Objective:This study aims to explore the prevalence,features,and risk factors of lower respiratory tract infections(LRTIs)in the intensive care unit(ICU)of a newly established hospital in Zunyi City.The goal is to dev...Objective:This study aims to explore the prevalence,features,and risk factors of lower respiratory tract infections(LRTIs)in the intensive care unit(ICU)of a newly established hospital in Zunyi City.The goal is to devise strategies for preventing LRTIs in the ICU of new hospitals,thereby mitigating the incidence of nosocomial LRTIs in ICU patients.Methods:A case-control study was conducted from March 2019 to December 2022 to investigate the incidence rate of LRTIs in the ICU of a newly constructed hospital in Zunyi City.Patients with LRTIs constituted the case group,while those without LRTIs constituted the control group,where a 1:1 matching principle was adhered to.A single-factor chi-square(χ2)test was employed to analyze the risk factors,with independent risk factors being explored using a multivariate logistic regression analysis.Results:A total of 169 strains of pathogenic bacteria were isolated,comprising 66.28%gram-negative bacteria,17.75%gram-positive bacteria,and 15.97%fungi.The most prevalent pathogens included Acinetobacter baumannii(43.20%),Candida albicans(10.65%),and Pseudomonas aeruginosa(8.88%).Of the 82 strains infected by multidrug-resistant bacteria in patients with LRTIs,81.7%were carbapenem-resistant Acinetobacter baumannii,9.8%were multidrug-resistant Pseudomonas aeruginosa,and 6.1%were carbapenem-resistant Escherichia coli.Identified risk factors included smoking history,total hospitalization days,ICU stay length,hypoproteinemia,indwelling gastric tube,intubation type,duration of mechanical ventilation,usage of antibacterial drugs,and administration of protein drugs(P<0.05).Multivariate logistic regression analysis demonstrated that these factors were independent risk factors for nosocomial LRTIs in ICU patients(P<0.05).Conclusion:ICU patients in our hospital were mainly infected by carbapenem-resistant Acinetobacter baumannii.To prevent LRTIs in patients,tailored preventive measures should be developed and the rational use of antibacterial drugs should be promoted.展开更多
Multiplex RT-PCR assays have been widely used tools for detection and differentiation of a panel of respiratory viral pathogens. In this study, we evaluated the Qiagen ResPlex lI V2.0 kit and explored factors influenc...Multiplex RT-PCR assays have been widely used tools for detection and differentiation of a panel of respiratory viral pathogens. In this study, we evaluated the Qiagen ResPlex lI V2.0 kit and explored factors influencing its sensitivity. Nasopharyngeal swab （NPS） specimens were prospectively collected from pediatric inpatients with lower respiratory tract infections at the time of admission in the Shenzhen Children＇s Hospital from May 2009 to April 2010. Total nucleic acids were extracted using the EZ1 system （Qiagen, Germany） and 17 respiratory viruses and genotypes including influenza A virus （FluA）, FluB, parainfluenza virus 1 （PIV1）, PIV2, PIV3, PIV4, respiratory syncytial virus （RSV）, human metapneumovirus （hMPV）, rhinoviruses （RhV）, enteroviruses （EnV）, human bocaviruses （hBoV）, adenoviruses （AdV）, four coronaviruses （229E, OC43, NL63 and HKU1）, and FluA 2009 pandemic H1NI（H1NI-p） were detected and identified by the ResPlex II kit. In parallel, 16 real-time TaqMan quantitative RT-PCR assays were used to quantitatively detect each virus except for RhV. Influenza and parainfluenza viral cultures were also performed. Among the total 438 NPS specimens collected during the study period, one or more viral pathogens were detected in 274 （62.6%） and 201（45.9%） specimens by monoplex TaqMan RT-PCR and multiplex ResPlex, respectively. When results from monoplex PCR or cell culture were used as the reference standard, the multiplex PCR possessed specificities of 92.9-100.0%. The sensitivity of multiplex PCR for PIV3, hMPV, PIV1 and BoV were 73.1%, 70%, 66.7% and 55.6%, respectively, while low sensitivities （11.1%-40.0%） were observed for FluA, EnV, OC43, RSV and H1N1. Among the seven viruses/genotypes detected with higher frequencies, multiplex PCR sensitivities were correlated significantly with viral loads determined by the TaqMan RT-PCR in FluA, H 1N 1-p and RSV （p=0.011-0.000） The Qiagen ResPlex II multiplex RT-PCR kit possesses excellent specificity for simultaneous detection of 17 viral pathogens in NPS specimens in pediatric inpatients at the time of admission. The sensitivity of multiplex RT-PCR was influenced by viral loads, specimen process methods, primer and probe design and amplification condition.展开更多
Objective: To investigate the prevalence of isolated organisms in patients with lower respiratory tract infections and the antibiotic susceptibilities at a tertiary care center. Methods: In this observational and cros...Objective: To investigate the prevalence of isolated organisms in patients with lower respiratory tract infections and the antibiotic susceptibilities at a tertiary care center. Methods: In this observational and cross-sectional analysis, 114 patients admitted in the intensive care unit were enrolled. The endotracheal aspirates and bronchoalveolar lavage were collected. The bacteria were isolated and identified, and finally, antimicrobial sensitive pattern of the isolated bacteria was examined. Results: The prevalence of infection was 72.72% in male patients and 27.28% in females. The predominant bacteria were Klebsiella pneumoniae (37.50%) followed by Acinetobacter spp. (36.36%), Pseudomonas aeruginosa (7.95%),Escherichia coli (6.81%), Proteus mirabilis (2.27%), atypical Escherichia coli (1.13%), Enterococcus spp. (1.13%),Elizabethkingia meningoseptica (1.13%),Staphylococcus aureus (1.13%),Proteus vulgaris (1.13%), Citrobacter freundii (1.13%), and Citrobacter koseri (1.13%). High resistance to cephalosporins (82.18%) was demonstrated in all Gram-negative bacteria. Bacteria showed susceptibility to colistin (88.75%) followed by tigecycline (83.11%), gentamycin (36.18%), and amikacin (49.23%). Conclusions: As the most frequent respiratory organisms, Klebsiella pneumoniae and Acinetobacter spp. have increased resistance to cephalosporins and susceptibility to colistin followed by tigecycline.展开更多
Objective:To examine the effects of human bocavirus type 1(HBoV1)on the course of lower respiratory tract infections in cases of monoinfection and coinfection,and the effects of HBoV1 viral load on the disease in chil...Objective:To examine the effects of human bocavirus type 1(HBoV1)on the course of lower respiratory tract infections in cases of monoinfection and coinfection,and the effects of HBoV1 viral load on the disease in children under six years old hospitalized with a diagnosis of HBoV1-associated lower respiratory tract infections.Methods:Children under six years of age,who were hospitalized with the diagnosis of lower respiratory tract infection due to HBoV1 between 1 January 2021 and 1 January 2022 were included in the study.Laboratory confirmation of the respiratory pathogens was performed using polymerase chain reaction(PCR).Results:Fifty-four(16.4%)children with HBoV1 among 329 children whose PCR was positive with bacterial/viral agent in nasopharyngeal swab samples were included in the study.There were 28(51.9%)males and 26(48.1%)females with a median age 23.4 months[interquartile range(IQR):13.2,30.0 months](min-max:1 month-68 months).HBoV1 was detected as a monoinfecton in 26(48.1%)children,and as a coinfection with other respiratory agents in 28 children(51.9%).In multiple regression analysis,coinfection(P=0.032)was associated with the length of hospitalization(P<0.001;R^(2)=0.166).There was a negative correlation(r=−0.281,P=0.040)between cough and cycle threshold.Fever was found to be positively correlated with C-reactive protein(r=0.568,P<0.001)and procalcitonin(r=0.472;P=0.001).Conclusions:Although we found a higher HBoV1 viral load in children with more cough symptoms in our study,it had no effect on the severity of the disease,such as length of hospital stay and need for intensive care.Coinfection was found to affect the length of hospitalization.展开更多
BACKGROUND The association between hospitalization for human respiratory syncytial virus(HRSV)bronchiolitis in early childhood and subsequent asthma is well established.The long-term prognosis for non-bronchiolitis lo...BACKGROUND The association between hospitalization for human respiratory syncytial virus(HRSV)bronchiolitis in early childhood and subsequent asthma is well established.The long-term prognosis for non-bronchiolitis lower respiratory tract infections(LRTI)caused by viruses different from HRSV and rhinovirus,on the other hand,has received less interest.AIM To investigate the relationship between infant LRTI and later asthma and examine the influence of confounding factors.METHODS The PubMed and Global Index Medicus bibliographic databases were used to search for articles published up to October 2021 for this systematic review.We included cohort studies comparing the incidence of asthma between patients with and without LRTI at≤2 years regardless of the virus responsible.The meta-analysis was performed using the random effects model.Sources of heterogeneity were assessed by stratified analyses.RESULTS This review included 15 articles(18 unique studies)that met the inclusion criteria.LRTIs at≤2 years were associated with an increased risk of subsequent asthma up to 20 years[odds ratio(OR)=5.0,95%CI:3.3-7.5],with doctor-diagnosed asthma(OR=5.3,95%CI:3.3-8.6),current asthma(OR=5.4,95%CI:2.7-10.6),and current medication for asthma(OR=1.2,95%CI:0.7-3.9).Our overall estimates were not affected by publication bias(P=0.671),but there was significant heterogeneity[I 2=58.8%(30.6-75.5)].Compared to studies with hospitalized controls without LRTI,those with ambulatory controls had a significantly higher strength of association between LRTIs and subsequent asthma.The strength of the association between LRTIs and later asthma varied significantly by country and age at the time of the interview.The sensitivity analyses including only studies with similar proportions of confounding factors(gender,age at LRTI development,age at interview,gestational age,birth weight,weight,height,smoking exposure,crowding,family history of atopy,and family history of asthma)between cases and controls did not alter the overall estimates.CONCLUSION Regardless of the causative virus and confounding factors,viral LRTIs in children<2 years are associated with an increased risk of developing a subsequent asthma.Parents and pediatricians should be informed of this risk.展开更多
Background: Despiteits recommendation in management guide lines for community acquired pneumonia (CAP), the CURB65 score is frequently not followed for disposition decisions in clinical routine. We therefore proposed ...Background: Despiteits recommendation in management guide lines for community acquired pneumonia (CAP), the CURB65 score is frequently not followed for disposition decisions in clinical routine. We therefore proposed an improved CURB65 A score, supplemented by proadre nome dull in (ProADM) levels for patients with CAP and other lower respiratory tract infections (LRTIs). In this study, we vali dated this risk based biomarker enhanced disposition in patients with LRTIs presenting to the emergency department of the University Hospital of Basel. Methods: In this prospective observational cohort study of 85 patients presenting with LRTIs, site of care was decided by the physicians in charge according to their judgement. Retro spectively the CURB65 A score was calculated and a virtual disposition assigned. This was compared with the existing disposition in order to identify efficacy of the novel risk based biomarker enhanced disposition. Results: The novel disposition criteria considered 14 patients suitable for outpatient treatment compared to 11 in the current disposition (p = 0.5). It detected 7 patients to be best treated outside the hospital for nursing reasons, while the current disposition detected only 1 patient requiring geriatric care (p = 0.09). Further, it decreased regular hospitalizations considerably (32 vs. 64, p 0.001). Conclusions: The novel risk based biomarker enhanced disposition is an objective, safe and probably more efficient disposition system to identify outpatient treatment options than the current practice at the University Hospital of Basel.展开更多
Background: Lower respiratory tract infections (LRTI) are among the leading causes of morbidity and mortality. A severe form of atypical pneumonia, Q fever, has been found in Northern Tanzania. Assessment of the quali...Background: Lower respiratory tract infections (LRTI) are among the leading causes of morbidity and mortality. A severe form of atypical pneumonia, Q fever, has been found in Northern Tanzania. Assessment of the quality of health care for lower respiratory tract infection from the clinicians’ performance has rarely been performed. Methods: A cross sectional descriptive study using the qualitative and quantitative approaches for assessing clinicians and patient files from 11 health facilities of Kilimanjaro region. The facilities were of 4 different levels of public health care delivery and 1 private independent hospital. Results: Medications for LRTI were highly variable in 346 files and from attempts of treatment reported in 53 clinician’s interviews. No file showed attempts for assessing the severity of Pneumonia. Only 6 (11.1%) clinicians could mention causes of atypical pneumonia. Only 7 clinicians (13.0%) were aware of Q-fever and could mention the cause. The quality of clinical records for monitoring the progress was not the same in all levels of care and the difference in availability was statistically significant as level of mental state χ2 (4) = 139.4;P展开更多
Objective To explore the prescribing patterns of outpatients receiving antibiotics for upper respiratory tract infections(URTIs)in rural Western China and to identify the correlation in terms of doctors and patients c...Objective To explore the prescribing patterns of outpatients receiving antibiotics for upper respiratory tract infections(URTIs)in rural Western China and to identify the correlation in terms of doctors and patients characteristics.Methods Totally 7 678 prescriptions for URTIs were collected from 680 primary health village clinics of 40 counties across 10 provinces of Western China.Two outcome variables were used in the analysis:the occurrence of prescribing at least one antibiotic drug for an URTI and the occurrence of prescribing two or more antibiotics for an URTI.GEE logistic regression models were used to examine the socioeconomic and demographic determinants of the above two outcome variables.Results The percentage of prescribing at least one antibiotic for URTIs was 48.6% while the percentage of prescribing antibiotic combination(two or more antibiotics)was 4.6%.The two measurements of antibiotic utilization differed remarkably among the 10 provinces.Patients diagnosed with tonsillitis and faucitis had higher odds(OR=8.86 for tonsillitis and OR=4.64 for faucitis)of antibiotic prescription than patients with other diagnosis of URTIs.Patients with tonsillitis and faucitis also had higher odds(OR=3.82 for tonsillitis and OR=2.71 for faucitis)of multiple antibiotic prescription than those with other diagnosis of URTIs.The number of drugs per prescription and injection in prescriptions were also significant predictors of antibiotic and multiple antibiotic utilization for URTIs.Conclusion It is concluded that the percentage of antibiotic prescription for URTIs is higher in rural Western China than in most of other countries with available data and that prescriptions of antibiotics for URTIs are associated with residence regions of patients,URTI diagnosis and background information on drug prescription.展开更多
基金Analysis of influencing factors and direct economic losses of ICU infection in a newly built tertiary comprehensive hospital(Project No:Qiankehe Support[2021]General 043)。
文摘Objective:This study aims to explore the prevalence,features,and risk factors of lower respiratory tract infections(LRTIs)in the intensive care unit(ICU)of a newly established hospital in Zunyi City.The goal is to devise strategies for preventing LRTIs in the ICU of new hospitals,thereby mitigating the incidence of nosocomial LRTIs in ICU patients.Methods:A case-control study was conducted from March 2019 to December 2022 to investigate the incidence rate of LRTIs in the ICU of a newly constructed hospital in Zunyi City.Patients with LRTIs constituted the case group,while those without LRTIs constituted the control group,where a 1:1 matching principle was adhered to.A single-factor chi-square(χ2)test was employed to analyze the risk factors,with independent risk factors being explored using a multivariate logistic regression analysis.Results:A total of 169 strains of pathogenic bacteria were isolated,comprising 66.28%gram-negative bacteria,17.75%gram-positive bacteria,and 15.97%fungi.The most prevalent pathogens included Acinetobacter baumannii(43.20%),Candida albicans(10.65%),and Pseudomonas aeruginosa(8.88%).Of the 82 strains infected by multidrug-resistant bacteria in patients with LRTIs,81.7%were carbapenem-resistant Acinetobacter baumannii,9.8%were multidrug-resistant Pseudomonas aeruginosa,and 6.1%were carbapenem-resistant Escherichia coli.Identified risk factors included smoking history,total hospitalization days,ICU stay length,hypoproteinemia,indwelling gastric tube,intubation type,duration of mechanical ventilation,usage of antibacterial drugs,and administration of protein drugs(P<0.05).Multivariate logistic regression analysis demonstrated that these factors were independent risk factors for nosocomial LRTIs in ICU patients(P<0.05).Conclusion:ICU patients in our hospital were mainly infected by carbapenem-resistant Acinetobacter baumannii.To prevent LRTIs in patients,tailored preventive measures should be developed and the rational use of antibacterial drugs should be promoted.
基金supported in part by Grant Name awarded to the State Key Lab of Respiratory Diseases,Guangzhou Medical College (2007DA780154F0910)
文摘Multiplex RT-PCR assays have been widely used tools for detection and differentiation of a panel of respiratory viral pathogens. In this study, we evaluated the Qiagen ResPlex lI V2.0 kit and explored factors influencing its sensitivity. Nasopharyngeal swab （NPS） specimens were prospectively collected from pediatric inpatients with lower respiratory tract infections at the time of admission in the Shenzhen Children＇s Hospital from May 2009 to April 2010. Total nucleic acids were extracted using the EZ1 system （Qiagen, Germany） and 17 respiratory viruses and genotypes including influenza A virus （FluA）, FluB, parainfluenza virus 1 （PIV1）, PIV2, PIV3, PIV4, respiratory syncytial virus （RSV）, human metapneumovirus （hMPV）, rhinoviruses （RhV）, enteroviruses （EnV）, human bocaviruses （hBoV）, adenoviruses （AdV）, four coronaviruses （229E, OC43, NL63 and HKU1）, and FluA 2009 pandemic H1NI（H1NI-p） were detected and identified by the ResPlex II kit. In parallel, 16 real-time TaqMan quantitative RT-PCR assays were used to quantitatively detect each virus except for RhV. Influenza and parainfluenza viral cultures were also performed. Among the total 438 NPS specimens collected during the study period, one or more viral pathogens were detected in 274 （62.6%） and 201（45.9%） specimens by monoplex TaqMan RT-PCR and multiplex ResPlex, respectively. When results from monoplex PCR or cell culture were used as the reference standard, the multiplex PCR possessed specificities of 92.9-100.0%. The sensitivity of multiplex PCR for PIV3, hMPV, PIV1 and BoV were 73.1%, 70%, 66.7% and 55.6%, respectively, while low sensitivities （11.1%-40.0%） were observed for FluA, EnV, OC43, RSV and H1N1. Among the seven viruses/genotypes detected with higher frequencies, multiplex PCR sensitivities were correlated significantly with viral loads determined by the TaqMan RT-PCR in FluA, H 1N 1-p and RSV （p=0.011-0.000） The Qiagen ResPlex II multiplex RT-PCR kit possesses excellent specificity for simultaneous detection of 17 viral pathogens in NPS specimens in pediatric inpatients at the time of admission. The sensitivity of multiplex RT-PCR was influenced by viral loads, specimen process methods, primer and probe design and amplification condition.
文摘Objective: To investigate the prevalence of isolated organisms in patients with lower respiratory tract infections and the antibiotic susceptibilities at a tertiary care center. Methods: In this observational and cross-sectional analysis, 114 patients admitted in the intensive care unit were enrolled. The endotracheal aspirates and bronchoalveolar lavage were collected. The bacteria were isolated and identified, and finally, antimicrobial sensitive pattern of the isolated bacteria was examined. Results: The prevalence of infection was 72.72% in male patients and 27.28% in females. The predominant bacteria were Klebsiella pneumoniae (37.50%) followed by Acinetobacter spp. (36.36%), Pseudomonas aeruginosa (7.95%),Escherichia coli (6.81%), Proteus mirabilis (2.27%), atypical Escherichia coli (1.13%), Enterococcus spp. (1.13%),Elizabethkingia meningoseptica (1.13%),Staphylococcus aureus (1.13%),Proteus vulgaris (1.13%), Citrobacter freundii (1.13%), and Citrobacter koseri (1.13%). High resistance to cephalosporins (82.18%) was demonstrated in all Gram-negative bacteria. Bacteria showed susceptibility to colistin (88.75%) followed by tigecycline (83.11%), gentamycin (36.18%), and amikacin (49.23%). Conclusions: As the most frequent respiratory organisms, Klebsiella pneumoniae and Acinetobacter spp. have increased resistance to cephalosporins and susceptibility to colistin followed by tigecycline.
文摘Objective:To examine the effects of human bocavirus type 1(HBoV1)on the course of lower respiratory tract infections in cases of monoinfection and coinfection,and the effects of HBoV1 viral load on the disease in children under six years old hospitalized with a diagnosis of HBoV1-associated lower respiratory tract infections.Methods:Children under six years of age,who were hospitalized with the diagnosis of lower respiratory tract infection due to HBoV1 between 1 January 2021 and 1 January 2022 were included in the study.Laboratory confirmation of the respiratory pathogens was performed using polymerase chain reaction(PCR).Results:Fifty-four(16.4%)children with HBoV1 among 329 children whose PCR was positive with bacterial/viral agent in nasopharyngeal swab samples were included in the study.There were 28(51.9%)males and 26(48.1%)females with a median age 23.4 months[interquartile range(IQR):13.2,30.0 months](min-max:1 month-68 months).HBoV1 was detected as a monoinfecton in 26(48.1%)children,and as a coinfection with other respiratory agents in 28 children(51.9%).In multiple regression analysis,coinfection(P=0.032)was associated with the length of hospitalization(P<0.001;R^(2)=0.166).There was a negative correlation(r=−0.281,P=0.040)between cough and cycle threshold.Fever was found to be positively correlated with C-reactive protein(r=0.568,P<0.001)and procalcitonin(r=0.472;P=0.001).Conclusions:Although we found a higher HBoV1 viral load in children with more cough symptoms in our study,it had no effect on the severity of the disease,such as length of hospital stay and need for intensive care.Coinfection was found to affect the length of hospitalization.
基金Supported by the European Union (EDCTP2 Programme),No. TMA2019PF-2705
文摘BACKGROUND The association between hospitalization for human respiratory syncytial virus(HRSV)bronchiolitis in early childhood and subsequent asthma is well established.The long-term prognosis for non-bronchiolitis lower respiratory tract infections(LRTI)caused by viruses different from HRSV and rhinovirus,on the other hand,has received less interest.AIM To investigate the relationship between infant LRTI and later asthma and examine the influence of confounding factors.METHODS The PubMed and Global Index Medicus bibliographic databases were used to search for articles published up to October 2021 for this systematic review.We included cohort studies comparing the incidence of asthma between patients with and without LRTI at≤2 years regardless of the virus responsible.The meta-analysis was performed using the random effects model.Sources of heterogeneity were assessed by stratified analyses.RESULTS This review included 15 articles(18 unique studies)that met the inclusion criteria.LRTIs at≤2 years were associated with an increased risk of subsequent asthma up to 20 years[odds ratio(OR)=5.0,95%CI:3.3-7.5],with doctor-diagnosed asthma(OR=5.3,95%CI:3.3-8.6),current asthma(OR=5.4,95%CI:2.7-10.6),and current medication for asthma(OR=1.2,95%CI:0.7-3.9).Our overall estimates were not affected by publication bias(P=0.671),but there was significant heterogeneity[I 2=58.8%(30.6-75.5)].Compared to studies with hospitalized controls without LRTI,those with ambulatory controls had a significantly higher strength of association between LRTIs and subsequent asthma.The strength of the association between LRTIs and later asthma varied significantly by country and age at the time of the interview.The sensitivity analyses including only studies with similar proportions of confounding factors(gender,age at LRTI development,age at interview,gestational age,birth weight,weight,height,smoking exposure,crowding,family history of atopy,and family history of asthma)between cases and controls did not alter the overall estimates.CONCLUSION Regardless of the causative virus and confounding factors,viral LRTIs in children<2 years are associated with an increased risk of developing a subsequent asthma.Parents and pediatricians should be informed of this risk.
文摘Background: Despiteits recommendation in management guide lines for community acquired pneumonia (CAP), the CURB65 score is frequently not followed for disposition decisions in clinical routine. We therefore proposed an improved CURB65 A score, supplemented by proadre nome dull in (ProADM) levels for patients with CAP and other lower respiratory tract infections (LRTIs). In this study, we vali dated this risk based biomarker enhanced disposition in patients with LRTIs presenting to the emergency department of the University Hospital of Basel. Methods: In this prospective observational cohort study of 85 patients presenting with LRTIs, site of care was decided by the physicians in charge according to their judgement. Retro spectively the CURB65 A score was calculated and a virtual disposition assigned. This was compared with the existing disposition in order to identify efficacy of the novel risk based biomarker enhanced disposition. Results: The novel disposition criteria considered 14 patients suitable for outpatient treatment compared to 11 in the current disposition (p = 0.5). It detected 7 patients to be best treated outside the hospital for nursing reasons, while the current disposition detected only 1 patient requiring geriatric care (p = 0.09). Further, it decreased regular hospitalizations considerably (32 vs. 64, p 0.001). Conclusions: The novel risk based biomarker enhanced disposition is an objective, safe and probably more efficient disposition system to identify outpatient treatment options than the current practice at the University Hospital of Basel.
文摘Background: Lower respiratory tract infections (LRTI) are among the leading causes of morbidity and mortality. A severe form of atypical pneumonia, Q fever, has been found in Northern Tanzania. Assessment of the quality of health care for lower respiratory tract infection from the clinicians’ performance has rarely been performed. Methods: A cross sectional descriptive study using the qualitative and quantitative approaches for assessing clinicians and patient files from 11 health facilities of Kilimanjaro region. The facilities were of 4 different levels of public health care delivery and 1 private independent hospital. Results: Medications for LRTI were highly variable in 346 files and from attempts of treatment reported in 53 clinician’s interviews. No file showed attempts for assessing the severity of Pneumonia. Only 6 (11.1%) clinicians could mention causes of atypical pneumonia. Only 7 clinicians (13.0%) were aware of Q-fever and could mention the cause. The quality of clinical records for monitoring the progress was not the same in all levels of care and the difference in availability was statistically significant as level of mental state χ2 (4) = 139.4;P
基金supported by the Chinese Ministry of Health and the United Nations Children's Fund(UNICEF)(No.YH001)
文摘Objective To explore the prescribing patterns of outpatients receiving antibiotics for upper respiratory tract infections(URTIs)in rural Western China and to identify the correlation in terms of doctors and patients characteristics.Methods Totally 7 678 prescriptions for URTIs were collected from 680 primary health village clinics of 40 counties across 10 provinces of Western China.Two outcome variables were used in the analysis:the occurrence of prescribing at least one antibiotic drug for an URTI and the occurrence of prescribing two or more antibiotics for an URTI.GEE logistic regression models were used to examine the socioeconomic and demographic determinants of the above two outcome variables.Results The percentage of prescribing at least one antibiotic for URTIs was 48.6% while the percentage of prescribing antibiotic combination(two or more antibiotics)was 4.6%.The two measurements of antibiotic utilization differed remarkably among the 10 provinces.Patients diagnosed with tonsillitis and faucitis had higher odds(OR=8.86 for tonsillitis and OR=4.64 for faucitis)of antibiotic prescription than patients with other diagnosis of URTIs.Patients with tonsillitis and faucitis also had higher odds(OR=3.82 for tonsillitis and OR=2.71 for faucitis)of multiple antibiotic prescription than those with other diagnosis of URTIs.The number of drugs per prescription and injection in prescriptions were also significant predictors of antibiotic and multiple antibiotic utilization for URTIs.Conclusion It is concluded that the percentage of antibiotic prescription for URTIs is higher in rural Western China than in most of other countries with available data and that prescriptions of antibiotics for URTIs are associated with residence regions of patients,URTI diagnosis and background information on drug prescription.
