin (PCT) by immunofluorescence, NLR by count method of laser scattering, and white blood (WBC) was counted. The differences in WBC, PCT, NLR and hs-CRP between different risk groups were compared, and the correlation was evaluated using Spearman's rank correlation analysis method. The changes in indexes were observed in the improved and death cases. Results:The high risk group had higher NLR, PCT and hs-CRP than low risk group (P<0.05), while no significant difference was found in WBC (P>0.05). No correlation was found between NLR and WBC, while a strong correlation was found between hs-CRP and PCT. The WBC, PCT, NLR and hs-CRP levels were significantly lower in the improved group than the death group (P<0.05). Conclusions:NLR combined with hs-CRP, WBC, and PCT has a good assessment of the severity of CAR, and high levels of NLR, hs-CRP, WBC, and PCT predict the severity of the disease and poor prognosis.

Role of Serum Procalcitonin Level in Differentiating between Pulmonary Tuberculosis and Community-Acquired Pneumonia

Pulmonary Tuberculosis (PTB) and Community-Acquired Pneumonia (CAP) are common causes of consolidation patch in chest radiograph. Sputum Z-N staining is positive in 30% to 60% cases only and sputum examination has poor yield in CAP. This study aimed to assess the value of serum Procalcitonin (PCT) levels in patients with Pulmonary Tuberculosis (PTB) and Community-Acquired Pneumonia (CAP). Patients with new opacity in chest radiograph were included in the study. Serum sample were taken at admission and stored. Patient’s diagnosis were confirmed and categorized into pulmonary TB group (32) and community-acquired pneumonia group (23). Their mean PCT level was compared with mean PCT level of 25 controls. Serum procalcitonin levels were found to be significantly elevated in patients of community-acquired pneumonia as compared to patients of pulmonary tuberculosis. In presence of consolidation in x-ray chest, increased level of serum procalcitonin might be used to differentiate pulmonary tuberculosis from community-acquired pneumonia. High level of serum procalcitonin was associated with high mortality rate in community-acquired pneumonia patients.

DIAGNOSTIC BEHAVIOR OF COMMUNITY-ACQUIRED PNEUMONIA:SURVEY CONDUCTED IN SOME REGIONS OF CHINA

Objective To analyze the spectrum of microbiological agents causing community-acquired pneumonia (CAP) in recent years. We also investigated the procedure of diagnosis as well as the empirical treatment for this disease in OPD (outpatient department) of pulmonary disease. Methods A total of 7097 patients from 150 hospitals in 24 provinces in China were enrolled in the study from Nov. 2002 to Mar. 2003. Every patient was diagnosed, treated and registered at the same time. Diagnostic behavior for doctors include chest radiograph and/or CT examination of the lung, as well as collecting sputum samples at the time of diagnosis for bacteria culture to identify the pathogen. Appointed staff fulfilled the questionnaires and information sheets in each center. After that, data were computerized and analyzed. Results There were 7404 valid information sheets and 7097 questionnaires taken into count. The majority CAP patients were from cities (77.3%), most of those who had medical insurance. Most CAP patients had productive cough (81.1%), and 76.7% and 18.2% CAP patients received chest film and CT examination respectively for diagnosis. Only 24% patients received sputum sample tested and with 36% got positive results. Streptococcus pneumoniae remained the main pathogen of CAP (43.2%). Most doctors used to prescribe β-lactam antibiotics as the first line of empirical therapy of CAP (51.1%) with oral taken as the main method for drug using (66.3%). Conclusion This survey provides a key point of empirical therapy in China. The procedure for diagnosing as well as the empirical treatment of CAP in OPD of pulmonary disease in China still to be improved, especially in accessing the pathogen. Guidelines developed to recognize and evaluate CAP should base on epidemiological information of the pathogen prevalence, then could offer a rational approach to the initial management of the CAP patients.

A rare case of community acquired Burkholderia cepacia infection presenting as pyopneumothorax in an immunocompetent individual

Burkholderia cepacia(6.cepacia)infection is rarely reported in an immunocompetent host.It is a well known occurence in patients with cystic fibrosis and chronic granulomatous disease where it increases both morbidity and mortality.It has also been included in the list of organisms causing nosocomial infections in an immunocompetent host,most of them transmitted from the immunocompromised patient in which this organism harbors.We report a rare case of isolation of B.cepacia from the bronchoalveolar lavage fluid of an immunocompetent agriculturist who presented with productive cough and fever associated with a pyopneumothorax.This is the first case of community acquired infection reported in an immunocompetent person in India.

Antimicrobial susceptibility profile of community acquired and nosocomial isolates of Escherichia coli from clinical blood culture specimens at a Nigerian university teaching hospital

Objective:To ascertain the antibiotic susceptibility patterns of Escherichia coli recovered from blood culture specimens in Calabar.Nigeria.Methods:The study was retrospective in nature and was carried out at University of Calabar Teaching Hospital(UCTH) Calabar.Data generated from blood culture specimens over a five year period(Feb.2004-Feb.2009) was compiled, relevant information such as age,sex,organism recovered and antibiotic susceptibility patterns were obtained from patients records.Samples were collected,transported,stored and processed using standard laboratory procedures.Data obtained was analysed using Epi Info 6 statistical software.Results:Escherichia coli was responsible for 15.3%(31/203) of the blood infections being the third most common microorganism encountered.The community acquired(CA) isolates of the organism were significantly less resistant(P【0.05),compared to the nosocomial(NC) isolates against ampicillin.cloxacillin,amoxicillin,tetracycline,co-trimoxazole.chloramphenicol and erythromycin.The sensitivity of both the NC and CA isolates of Escherichia coli to amikacin, augmentin,ofloxacin,ciprofloxacin,ceftazidime,cefuroxime,ceftriaxone and rifampicin was generally high(80-100%) with no significant difference(P】0.05).Majority(】95.0%) of the NC isolates of Escherichia coli were resistant to six of the antibiotics tested.Conclusions:Control mechanisms for hospital acquired infections should be stepped up so as lo limit the spread of the highly resistant bacterial strains.Also the sale and consumption of antibiotics by the public need to be regulated.

Changes in the pathogen spectrum of hospitalized adults with community-acquired pneumonia in Fujian Province: A multicenter, retrospective study from 2012 to 2018

To the Editor:Community-acquired pneumonia(CAP)in adults refers to inflammation of the lung parenchyma involving the alveolar wall.It occurs in the community environment(outside the hospital),including pneumonia caused by pathogens with definite latency after admission.

中医辨证治疗方案对老年社区获得性肺炎出院后患者生存质量和疗效满意度的评价研究

背景社区获得性肺炎(CAP)为常见的感染性疾病之一,尤其在老年患者中,其临床症状不典型,易出现严重并发症,缺乏有效的治疗措施,常预后不良。目的探究中医辨证治疗方案对老年CAP出院(1周内)患者的生存质量及其疗效满意度情况。方法本研究为多中心、随机双盲安慰剂临床研究。选取河南中医药大学第一附属医院、河南省胸科医院、河南省人民医院、郑州市中医院、郑州人民医院5家医院呼吸科2018年4月—2020年1月病房收治的老年CAP出院后患者为研究对象,采用中央随机入组模式将患者分为试验组和对照组。试验组患者经中医辨证后给予相应中药颗粒剂进行治疗,气虚痰湿证给予补肺健脾化痰方,气阴虚痰热证给予益气养阴清肺方。对照组则给予与中药颗粒外观、重量、颜色、气味基本一致的安慰剂。治疗疗程为2个月,随访至治疗开始后6个月。比较两组患者治疗前、治疗1个月、治疗2个月、随访3个月、随访6个月的生存质量[采用中文版生存质量评分量表(SF-36)评价]和疗效满意度[采用肺炎患者疗效满意度问卷(ESQ-CAP)评价]。结果纳入120例患者中,脱落8例,最终纳入符合方案集的病例112例,其中试验组54例、对照组58例。治疗前两组性别、年龄、出院后时间、中医辨证分型、CUBR-65评分、基础疾病比较,差异无统计学意义(P>0.05)。组别对SF-36生理机能领域评分(F组间=5.057,P组间=0.027)、一般健康状况领域评分(F组间=7.286,P组间=0.008)、情感职能领域评分(F组间=6.858,P组间=0.010)主效应显著。组间比较:治疗2个月、随访3个月、随访6个月,试验组SF-36生理机能领域评分高于对照组(P<0.05);治疗1、2个月和随访3、6个月,试验组SF-36一般健康状况领域、情感职能领域评分高于对照组(P<0.05);随访3、6个月,试验组SF-36精神健康领域评分高于对照组(P<0.05)。组别对ESQ-CAP日常生活与能力领域评分(F组间=16.218,P组间<0.001)、方便领域评分(F组间=25.013,P组间<0.001)及ESQ-CAP总分(F组间=13.843,P组间<0.001)主效应显著。治疗2个月和随访3、6个月,试验组ESQ-CAP日常生活与能力领域评分高于对照组(P<0.05)。治疗1、2个月和随访3、6个月,试验组ESQ-CAP方便领域评分及ESQ-CAP总分高于对照组(P<0.05)。随访3个月,试验组ESQ-CAP总体疗效领域评分高于对照组(P<0.05)。结论中医辨证治疗方案对于老年CAP出院后患者的生存质量和疗效满意度具有较好的改善作用。

背俞穴指揉弹拨法改善老年社区获得性肺炎病人排痰的效果

目的:探讨背俞穴指揉弹拨法改善老年社区获得性肺炎(CAP)病人排痰的效果。方法:纳入2021年9月—2022年11月入住巴中市某三级甲等综合医院老年病科的老年CAP病人96例为研究对象,采用随机数字表法将病人分为试验组和对照组,每组48例,对照组接受常规背部叩击排痰护理,试验组在对照组基础上实施背俞穴指揉弹拨法。比较两组病人排痰费力改善情况、排痰有效率、经皮脉搏血氧饱和度(SpO2)、焦虑状况及住院时间。结果:干预开始后7 d,试验组病人排痰费力改善率为95.83%,高于对照组(81.25%);试验组病人干预后排痰总有效率为93.75%,高于对照组(79.17%);试验组病人干预后SpO2为(97.72±1.05)%,高于对照组[(95.23±1.27)%];试验组病人干预后焦虑程度低于对照组;试验组病人住院时间为(10.03±1.29)d,短于对照组[(12.94±1.22)d],差异均有统计学意义(P<0.05)。结论:背俞穴指揉弹拨法在一定程度上有利于改善老年CAP病人的排痰能力,提升病人血氧饱和度,改善病人焦虑状态,缩短病人住院时间。