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.

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.

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.

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.

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.

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.

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.

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.

Treatment of Pneumocystis jirovecii pneumonia in non-human immunodeficiency virus-infected patients using a combination of trimethoprim-sulfamethoxazole and caspofungin

BACKGROUND Pneumocystis jirovecii pneumonia(PJP)is an infectious disease common in immunocompromised hosts.However,the currently,the clinical characteristics of non-HIV patients with PJP infection have not been fully elucidated.AIM To explore efficacy of trimethoprim–sulfamethoxazole(TMP-SMX)and caspofungin for treatment of non-human immunodeficiency virus(HIV)-infected PJP patients.METHODS A retrospective study enrolled 22 patients with non-HIV-infected PJP treated with TMP-SMX and caspofungin from 2019 to 2021.Clinical manifestations,treatment and prognosis of the patients were analyzed.RESULTS Five patients presented with comorbidity of autoimmune diseases,seven with lung cancer,four with lymphoma,two with organ transplantation and four with membranous nephropathy associated with use of immunosuppressive agents.The main clinical manifestations of patients were fever,dry cough,and progressive dyspnea.All patients presented with acute onset and respiratory failure.The most common imaging manifestation was ground glass opacity around the hilar,mainly in the upper lobe.All patients were diagnosed using next-generation sequencing,and were treated with a combination of TMP-SMX and caspofungin.Among them,17 patients received short-term adjuvant glucocorticoid therapy.All patients recovered well and were discharged from hospital.CONCLUSION Non-HIV-infected PJP have rapid disease progression,high risk of respiratory failure,and high mortality.Combination of TMP-SMX and caspofungin can effectively treat severe non-HIVinfected PJP patients with respiratory failure.

Lack of Response in Severe Pneumocystis Pneumonia to Combined Caspofungin and Clindamycin Treatment: a Case Report

PNEUMOCYSTIS pneumonia (PCP) is among the most common opportunistic infections in patients with acquired immune deficiency syndrome (AIDS).Although trimethoprim-sulfamethoxazole (TMP-SMX) is the first line therapy for that condition given its efficacy,approximately one third of patients experienced dose-limiting toxicity.1 For cases of severe to moderate PCP,if TMP-SMX treatment fails or is contraindicated,primaquine combined with clindamycin or intravenous pentamidine is recommended as second line therapy.2 However,both primaquine and pentamidine are associated with severe adverse reactions and often unavailable at hospitals in China.3 As a result,other treatment options have been explored.

Efficacy and significance of various scores for pneumonia severity in the management of patients with community-acquired pneumonia in China

Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index （PSI）,CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay （LOS） were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in the high-risk CAP sub-group.The 30-day mortality of patients who underwent ICU treatment on admission was also higher than for non-ICU treatment,but much lower than for those patients who took ICU treatment subsequent to the failure of non-ICU treatment.Conclusions Each severity score system,CURB-65,sepsis severity score and especially PSI,was capable of effectively predicting CAP mortality.Delayed ICU admission was related to higher mortality rates in severe CAP patients.

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.

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.

Clinical efficacy and safety of moxifloxacin versus levofloxacin plus metronidazole for community-acquired pneumonia with aspiration factors

Background Community-acquired pneumonia （CAP） is a common infectious disease throughout the world and the incidence continues to grow as the population ages.Aspiration is an important pathogenic mechanism for pneumonia in the elderly and the management of patients with community-acquired pneumonia with aspiration factors is a major medical problem.Our study aimed to assess whether moxifloxacin in comparison to levofloxacin plus metronidazole are effective and safe in the treatment of community-acquired pneumonia with aspiration factors.Methods In this prospective,multicenter,open-label,randomized controlled trial,77 patients with mild-to-moderate community-acquired pneumonia with aspiration factors were enrolled and randomly assigned to receive moxifloxacin or levofloxacin plus metronidazole.The primary efficacy variables were clinical outcomes in evaluable patients at a follow-up visit 7 to 14 days after the end of therapy.Results Seven days after the end of therapy a clinical cure was achieved for 76.7％ （23 of 37） of efficacy-evaluable patients in the moxifloxacin group and 51.7％ （15 of 40） of patients in the levofloxacin plus metronidazole group.There was a significant difference between the two groups （x2=4.002,P ＜0.05）.Bacteriological success rates were similar in the moxifloxacin group （93.3％） and levofloxacin plus metronidazole group （96.4％）,there was no significant difference between the two groups （P ＞0.05）.The overall adverse event rate was 10.8％ （4/37） in the moxifloxacin group versus 17.5％ （7/40） in the levofloxacin plus metronidazole group,there was no significant difference between the two groups （P＞0.05）.No serious adverse events were observed.Conclusions Moxifloxacin is effective and safe for treatment of community-acquired pneumonia with aspiration factors.And the regimen of moxifloxacin monotherapy is more convenient compared with levofloxacin plus metronidazole.

Etiology and antimicrobial resistance of community-acquired pneumonia in adult patients in China

Background Appropriate antimicrobial therapy of community-acquired pneumonia （CAP） is mainly based on the distribution of etiology and antimicrobial resistance of major pathogens. We performed a prospective observational study of adult with CAP in 36 hospitals in China. Methods Etiological pathogens were isolated in each of the centers, and all of the isolated pathogens were sent to Zhongshan Hospital for antimicrobial susceptibility tests using agar dilution. Results A total of 593 patients were enrolled in this study, and 242 strains of bacteria were isolated from 225 patients. Streptococcus pneumoniae （79/242, 32.6%） was the most frequently isolated pathogen, followed by Haemophilus influenzae （55/242, 22.7%） and Klebsiella pneumoniae （25/242, 10.3%）. Totally 527 patients underwent serological tests for atypical pathogens; Mycoplasma pneumoniae and Chlamydia pneumoniae infections were identified in 205 （38.9%） and 60 （11.4%） patients respectively. Legionella pneumophila infections were identified in 4.0% （13/324） of patients. The non-susceptibility rate of isolated Streptococcus pneumoniae to erythromycin and penicillin was 63.2% and 19.1% respectively. Six patients died from the disease, the 30-day mortality rate was 1.1% （6/533）. Conclusions The top three bacteria responsible for CAP in Chinese adults were Streptococcus pneumonia, Haemophilus influenza and Klebsiella pneumonia. There was also a high prevalence of atypical pathogens and mixed pathogens. The resistance rates of the major isolated pathogens were relatively low except for the high prevalence of macrolide resistance in Streptococcus pneumoniae.