Clinical characteristics of community-acquired pneumonia in children caused by mycoplasma pneumoniae with or without myocardial damage:A single-center retrospective study

BACKGROUND Mycoplasma pneumoniae(MP)is a prevalent pathogen that causes respiratory infections in children and adolescents.AIM To assess the differences in the clinical features of MP-associated communityacquired pneumonia(CAP)in children who presented with mild or severe mycoplasma pneumoniae pneumonia(MPP);to identify the incidence of myocardial damage between the two groups.METHODS This work is a retrospective study.We identified children between 2 mo and 16 years of age with clinical and radiological findings consistent with CAP.We admitted patients to the inpatient department of the Second Hospital of Jilin University,Changchun,China,from January 2019 to December 2019.RESULTS A total of 409 hospitalized patients were diagnosed with MPP.Among them were 214(52.3%)males and 195(47.7%)females.The duration of fever and cough was the longest in severe MPP cases.Similarly,plasma levels of highly sensitive Creactive protein(t=-2.834,P<0.05),alanine transaminase(t=-2.511,P<0.05),aspartate aminotransferase(t=-2.939,P<0.05),and lactate dehydrogenase(LDH)(t=-2.939,P<0.05)were all elevated in severe MPP cases compared with mild MPP cases,and these elevations were statistically significant(P<0.05).Conversely,the neutrophil percentage was significantly lower in severe MPP cases than in mild MPP cases.The incidence of myocardial damage was significantly higher in severe MPP cases than in mild MPP cases(χ^(2)=157.078,P<0.05).CONCLUSION Mycoplasma pneumoniae is the main cause of CAP.The incidence of myocardial damage was higher and statistically significant in severe MPP cases than in mild MPP cases.

Heparin-binding protein combined with human serum albumin in early assessment of community-acquired pneumonia:A retrospective study

Objective:To investigate the application of heparin-binding protein along with albumin(HBP+ALB)in evaluating the severity of community-acquired pneumonia(CAP)and compares it with single HBP,white blood cells(WBCs),C-reactive protein(CRP),and procalcitonin(PCT).Methods:A total of 226 patients with CAP admitted to the Emergency Department of Zhujiang Hospital,Southern Medical University,Guangdong,China,between March 1,2021,and March 1,2022,were enrolled.The patients were grouped into two groups:mild CAP(n=175)and severe CAP(sCAP)(n=51).Patients'characteristics and laboratory data were obtained.ROC curve and the value of the area under the curve(AUC)were used to evaluate the predictive values of HBP,ALB,WBC,CRP,and PCT.Results:WBC count,CRP,PCT,HBP,creatinine,and D-dimer were higher in the sCAP group,while ALB was lower in the sCAP group(P<0.05)than those in the mild CAP group.The AUCs of WBC,CRP,PCT,HBP,and HBP+ALB were 0.633(95%CI:0.545-0.722,P<0.05),0.635(95%CI:0.542-0.729,P<0.05),0.705(95%CI:0.619-0.791,P<0.05),0.809(95%CI:0.736-0.883,P<0.05),and 0.889(95%CI:0.842-0.936,P<0.05),respectively.Conclusions:HBP+ALB has a higher predictive value than single HBP,PCT,CRP and WBC used alone for the early assessment of CAP.

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.

Clinical characteristics and prognosis of community-acquired pneumonia in autoimmune disease-induced

BACKGROUND:Community-acquired pneumonia(CAP)in autoimmune diseases(AID)-induced immunocompromised host(ICH)had a high incidence and poor prognosis.However,only a few studies had determined the clinical characteristics of these patients.Our study was to explore the characteristics and predictors of mortality in CAP patients accompanied with AID-induced ICH.METHODS:From 2013 to 2018,a total of 94 CAP patients accompanied with AID-induced ICH,admitted to Emergency Department of Zhongshan Hospital,Fudan University,were enrolled in this study.Clinical data and the risk regression estimates of repeated predictors were evaluated by generalized estimating equations(GEEs)analysis.An open-cohort approach was used to classify patient's outcomes into the survival or non-survival group.RESULTS:The hospital mortality of patients with CAP occurring in AID-induced ICH was 60.64%.No significant differences were found with respect to clinical symptoms and lung images between survival and non-survival groups,while renal insufficiency and dysfunction of coagulation had higher proportions in non-survival patients(P<0.05).Both noninvasive ventilation(NIV)and invasive mechanical ventilation(IMV)were performed more frequently in non-survival group(P<0.05).By the multivariate GEEs analysis,the repeated measured longitudinal indices of neutrophilto-lymphocyte ratio(NLR)(odds ratio[OR]=1.055,95%confidence interval[95%CI]1.025–1.086),lactate dehydrogenase(LDH)(OR=1.004,95%CI 1.002–1.006)and serum creatinine(s Cr)(OR=1.018,95%CI 1.008–1.028),were associated with a higher risk of mortality.CONCLUSION:The CAP patients in AID-induced ICH had a high mortality.A significant relationship was demonstrated between the factors of NLR,LDH,s Cr and mortality risk in these patients.

Correlation Between the Clinical Severity, Bacterial Load, and Inflammatory Reaction in Children with Mycoplasma Pneumoniae Pneumonia

Given the lack of defining features in the clinical manifestations and radiographic findings for children with mycoplasma pneumoniae pneumonia(MPP),quantitative polymerase chain reaction(qPCR)has become a useful diagnostic method.This study was performed to explore the relationship between the qPCR findings,clinical symptoms,and inflammatory markers in children with MPP.Four hundred children with MPP have been enrolled in this retrospective analysis.All clinical and analytical information,including mycoplasma pneumoniae(MP)PCR results,has been collected.Based on the PCR results,the patients were divided into groups with load values(copy number)<105(54 cases),2105 and<106(71 cases),2106 and<107(112 cases),>107 and<108(114 cases),and>108(49 cases).The clinical features(including symptoms and signs)and inflammatory indicators were compared among the groups.The incidence of high fever(above 39℃),thermal peak during the entire hospitalization period,fever duration,days of hospitalization,and plasma lactate dehydrogenase(LDH)levels were statistically correlated with the MP PCR load value in children with MPP.The analysis of relevance degree showed the correlative order as a thermal peak of hospitalization>duration of fever>period of hospitalization>LDH value>C-reactive protein value.The host immune response was significantly greater in the complication group than in the non-complication group.

Can we predict which patients with community-acquired pneumonia are likely to have positive blood cultures？

BACKGROUND： Blood cultures （BC ） are commonly ordered during the initial assessment ofpatients with community-acquired pneumonia （CAP）, yet their yield remains low. Selective use of BCwould allow the opportunity to save healthcare resources and avoid patient discomfort. The studywas to determine what demographic and clinical factors predict a greater likelihood of a positiveblood culture result in patients diagnosed with CAP.METHODS： A structured retrospective systematic chart audit was performed to comparerelevant demographic and clinical details of patients admitted with CAP, in whom blood culture resultswere positive, with those of age, sex, and date-matched control patients in whom blood cultureresults were negative.RESULTS： On univariate analysis, eight variables were associated with a positive BC result.After logistic regression analysis, however, the only variables statistically significantly associatedwith a positive BC were WBC less than 4.5 x 109/L [likelihood ratio （LR）： 7.75, 95% CI=2.89-30.39], creatinine 〉106 !mol/L （LR： 3.15, 95%CI=1.71-5.80）, serum glucose〈6.1 mmol/L （LR： 2.46,95%CI=1.14-5.32）, and temperature 〉 38 °C （LR： 2.25, 95% CI =1.21-4.20）. A patient with all of thesevariables had a LR of having a positive BC of 135.53 （95% CI=25.28-726.8） compared to patientswith none of these variables.CONCLUSIONS： Certain clinical variables in patients with CAP admitted to hospitals doappear to be associated with a higher probability of a positive yield of BC, with combinations of thesevariables increasing this likelihood. We have identified a subgroup of CAP patients in whom bloodcultures are more likely to be useful.

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.

Outcome prediction value of National Early Warning Score in septic patients with community-acquired pneumonia in emergency department: A single-center retrospective cohort study

BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with community-acquired pneumonia(CAP)compared with other commonly used severity scores(CURB65,Pneumonia Severity Index[PSI],Sequential Organ Failure Assessment[SOFA],quick SOFA[qSOFA],and Mortality in Emergency Department Sepsis[MEDS])and admission lactate level.METHODS:Adult patients diagnosed with CAP admitted between January 2017 and May 2019 with admission SOFA≥2 from baseline were enrolled.Demographic characteristics were collected.The primary outcome was the 28-day mortality after admission,and the secondary outcome included ICU admission and mechanical ventilation use.Outcome prediction value of parameters above was compared using receiver operating characteristics(ROC)curves.Cox regression analyses were carried out to determine the risk factors for the 28-day mortality.Kaplan-Meier survival curves were plotted and compared using optimal cut-off values of qSOFA and NEWS.RESULTS:Among the 340 enrolled patients,90 patients were dead after a 28-day follow-up,62 patients were admitted to ICU,and 84 patients underwent mechanical ventilation.Among single predictors,NEWS achieved the largest area under the receiver operating characteristic(AUROC)curve in predicting the 28-day mortality(0.861),ICU admission(0.895),and use of mechanical ventilation(0.873).NEWS+lactate,similar to MEDS+lactate,outperformed other combinations of severity score and admission lactate in predicting the 28-day mortality(AUROC 0.866)and ICU admission(AUROC 0.905),while NEWS+lactate did not outperform other combinations in predicting mechanical ventilation(AUROC 0.886).Admission lactate only improved the predicting performance of CURB65 and qSOFA in predicting the 28-day mortality and ICU admission.CONCLUSIONS:NEWS could be a valuable predictor in septic patients with CAP in emergency departments.Admission lactate did not predict well the outcomes or improve the severity scores.A qSOFA≥2 and a NEWS≥9 were strongly associated with the 28-day mortality,ICU admission,and mechanical ventilation of septic patients with CAP in the emergency departments.

Influence of overweight and obesity on the mortality of hospitalized patients with community-acquired pneumonia

BACKGROUND Obesity is associated with a better prognosis in patients with community-acquired pneumonia(the so-called obesity survival paradox),but conflicting results have been found.AIM To investigate the relationship between all-cause mortality and body mass index in patients with community-acquired pneumonia.METHODS This retrospective study included patients with community-acquired pneumonia hospitalized in the First Hospital of Qinhuangdao from June 2013 to November 2018.The patients were grouped as underweight(<18.5 kg/m^(2)),normal weight(18.5-23.9 kg/m^(2)),and overweight/obesity(≥24 kg/m^(2)).The primary outcome was all-cause hospital mortality.RESULTS Among 2327 patients,297(12.8%)were underweight,1013(43.5%)normal weight,and 1017(43.7%)overweight/obesity.The all-cause hospital mortality was 4.6%(106/2327).Mortality was lowest in the overweight/obesity group and highest in the underweight group(2.8%,vs 5.0%,vs 9.1%,P<0.001).All-cause mortality of overweight/obesity patients was lower than normal-weight patients[odds ratio(OR)=0.535,95%confidence interval(CI)=0.334-0.855,P=0.009],while the allcause mortality of underweight patients was higher than that of normal-weight patients(OR=1.886,95%CI:1.161-3.066,P=0.010).Multivariable analysis showed that abnormal neutrophil counts(OR=2.38,95%CI:1.55-3.65,P<0.001),abnormal albumin levels(OR=0.20,95%CI:0.06-0.72,P=0.014),high-risk Confusion-Urea-Respiration-Blood pressure-65 score(OR=2.89,95%CI:1.48-5.64,P=0.002),and intensive care unit admission(OR=3.11,95%CI:1.77-5.49,P<0.001)were independently associated with mortality.CONCLUSION All-cause mortality of normal-weight patients was higher than overweight/obesity patients,lower than that of underweight patients.Neutrophil counts,albumin levels,Confusion-Urea-Respiration-Blood pressure-65 score,and intensive care unit admission were independently associated with mortality in patients with community-acquired pneumonia.

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.

Improving antibiotic prescribing in the emergency department for uncomplicated community-acquired pneumonia

BACKGROUND:The Pediatric Infectious Disease Society(PIDS)and Infectious Disease Society of America(IDSA)published an evidence-based guideline for the treatment of uncomplicated communityacquired pneumonia(CAP)in children,recommending aminopenicillins as the first-line therapy.Poor guideline compliance with 10%–50%of patients admitted to the hospital receiving narrow-spectrum antibiotics has been reported.A new clinical practice guideline(CPG)was implemented in our emergency department(ED)for uncomplicated CAP.The aim of this study was to examine baseline knowledge and ED provider prescribing patterns pre-and post-CPG implementation.METHODS:Prior to CPG-implementation,an anonymous case-based survey was distributed to evaluate knowledge of the current PIDS/IDSA guideline.A retrospective chart review of patients treated in the ED for CAP from January 2015 to February 2017 was performed to assess prescribing patterns for intravenous(IV)antibiotics in the ED at Children’s National Health System pre-and post-CPG implementation.RESULTS:ED providers were aware of the PIDS/IDSA guideline recommendations,with 86.4%of survey responders selecting ampicillin as the initial antibiotic of choice.However,only 41.2%of patients admitted to the hospital with uncomplicated CAP pre-CPG received ampicillin(P<0.01).There was no statistically signifi cant increase in ampicillin prescribing post-CPG(P=0.40).CONCLUSIONS:Providers in the ED are aware of the PIDS/IDSA guideline regarding the first-line therapy for uncomplicated CAP;however,this knowledge does not translate into clinical practice.Implementation of a CPG in isolation did not significantly change prescribing patterns for uncomplicated CAP.

Analysis on the Clinical Effect of Shenling Baizhu San Combined with Routine Treatment on Bacterial Pneumonia in Children

[Objectives]To explore the effect of Shenling Baizhu San combined with routine treatment on the clinical efficacy,gastrointestinal function protection,inflammatory response and immune function of children with bacterial pneumonia.[Methods]From July 2017 to January 2018,80 children with bacterial pneumonia were randomly selected and divided into observation group and control group with 40 cases in each group.The control group was treated with conventional Western medicine,while the observation group was treated with Shenling Baizhu San on the basis of conventional treatment,with a period of 10 d.Then,we compared the clinical efficacy,incidence of gastrointestinal symptoms,WBC,CRP,CD4+and CD8+levels between the two groups.[Results]The clinical efficacy of the observation group was better than that of the control group(P<0.05).After treatment,the levels of WBC and CRP in the two groups decreased,especially in the observation group(P<0.05).After treatment,the level of CD4+in both groups increased significantly,while the level of CD8+decreased significantly,and the level of CD4+in the observation group was significantly higher than that in the control group after treatment.The incidence of gastrointestinal symptoms in the observation group was significantly lower than that in the control group(P<0.01).[Conclusions]Shenling Baizhu San can obviously improve the clinical effect of bacterial pneumonia in children and has the protective effect of gastrointestinal tract,and its mechanism may be related to its anti-inflammatory and immunomodulatory effects.

Association between community-acquired pneumonia and platelet indices: A case-control study

Objective:To examine whether the platelet index would be applicable for the diagnosis of community-acquired pneumonia(CAP).Methods:In this study,64 CAP patients(the case group)and 68 healthy children(the control group)were included from 2017 to 2018.Baseline variables were recorded including total white blood cells,neutrophils,lymphocytes,red blood cells,platelet,mean platelet volume,platelet distribution width,erythrocyte sedimentation rate,and C-reactive protein,and compared between the case group and the control group.The cutoff value,sensitivity,and specificity of neutrophil-to-lymphocyte ratio,platelet,neutrophils,lymphocytes,and platelet larger cell ratio were calculated by receiver-operating characteristic curves.Results:The median platelet count of the case group and the control group were(411.09±67.40)mm3 and(334.48±78.15)mm3,respectively(P=0.000).The median neutrophil count of the case group was higher than that of the control group,while the lymphocyte level of the case group was lower.Differences in other variables including the mean platelet volume,platelet distribution width,C-reactive protein,and erythrocyte sedimentation rate were not statistically significant between the two groups.Conclusions:Due to the different levels of platelet,neutrophil and lymphocyte indices in the case and the control group,these indices can be used simultaneously for the diagnosis of CAP.

Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain:Prevalence and antibiotics susceptibility pattern

BACKGROUND Ventilator-associated pneumonia(VAP)is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that.It is the most common infection encountered among intubated patients.VAP incidence showed wide variability between countries.AIM To define the VAP incidence in the intensive care unit(ICU)in the central gove-rnment hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020.It included adult and adolescent patients(>14 years old)admitted to the ICU and required intubation and mechanical ventilation.VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score,which considers the clinical,laboratory,microbiological,and radiographic evidence.RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155.Forty-six patients developed VAP during their ICU stay(29.7%).The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period,with a mean age of 52 years±20.Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96±6.55.Gram-negative contributed to most VAP cases in our unit,with multidrug-resistant Acinetobacter being the most identified pathogen.CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark,which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.

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.

Application of 16s rDNA Sequencing in the Analysis of Pathogenic Bacteria in Sputum of Severe Bacterial Pneumonia

Objective: 120 patients with severe pneumonia who were kept in the comprehensive ICU of our hospital in 2018 were selected, and 16s rDNA sequencing was performed to analyze the composition of pathogenic bacteria in the sputum of severe pneumonia. Methods: The sputum samples of patients with severe bacterial pneumonia were collected, and the diversity of pathogens in the samples was analyzed by polymerase chain reaction (PCR) amplification and high-throughput sequencing (16s rDNA PCR-DGGE). Results: Sequence showed that sputum samples contained a relatively large number of species, and there were many species that were not detected by sequencing. The dominant bacteria were Streptococcus, Sphingomonas, Corynebacterium, Denatobacteria, Aquobacteria, Acinetobacteria, Prevotella, Klebsiella, Pseudomonas, etc. Conclusion: Bacteria caused by sputum of severe bacterial pneumonia are complex and diverse, which provides new methods and ideas for individualized treatment of patients with severe pneumonia.

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.

Bacteriological Profile of Infections Encountered in a Pneumology Service in a Moderate-Income Country [Pneumology Department of CHU Cocody (Côte d’Ivoire)]

Introduction: Infections represent a real public health problem aggravating the morbidity and mortality of hospitalized patients. Methods: This was a retrospective study with descriptive purposes over a period of 05 years, in the Pneumology Department of the University Hospital of Cocody. Results: The average age in our population was 42 years. We observed a male predo- minance of 64.5%, with a sex ratio of 1.8. Medical history was dominated by HIV infection (23.5%), followed by tuberculosis (15.6%). Concerning lifestyle, smoking was found in 38% of cases. Symptoms progressed chronically in 80% of cases. An infectious syndrome was found in 75% of cases. Microbial culture was positive in 42% of cases. Pseudomonas aeruginosa and Klebsiella pneumoniae were encountered in 26.4% of cases each, followed by Echerichia coli in 10.4% of cases. Klebsiella pneumoniae in the first three years topped the list, but gradually. Pseudomonas aeruginosa maintained its leadership over the last three years. Pseudomonas aeruginosa isolates expressed a resistance rate of 9.8% to ceftazidime and 8.1% to imipenem;to aztreonam (36%), ticarcillin (33.3%) and levofloxacin. These strains were susceptible to fosfomycin (100%), mero- penem (96.6%) and amikacin (96%). For isolated strains of Entero- bacteria- ceae, resistance was observed about ticarcillin (83.3%) and amoxicillin clavula- nic acid (71.2%). Streptococcaceae showed resistance to tetracycline (69.2%) and erythromycin (50%). Over the years there has been an increase in re- sistance to amoxicillin-clavulanic acid ceftriaxone. The death rate was 14%. Conclusion: The bacterial profile of infections is dominated by germs respon- sible for nosocomial infection with significant mortality.

Secondary Bacterial Organizing Pneumonia in a Patient Recovered from COVID-19 Disease: A Case Report

COVID-19 disease is a global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) that mainly presents with pneumonia, but has variable multi-systemic manifestations. Concomitant bacterial infections associated with the acute stage of COVID-19 disease have been rarely reported in the literature. However, to our knowledge, post viral organizing pneumonia (OP) secondary to bacterial infection after recovery from SARS-CoV2 infection has not been noted before. We report a 27-year-old male patient with Type 1 Diabetes Mellitus who presented with fever post recovery from COVID-19 disease for seven weeks and was found to have OP secondary to Klebsiella pneumoniae. Furthermore, the bronchoalveolar lavage was positive for SARS-CoV2 by RT-PCR despite multiple negative nasopharyngeal RT-PCR. The patient was successfully treated with antibiotics only. Therefore, we conclude that early recognition of OP secondary to bacterial infection in patients with COVID-19 disease and prompt antibiotic treatment could avoid the use of a prolonged course of steroids.