Objective To evaluate risk factors of hospital - acquired pneumonia in patients with neurosurgical diseases. Methods Totally 17 literatures from 2001 - 2009 were selected according to the criteria and assessed by Meta...Objective To evaluate risk factors of hospital - acquired pneumonia in patients with neurosurgical diseases. Methods Totally 17 literatures from 2001 - 2009 were selected according to the criteria and assessed by Meta - analysis. The pools OR values of influencing factors展开更多
Background:Candida species(Candida spp.)are commonly isolated microorganisms from lower respiratory tract(LRT)specimens of patients with hospital-acquired pneumonia(HAP);however,the clinical significance remains contr...Background:Candida species(Candida spp.)are commonly isolated microorganisms from lower respiratory tract(LRT)specimens of patients with hospital-acquired pneumonia(HAP);however,the clinical significance remains controversial.This study aimed to investigate the correlation between Candida spp.in the LRT and the clinical features and prognosis of HAP.Methods:This retrospective analysis included eligible patients with HAP from the database of a prospective study carried out between 2018 and 2019 in nine Chinese hospitals.Data on demographics,clinical characteristics,and prognosis were collected and analyzed.Propensity score matching(PSM)was used to balance the baseline characteristics.Results:A total of 187 HAP patients were enrolled.After PSM of severity score,27 cases with positive sputum culture of Candida spp.were compared with the control group at a ratio of 1:1.The Candida-positive group had more bacterial isolates in blood culture than the Candida-negative group(39.1%[9/23]vs.7.7%[2/26],χ^(2)=6.928,effect size[ES]=0.38,95%CI:0.12-0.61,P=0.008).The proportion of patients with chronic lung diseases was significantly higher in the Candida-positive group(55.6%[15/27]vs.22.2%[6/27],χ^(2)=6.312,ES=0.34,95%CI:0.07-0.59,P=0.012).The 30-day prognosis of HAP was significantly different between the two groups(80.8%[21/26]vs.38.5%[10/26],χ^(2)=9.665,ES=0.43,95%CI:0.19-0.66,P=0.002).Univariable logistic regression analysis showed that LRT Candida spp.colonization was a risk factor for 30-day mortality of HAP(OR=6.720,95%CI:1.915-23.577,P=0.003).Conclusions:Candida spp.in the LRT was associated with 30-day mortality of HAP.Patients with chronic under-lying lung diseases tend to have Candida spp.colonization.展开更多
Background： It is important to achieve the definitive pathogen identification in hospital-acquired pneumonia （HAP）, but the traditional culture results always delay the target antibiotic therapy. We assessed the me...Background： It is important to achieve the definitive pathogen identification in hospital-acquired pneumonia （HAP）, but the traditional culture results always delay the target antibiotic therapy. We assessed the method called quantitative loop-mediated isothermal amplification （qLAMP） as a new implement for steering of the antibiotic decision-making in HAP. Methods： Totally, 76 respiratory tract aspiration samples were prospectively collected from 60 HAP patients. DNA was isolated from these samples. Specific DNA fragments for identifying 11 pneumonia-related bacteria were amplified by qLAMP assay. Culture results of these patients were compared with the qLAMP results. Clinical data and treatment strategies were analyzed to evaluate the effects of qLAMP results on clinical data. McNemar test and Fisher＇s exact test were used for statistical analysis. Results： The detection of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Stenotrophomonas maltophilia, Streptococcus pneumonia, and Acinetobacter baumannii by qLAMP was consistent with sputum culture （P 〉 0.05）. The qLAMP results of 4 samples for Haemophilus influenzae, Legionella pneumophila, or Mvcoplasma pneumonia （MP） were inconsistent with culture results; however, clinical data revealed that the qLAMP results were all reliable except 1 MP positive sample due to the lack of specific species identified in the final diagnosis. The improvement of clinical condition was more significant （P 〈 0.001） in patients with pathogen target-driven therapy based on qLAMP results than those with empirical therapy. Conclusion： qLAMP is a more promising method for detection of pathogens in an early, rapid, sensitive, and specific manner than culture.展开更多
Background:Hospital-acquired pneumonia(HAP)is the most common hospital-acquired infection in China with substantial morbidity and mortality.But no specific risk assessment model has been well validated in patients wit...Background:Hospital-acquired pneumonia(HAP)is the most common hospital-acquired infection in China with substantial morbidity and mortality.But no specific risk assessment model has been well validated in patients with HAP.The aim of this study was to investigate the published risk assessment models that could potentially be used to predict 30-day mortality in HAP patients in non-surgical departments.Methods:This study was a single-center,retrospective study.In total,223 patients diagnosed with HAP from 2012 to 2017 were included in this study.Clinical and laboratory data during the initial 24 hours after HAP diagnosis were collected to calculate the pneumonia severity index(PSI);consciousness,urea nitrogen,respiratory rate,blood pressure,and age≥65 years(CURB-65);Acute Physiology and Chronic Health Evaluation II(APACHE II);Sequential Organ Failure Assessment(SOFA);and Quick Sequential Organ Failure Assessment(qSOFA)scores.The discriminatory power was tested by constructing receiver operating characteristic(ROC)curves,and the areas under the curve(AUCs)were calculated.Results:The all-cause 30-day mortality rate was 18.4%(41/223).The PSI,CURB-65,SOFA,APACHE II,and qSOFA scores were significantly higher in non-survivors than in survivors(all P<0.001).The discriminatory abilities of the APACHE II and SOFA scores were better than those of the CURB-65 and qSOFA scores(ROC AUC:APACHE II vs.CURB-65,0.863 vs.0.744,Z=3.055,P=0.002;APACHE II vs.qSOFA,0.863 vs.0.767,Z=3.017,P=0.003;SOFA vs.CURB-65,0.856 vs.0.744,Z=2.589,P=0.010;SOFA vs.qSOFA,0.856 vs.0.767,Z=2.170,P=0.030).The cut-off values we defined for the SOFA,APACHE II,and qSOFA scores were 4,14,and 1.Conclusions:These results suggest that the APACHE II and SOFA scores determined during the initial 24 h after HAP diagnosis may be useful for the prediction of 30-day mortality in HAP patients in non-surgical departments.The qSOFA score may be a simple tool that can be used to quickly identify severe infections.展开更多
Background Hospital-acquired pneumonia （HAP） is the most common and most serious nosocomial infection for cardiac surgery patients, with high incidence and fatality ratel. It is important for cardiac surgeons to cor...Background Hospital-acquired pneumonia （HAP） is the most common and most serious nosocomial infection for cardiac surgery patients, with high incidence and fatality ratel. It is important for cardiac surgeons to correctly identify HAP, assess the severity, and then adjust anti-infection method, which can reduce the mortality rate, shorten hospitalization time, and reduce the waste of medical resources. The purpose of this research is to evaluate the application value of lung CT in diagnosis and treatment of HAP after cardiac surgery. Methods A retrospective analysis was conducted for clinical data about 76 cardiac surgery patients who were diagnosed with HAP during January to December 2013. The clinical data mainly included symptoms, physical signs, laboratory examinations （such as routine blood tests and serum procalcitonin）, and lung CT and X-ray data. Our focus is on the comparison between lung CT and X-ray data. Results The positive diagnostic rate, false negative rate, and false positive rate of lung CT were 71/76 （93.4%）, 5/76 （6.6%）, and 1/76 （1.3%） respectively. The coincidence rate of X-ray and CT was 45/76 （59.2%）, and the false negative rate of X-ray was 23/76 （30.3%）. Conclusion Lung CT is better than X-ray in diagnosis of HAP after cardiac surgery and assessment of severity, and has greater significance for guiding the rational useof antibiotics. Therefore, lung CT is worthy of application and popularization.展开更多
文摘Objective To evaluate risk factors of hospital - acquired pneumonia in patients with neurosurgical diseases. Methods Totally 17 literatures from 2001 - 2009 were selected according to the criteria and assessed by Meta - analysis. The pools OR values of influencing factors
文摘Background:Candida species(Candida spp.)are commonly isolated microorganisms from lower respiratory tract(LRT)specimens of patients with hospital-acquired pneumonia(HAP);however,the clinical significance remains controversial.This study aimed to investigate the correlation between Candida spp.in the LRT and the clinical features and prognosis of HAP.Methods:This retrospective analysis included eligible patients with HAP from the database of a prospective study carried out between 2018 and 2019 in nine Chinese hospitals.Data on demographics,clinical characteristics,and prognosis were collected and analyzed.Propensity score matching(PSM)was used to balance the baseline characteristics.Results:A total of 187 HAP patients were enrolled.After PSM of severity score,27 cases with positive sputum culture of Candida spp.were compared with the control group at a ratio of 1:1.The Candida-positive group had more bacterial isolates in blood culture than the Candida-negative group(39.1%[9/23]vs.7.7%[2/26],χ^(2)=6.928,effect size[ES]=0.38,95%CI:0.12-0.61,P=0.008).The proportion of patients with chronic lung diseases was significantly higher in the Candida-positive group(55.6%[15/27]vs.22.2%[6/27],χ^(2)=6.312,ES=0.34,95%CI:0.07-0.59,P=0.012).The 30-day prognosis of HAP was significantly different between the two groups(80.8%[21/26]vs.38.5%[10/26],χ^(2)=9.665,ES=0.43,95%CI:0.19-0.66,P=0.002).Univariable logistic regression analysis showed that LRT Candida spp.colonization was a risk factor for 30-day mortality of HAP(OR=6.720,95%CI:1.915-23.577,P=0.003).Conclusions:Candida spp.in the LRT was associated with 30-day mortality of HAP.Patients with chronic under-lying lung diseases tend to have Candida spp.colonization.
文摘Background： It is important to achieve the definitive pathogen identification in hospital-acquired pneumonia （HAP）, but the traditional culture results always delay the target antibiotic therapy. We assessed the method called quantitative loop-mediated isothermal amplification （qLAMP） as a new implement for steering of the antibiotic decision-making in HAP. Methods： Totally, 76 respiratory tract aspiration samples were prospectively collected from 60 HAP patients. DNA was isolated from these samples. Specific DNA fragments for identifying 11 pneumonia-related bacteria were amplified by qLAMP assay. Culture results of these patients were compared with the qLAMP results. Clinical data and treatment strategies were analyzed to evaluate the effects of qLAMP results on clinical data. McNemar test and Fisher＇s exact test were used for statistical analysis. Results： The detection of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Stenotrophomonas maltophilia, Streptococcus pneumonia, and Acinetobacter baumannii by qLAMP was consistent with sputum culture （P 〉 0.05）. The qLAMP results of 4 samples for Haemophilus influenzae, Legionella pneumophila, or Mvcoplasma pneumonia （MP） were inconsistent with culture results; however, clinical data revealed that the qLAMP results were all reliable except 1 MP positive sample due to the lack of specific species identified in the final diagnosis. The improvement of clinical condition was more significant （P 〈 0.001） in patients with pathogen target-driven therapy based on qLAMP results than those with empirical therapy. Conclusion： qLAMP is a more promising method for detection of pathogens in an early, rapid, sensitive, and specific manner than culture.
基金University of Michigan Health System-Peking University Health Science Center Joint Institute for Translational and Clinical Research(No.BMU2019JI006)Peking University Third Hospital(No.BYSYDL2019007)。
文摘Background:Hospital-acquired pneumonia(HAP)is the most common hospital-acquired infection in China with substantial morbidity and mortality.But no specific risk assessment model has been well validated in patients with HAP.The aim of this study was to investigate the published risk assessment models that could potentially be used to predict 30-day mortality in HAP patients in non-surgical departments.Methods:This study was a single-center,retrospective study.In total,223 patients diagnosed with HAP from 2012 to 2017 were included in this study.Clinical and laboratory data during the initial 24 hours after HAP diagnosis were collected to calculate the pneumonia severity index(PSI);consciousness,urea nitrogen,respiratory rate,blood pressure,and age≥65 years(CURB-65);Acute Physiology and Chronic Health Evaluation II(APACHE II);Sequential Organ Failure Assessment(SOFA);and Quick Sequential Organ Failure Assessment(qSOFA)scores.The discriminatory power was tested by constructing receiver operating characteristic(ROC)curves,and the areas under the curve(AUCs)were calculated.Results:The all-cause 30-day mortality rate was 18.4%(41/223).The PSI,CURB-65,SOFA,APACHE II,and qSOFA scores were significantly higher in non-survivors than in survivors(all P<0.001).The discriminatory abilities of the APACHE II and SOFA scores were better than those of the CURB-65 and qSOFA scores(ROC AUC:APACHE II vs.CURB-65,0.863 vs.0.744,Z=3.055,P=0.002;APACHE II vs.qSOFA,0.863 vs.0.767,Z=3.017,P=0.003;SOFA vs.CURB-65,0.856 vs.0.744,Z=2.589,P=0.010;SOFA vs.qSOFA,0.856 vs.0.767,Z=2.170,P=0.030).The cut-off values we defined for the SOFA,APACHE II,and qSOFA scores were 4,14,and 1.Conclusions:These results suggest that the APACHE II and SOFA scores determined during the initial 24 h after HAP diagnosis may be useful for the prediction of 30-day mortality in HAP patients in non-surgical departments.The qSOFA score may be a simple tool that can be used to quickly identify severe infections.
基金supported by the National Natural Science Fund(No.81300034)
文摘Background Hospital-acquired pneumonia （HAP） is the most common and most serious nosocomial infection for cardiac surgery patients, with high incidence and fatality ratel. It is important for cardiac surgeons to correctly identify HAP, assess the severity, and then adjust anti-infection method, which can reduce the mortality rate, shorten hospitalization time, and reduce the waste of medical resources. The purpose of this research is to evaluate the application value of lung CT in diagnosis and treatment of HAP after cardiac surgery. Methods A retrospective analysis was conducted for clinical data about 76 cardiac surgery patients who were diagnosed with HAP during January to December 2013. The clinical data mainly included symptoms, physical signs, laboratory examinations （such as routine blood tests and serum procalcitonin）, and lung CT and X-ray data. Our focus is on the comparison between lung CT and X-ray data. Results The positive diagnostic rate, false negative rate, and false positive rate of lung CT were 71/76 （93.4%）, 5/76 （6.6%）, and 1/76 （1.3%） respectively. The coincidence rate of X-ray and CT was 45/76 （59.2%）, and the false negative rate of X-ray was 23/76 （30.3%）. Conclusion Lung CT is better than X-ray in diagnosis of HAP after cardiac surgery and assessment of severity, and has greater significance for guiding the rational useof antibiotics. Therefore, lung CT is worthy of application and popularization.
