Acute Eosinophilic Pneumonia (AEP) Due to Daptomycin: Is Autoimmunity a Clinico-Pathophysiologic Bridge to AEP?

Daptomycin induced acute eosinophilic pneumonia is a rare and potentially life threatening condition characterized by rapid respiratory failure, pulmonary infiltrates and eosinophilia. Risk factors for acute eosinophilic pneumonia include smoking, environmental irritants or inhalants and certain medications such as Daptomycin [1]. In this review of literature, we aim to explore the potential triggers for developing acute eosinophilic pneumonia in patients exposed to Daptomycin. The exact immune mechanism for daptomycin induced AEP is unknown, however the current proposed mechanism describes a T helper 2 lymphocyte response to inactivated daptomycin in the pulmonary surfactant, which leads to eosinophilia. Disordered T regulatory cell function is seen in patients with certain cancers, allergies and autoimmune conditions. We propose that patients with these underlying risk factors may be at increased risk of developing AEP after becoming exposed to Daptomycin. Understanding potential risk factors is crucial for health care workers as it allows them to identify susceptible populations, explore preventative measures and treat accordingly.

Efficacy and safety of carrimycin in ten patients with severe pneumonia following solid organ transplantation

BACKGROUND The number of patients undergoing solid organ transplantation has increased annually.However,infections in solid organ transplant recipients can have a severe effect on patient survival owing to the continued use of immunosuppressants.Carrimycin is a novel macrolide antibiotic produced by genetically engineered streptomyces spiramyceticus harboring a 4’’-O-isovaleryltransferase gene(ist)from streptomyces thermotoleran.Carrimycin has good antibacterial and antiviral effects.However,no relevant studies have been conducted on the efficacy and safety of carrimycin in patients with severe pneumonia(SP)after solid organ transplantation.AIM To explore the efficacy and safety of carrimycin in patients with SP after solid organ transplantation to provide a medication reference for clinical treatment.METHODS In March 2022,ten patients with SP following solid-organ transplantation were treated at our hospital between January 2021 and March 2022.When the condition was critical and difficult to control with other drugs,carrimycin was administered.These ten patients'clinical features and treatment protocols were retrospectively analyzed,and the efficacy and safety of carrimycin for treating SP following solid organ transplantation were evaluated.RESULTS All ten patients were included in the analysis.Regarding etiological agent detection,there were three cases of fungal pneumonia,two cases of bacterial pneumonia,two cases of Pneumocystis pneumonia,and three cases of mixed infections.After treatment with carrimycin,the disease in seven patients significantly improved,the course of the disease was significantly shortened,fever was quickly controlled,chest computed tomography was significantly improved,and oxygenation was significantly improved.Finally,the patients were discharged after curing.One patient died of acute respiratory distress syndrome,and two patients discontinued treatment.CONCLUSION Carrimycin is a safe and effective treatment modality for SP following solid organ transplantation.Carrimycin may have antibacterial and antiviral effects in patients with SP following solid organ transplantation.

Preventive Effects of Five Drugs on Mycoplasma Pneumonia of Swine (MPS)

The paper was to explore the preventive effects of five drugs on mycoplasma pneumonia of swine （MPS） and to provide reference for clinical medication of pig farms in Hainan Province. A total of 444 health piglets were randomly divided into 6 groups, including five medication groups （72 piglets in group A, 74 pig- lets in group B, 72 piglets in group C, 76 piglets in group D, 76 piglets in group E） and one control group （74 piglets）. The piglets in experimental groups were treated drugs once a day for successive 5 days at 30, 60, 90, 120 and 150 of age. The piglets in control group were free of medication. At 70 and 140 days of age, 15 piglets of each group were randomly selected to collect their blood sermn. The Mycoplasma hyopneumoniae （M-Hyo） antibodies in serum were measured by en- zyme-linked immunosorbent assay （ELISA）. During the experiment, the incidence rates of respiratory disease, lung lesion, feed conversion rate, average daily gain （ADG）, and mortality rate of pigs were also observed and recorded. The results showed that the five drugs had significant difference in preventative effects. Group C （Zhiyuanjing group） received the best preventive effect and the highest economic benefits. Compared with control group, the ADG and feed conversion rate in group C were increased by 7.53% and 9.09%, respectively; the incidence rate of respiratory disease was reduced by 13.44% and lung lesion was alleviated by 81.43% ; and the earnings of each pig could rise by 132.70 yuan. The preventative effect and economic benefit of the drugs was sequenced by Chansu Kechuanling and Bingchan Kechuanwang. Wante Feilin and amoxicillin had weaker preventive effects against MPS but greatly influenced growth performance of pigs, so they should be used alternatively with other drugs.

Analysis on clinical distribution and drug resistance of Klebsiella pneumoniae isolated for 5 consecutive years

Objective:To analyze the clinical distribution and drug resistance of Klebsiella pneumoniae isolated from patients in a certain hospital and provide a basis for the rational use of antibiotics in the clinical treatment for the infection of Klebsiella pneumoniae.Methods:1,192 strains of Klebsiella pneumoniae isolated from clinical specimens from 2012 to 2016 were collected.The strains were identified by VITEK-2 Compact Microbiological Identification System,and the corresponding results of the antimicrobial susceptibility test were interpreted in accordance with the standards recommended by Clinical and Laboratory Standards Institute(CLSI).Results:1,192 strains of Klebsiella pneumoniae were mainly isolated from sputum(65.6%),and most of them were from Respiratory Medicine Department and Medical Intensive Care Unit of Respiratory Medicine Department(MICU),accounting for 41.4%.Out of 1,192 strains,448 strains were detected to produce extended-spectrum beta-lactamases(ESBLs),accounting for 37.6%.In addition,the detection rates of ESBL-producing Klebsiella pneumoniae for 5 consecutive years showed an increasing trend year by year,and they were higher than the national average values published by China Antimicrobial Resistance Surveillance System(CARSS)in the corresponding period.The drug resistance rate of ESBL-producing Klebsiella pneumoniae was significantly higher than that of non ESBL-producing strains.Conclusions:The infection caused by Klebsiella pneumoniae mainly occurs in the lower respiratory tract,and the drug resistance rates of Klebsiella pneumoniae to antibiotics in the drug susceptibility spectrum are maintained at a high level.Therefore,the rational selection of antibiotics for the clinical treatment of lower respiratory tract infection caused by Klebsiella pneumoniae must be based on the production of ESBLs and the results of antimicrobial susceptibility test.

Predominance of Multi-Drug Resistant <i>Klebsiella pneumonia</i>and Other Gram Negative Bacteria in Neonatal Sepsis in Equatorial Guinea

The study was conducted on new-born babies in whom septicemia was suspected, to determine the prevalence of bacterial strains isolated and their sensitivity to antimicrobial drugs. The study was carried out at La Paz Medical Center, Microbiology section, Malabo, Equatorial Guinea from August 2013 to October 2015. Out of 293 septicemia suspected cases, 29 (10%) blood cultures were positive, 28 with bacterial growth and 1 with growth of Candida sp. The mortality rate of neonates caused by Gram negative bacterial sepsis was 34.7%. Among the Gram negative bacteria (24 isolates), the most common types were Klebsiella pneumoniae (16 = 69.6%), followed by Escherichia coli (4 = 17.4%) and Acinetobacter species (4 = 17.4%). Four Gram positive bacteria were also isolated and identified all ascoagulase-negative staphylococci. All the Klebsiella pneumoniae isolates and Acinetobacter species demonstrated Multi Drug Resistance against different antibiotics with Extended-spectrum β-lactamase (ESBL) activity. The most frequent causative agent of bacterial sepsis in new-born children was Klebsiella pneumoniae. An alarming level of Multi Drug Resistance (MDR) Klebsiella pneumoniae strains to the first choice antibiotic treatment was observed.

Risk of fracture and pneumonia from acid suppressive drugs

A recently published systematic review and meta-analy-sis, incorporating all relevant studies on the association of acid suppressive medications and pneumonia identi-fied up to August 2009, revealed that for every 200 patients, treated with acid suppressive medication, one will develop pneumonia. They showed the overall risk of pneumonia was higher among people using proton pump inhibitors （PPIs） [adjusted odds ratio （OR） = 1.27, 95% CI： 1.11-1.46, I2 = 90.5%] and Histamine-2 re-ceptor antagonists （H2RAs） （adjusted OR = 1.22, 95% CI： 1.09-1.36, I2 = 0.0%）. In the randomized controlled trials, use of H2RAs was associated with an elevated risk of hospital-acquired pneumonia （relative risk 1.22, 95% CI： 1.01-1.48, I2 = 30.6%）. Another meta-analysis of 11 studies published between 1997 and 2011 found that PPIs, which reduce stomach acid production, were associated with increased risk of fracture. The pooled OR for fracture was 1.29 （95% CI： 1.18-1.41） with use of PPIs and 1.10 （95% CI： 0.99-1.23） with use of H2RAs, when compared with non-use of the respective medications. Long-term use of PPIs increased the risk of any fracture （adjusted OR = 1.30, 95% CI： 1.15-1.48） and of hip fracture risk （adjusted OR = 1.34, 95% CI： 1.09-1.66）, whereas long-term H2RA use was not sig-nifcantly associated with fracture risk. Clinicians should carefully consider when deciding to prescribe acid-sup-pressive drugs, especially for patients who are already at risk for pneumonia and fracture. Since it is unneces-sary to achieve an achlorhydric state in order to resolve symptoms, we recommend using the only minimum effective dose of drug required to achieve the desired therapeutic goals.

Isolation, Identification and Drug Susceptibility Test of a Strain of Escherichia coli Causing Fox Pneumonia

[Objective] The paper was to determine the pathogen causing fox pneumonia in a breeding factory in Changli County.[Method]Through autopsy, a dominant strain was isolated from the lung of dead foxes, which was then performed Gram staining, 16 S rRNA sequence analysis and biochemical identification.[Result] The strain was negative in Gram staining, and was identified as E. coli through 16 S rRNA sequence analysis and biochemical identification. Drug susceptibility test was conducted using 15 kinds of drug susceptibility papers. The E. coli was sensitive to florfenicol, enrofloxacin, ceftriaxone, norfloxacin;intermediately sensitive to amikacin, gentamicin;and strongly resistant to penicillin, ampicillin,cefradine, sulfamethoxazole, lincomycin, streptomycin and amoxicillin.[Conclusion] It is difficult to treat E. coli causing fox pneumonia with traditional antibiotics clinically.

Management of Multi-Drug Resistant Methicillin Resistant <i>Staphylococcus aureus</i>Induced Pneumonia with New Antibiotic Adjuvant Entity: A Retrospective Study

Aim/Objective: Increase in incidences of pneumonia due to multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA) in both community and health care settings is of great concern globally. Present study aims to retrospectively analyze the efficacy of new fixed dose combination with antibiotic adjuvant entity (FDC) in comparison with vancomycin to treat patients with multi-drug resistant MRSA pneumonia. Materials and Methods: During this retrospective study, case sheets of patients who were treated for MRSA pneumonia with vancomycin or fixed dose combination of vancomycin + ceftriaxone + adjuvant (FDC) between 20 March 2010 to 20 October 2014 at tertiary care center, were analyzed. Various demographic features, antibiotic therapy, length of treatment duration and the resulting efficacy were evaluated. Microbiological success was measured in terms of bacterial eradication, while clinical success was monitored in terms of complete omission of systemic signs and symptoms. Results: Among 136 patients analyzed, 113 cases were having positive culture for MRSA, and hence were further analyzed. Out of these 113 patients, empirical treatment with vancomycin was given in 59 patients and 54 patients were treated with FDC empirically. After initial culture reports, 22 patients showing resistance to vancomycin were shifted to FDC. Amidst all the patients, 24 (64.86%) of 37 from vancomycin group and 62 (81.57%) of 76 from FDC group achieved clinical success. 9 patients out of these failure cases were cured with FDC + colistin combination therapy. Failure rates in FDC treated patients were significantly low (6.57%) as compared to vancomycin group (13.51%). Conclusion: For the treatment of different types of multi-drug resistant MRSA pneumonia, the empirical intravenous FDC therapy was safe and well tolerated with higher efficacy than vancomycin. Most of the vancomycin failure cases responded to FDC therapy and were cured. This retrospective study also concludes that an alternative option of FDC + colistin is safe and effective to treat the patients which fail to respond to FDC monotherapy.

Children with Pneumonia Caused by Streptococcus pneumoniae Resistance Analysis and Clinical Features

Objective: To analyze the causes of childhood pneumonia Streptococcus pneumoniae resistance and clinical characteristics, and provide a basis for better and timely clinical therapy, and medication to reduce blind-ness. Methods: MIC method in our hospital 114 under 2020 pediatric pneumococcal respiratory infection in children with lower respiratory tract specimens were isolated antimicrobial susceptibility testing, and analyzed retrospectively. Results: 84 male children, 30 female children, the largest of which 9 years old, the youngest two months, infants less than 1 year old, 90 people;suffering from bronchial pneumonia, 90 cases, 21 cases of pneumonia, wheezing, 3 cases of bronchitis, the average length of stay for about a week;improved in 79 cases, 33 cases were cured, 2 cases transferred to higher level hospitals. All children with throat congestion, swollen tonsils, lung breath sounds rough, smell and moist rales. 114 penicillin-resistant Streptococcus pneumoniae was 64.9%, erythromycin 97.4%, clindamycin 86.8%, tetracycline 87.7%, trimethoprim-sulfamethoxazole 82.5%, amoxicillin 21.9%, cefotaxime 49.1%, chloramphenicol 10.5%, was not found to levofloxacin and van-comycin. Conclusion: Penicillin, erythromycin, and clindamycin are not as pneumococcal pneumonia in children experience preferred medi-cation in children less than one year old child could easily cause lung chain Streptococcus pneumoniae. Therefore, the antimicrobial resistance of Streptococcus pneumoniae analysis provides a reference for experi-enced clinicians to adjust medication.

A Five-year Surveillance of Carbapenemase-producing Klebsiella pneumoniae in a Pediatric Hospital in China Reveals Increased Predominance of NDM-1

Objective To characterize carbapenem （CPM）-non-susceptible Klebsiella pneumoniae （K. pneumoniae） and carbape-nemase produced by these strains isolated from Beijing Children＇s Hospital based on a five-year surveillance. Methods The Minimal Inhibition Concentration values for 15 antibiotics were assessed using the Phonixl00 compact system. PCR amplification and DNA sequencing were used to detect genes encoding carbapenemases. WHONET 5.6 was finally used for resistance analysis. Results In total, 179 strains of CPM-non-susceptible K. pneumoniae were isolated from January, 2010 to December, 2014. The rates of non-susceptible to imipenem and meropenem were 95.0% and 95.6%, respectively. In the 179 strains, 95 （53.1%） strains carried the blalMP gene, and IMP-4 and IMP-8 were detected in 92 （96.8%） and 3 （3.2%） IMP-producing isolates, respectively. 65 （36.3%） strains carried the blaNDM_1 gene. 6 （3.4%） strains carried the blaKpc gene, and KPC-2 were detected in 6 KPC-producing isolates. In addition, New Delhi-Metallo-1 （NDM-1） producing isolates increased from 7.1% to 63.0% in five years and IMP-4 producing isolates decreased from 75.0% to 28.3%. Conclusion High frequencies of multiple resistances to antibiotics were observed in the CPM-non-susceptible K. pneumoniae strains isolated from Beijing Children＇s Hospital. The production of IMP-4 and NDM-1 metallo-13-1actamases appears to be an important mechanism for CPM-non- susceptible in K. pneumoniae.

Whole Genome Analysis Reveals New Insights into Macrolide Resistance in Mycoplasma pneumoniae

Objective Mutations in 23 S rRNA gene are known to be associated with macrolide resistance in Mycoplasma pneumoniae（M. pneumoniae）. However, these mutations alone do not fully explain the high resistance rates in Asia. The aim of this study was to investigate other possible mutations involved in macrolide resistance in M. pneumoniae. Methods The whole genomes of 10 clinical isolates of M. pneumoniae with macrolide resistance were sequenced by Illumina Hi Seq2000 platform. The role of the macrolide-specific efflux transporter was assessed by efflux-pump inhibition assays with reserpine and carbonyl cyanide m-chlorophenyl-hydrazone（CCCP）. Results A total of 56 single nucleotide polymorphisms（SNPs） were identified in 10 clinical isolates in comparison to the reference strains M129 and FH. Strikingly, 4 of 30 SNPs causing non-synonymous mutations were clustered in macrolide-specific efflux system gene mac B encoding macrolide-specific efflux pump protein of the ATP-binding cassette transporter family. In assays of the minimal inhibitory concentrations（MIC） of macrolide antibiotics in the presence of the efflux pump inhibitors caused a significant decrease of MICs, even under detectable levels in some strains. Conclusion Our study suggests that macrolide efflux pump may contribute to macrolide resistance in M. pneumoniae in addition to the common point mutations in 23 S r RNA gene.

Study of Klebsiella pneumoniae producing extendedspectrum β-lactamases against aminoglycosides

Klebsiella pneumoniae （ K. pneumoniae） is one of the main gmn-negative bacilli in clinical practice. Nosocomial infections caused by K. pneumoniae producing extended-spectrum β-lactamases （ESBLs） are very difficult to treat. This paper investigated the resistant characteristics of K. pneumoniae producing ESBLs and their aminoglycoside-modifying enzyme gene expressions including Nacetyltransferases and O-adenyltransferases. Bacteria identification and ESBLs confirmatory tests were performed by Phoenix^TM-100 system. And minimum inhibitory concentrations （MICs） of gentamicin, amikacin, kanamycin, tobranycin, netilmicin and neomycin in 53 K. pneumoniae isolates were detected by agar dilution. In addition, six aminoglycoside-modifying enzyme genes were amplified by polymerase chain reaction （PCR） and verified by DNA sequencer. It was found that imipenem and meropenem against 120 K. pneumoniae isolates produced powerful antimicrobial activities. The resistant rates of gentamicin and amikacin were 55.0% and 46.7%, respectively. Except neomycin, MIC50 and MIC90 of gentamicin, amikacin, kanamycin, tobramycin and netilmicin in 53 K. pneumoniae were all 〉 128 μg/ml, and the resistant rates were 83.0%, 52.3%, 75.5%, 81.1% and 69.8%, respectively. However, neomycin was only 39.6%. In addition, five modifying enzyme genes, including aac（3）-Ⅰ, aac（3）-Ⅱ, aac（6＇）-Ⅰb, ant（3＂）-Ⅰ, ant（2＂）-Ⅰ genes, were found in 53 isoaltes except aac （6＇）-Ⅱ, and their positive rates were 11.3%, 67.9%, 47.2%, 1.9% and 39.6%, respectively. It was also confirmed by nucleotide sequence analysis that the above resistant genes shared nearly 100% identities with GenBank published genes. The results obtained in the present study indicated that K. pneumoniae producing ESBLs strains are rapidly spreading in our hospital, and their resistance to aminoglycosides may be associated with aminoglycoside-modifying enzyme gene expressions.

The relationship between antimicrobial consumption and the rates of resistance of Klebsiela pneumoniae in respiratory unit

Objective To investigate the relationship between the consumption of antibacterial agents and resistance rate of Klebsiela pneumoniae(KP)in the hospital respiratory unit for 3 consecutive years in 2005-2007.Methods The total antibacterial consumption expressed as defined DDDs/100BD,as well as resistance rate of total KP and producing ESBLs KP were collected,and their correlation was analyzed.Results The rate of resistance of KP to cefoperazone/sulbactam,Cefepime,Imipenem,Moxifloxacin was significantly positively associated with the consumption of Cefotaxime,Ceftazidime,Moxifloxacin,Amikacin respectively;A significant positive association was observed between the rate of resistance of KP to Piperacillin/Tazobactam,Ceftriaxone and the consumption of Imipenem;The rate of resistance of KP to Piperacillin,Cefotaxime,Ciprofloxacin was significantly positively associated with the consumption of Levofloxacin.ESBLs producing bacilli of KP were detected in 44 of 75 isolates(58.7%),The rate of resistance of producing ESBLs KP to Piperacillin/Tazobactam,Ceftriaxone was significantly positively associated with the consumption of Imipenem,Ceftazidime;A significant positive association was observed between the rate of resistance of producing ESBLs KP to Piperacillin,Imipenem and the consumption of Moxifloxacin.There was no significant correlation in other drugs.Conclusions A relationship existed between antimicrobial consumption and rates of resistance of KP in the hospital respiratory unit.We must use antibiotics carefully and with reason to control and lessen the drug resistance of bacterial.

Prevalence and Antimicrobial Susceptibility Pattern of Streptococcus pneumoniae at General Hospital in the Central Region of Japan from December 2013 to February 2014

Streptococcus pneumonia infection is important cause of morbidity and mortality. This study was conducted to find out the prevalence and antimicrobial susceptibility pattern of Streptococcus pneumoniae isolates at general hospitalin the central region of Japan from December 2013 to February 2014. Streptococcus pneumoniae was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by micro dilution assay according to CLSI recommendation. One hundred fifty-three Streptococcus pneumoniae were isolated among which 80 (52.2%) were males and 73 (47.8%) were females. Nasal discharge (134%/87.6%) contributed more than other biological materials. The age incidence of (0 - 1) years, (1 - 10) years, (11 - 40) years, (41 - 60) years and >60 years age groups were 26 (17.0%), 110 (71.9%), 3 (2.0%), 10 (6.5%), and 4 (2.6%) respectively. Positive samples were received mostly from the pediatrics (137%/89.5%), respiratory medicine (12%/7.8%) and lowest from gastroenterology (1%/0.6%) and neurology (1/ 0.6%) department. Vancomycin and rifampicin were the most active antibiotics with 100% susceptibility rates. The next best were levofloxacin, penicillin G and ceftriaxone. Our study revealed that 82 Streptococcus pneumonia isolates had multidrug resistant ability (53.6%). Streptococcus pneumoniae infection spreads among community easily and inappropriate use of antibiotics contributes to their resistance. Continuous antimicrobial susceptible surveys are essential to guide policy on the adequate use of antibiotics to reduce the morbidity and mortality and reduce the emergency of antimicrobial resistance.

Clinical efficacy of Buzhong Yiqi decoction(补中益气汤)in the treatment of hospital-acquired pneumonia with multi-drug resistant bacteria:a prospective,randomized,multicenter controlled trial

OBJECTIVE:To evaluate the efficacy and safety of Buzhong Yiqi decoction(补中益气汤,BZYQ)in the treatment of hospital-acquired pneumonia(HAP)with multi-drug-resistant bacteria(MDRB).METHODS:This 28-day study was conducted at 5 clinical centers in Shanghai.The eligible patients were randomly assigned(1∶1)into the intervention group(BZYQ plus conventional Western Medicine therapy)and control group(conventional Western Medicine therapy).The primary outcomes were the clinical response,clinical pulmonary infection score(CPIS),and microbiologic response.The secondary outcomes were the 28-day allcause mortality(ACM),Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,ventilator weaning rate,length of mechanical ventilation(MV),length of hospital stay,and changes of infection indicators.RESULTS:Altogether 83 subjects in the intervention group and 85 subjects in the control group were analyzed.The clinical success rate(48.2%)and the pathogen eradication rate(59.0%)of the intervention group were all better than those of the control group(32.9%and 38.9%,respectively)with statistically significant differences(P<0.05).The CPIS score of the intervention group(8.9±1.7)was lower than that of the control group(9.6±2.5)(P<0.05).The length of MV in the intervention group[(13.7±6.4)d]was significantly shorter than that of the control group[(17.2±7.2)d](P<0.05).The 28-day ACM of the intervention group(13.33%)was lower than that of the control group(21.2%)with no statistically significant difference(P>0.05).The differences between two groups in ventilator weaning rate,length of hospital stay,and APACHEⅡscore were not statistically significant(P>0.05).The intervention group displayed decreases in white blood cell count,C-reactive protein,neutrophil percentage,and procalcitonin at day 28 compared with baseline(P<0.05).No serious adverse events occurred in either group during the 28-day follow-up.CONCLUSION:BZYQ may be an effective therapeutic option for the management of HAP with MDRB.

TCM DIFFERENTIAL TREATMENT OF CHILD HOOD PERSISTING PNEUMONIA -A Report of 52 Cases

According to TCM differentiation of the symptoms and signs, 52 children with presisting pneumonia were divided into the following four types: 1) deficiency of body fluid due to accumulation of heat in the lung, 2) earth failing to generate metal, 3) deficiency of the Ying and Wei systems, and 4) excessiveness of pathogens due to qi deficiency. After treatment for 2-3 weeks, 40 cases were cured, 8 improved, and 4 ineffective.

Progression of anti-mycoplasma drug therapy in children with refractory mycoplasma pneumonia

The incidence of refractory mycoplasma pneumoniae pneumonia(RMPP)in children is increasing year by year,and the disease is progressing rapidly.It is accompanied by serious complications and legacy effects,seriously affecting the quality of life of children.The selection,dosage,and course of anti-MP drugs in children with RMPP have brought a lot of troubles to pediatric hospitals.In the present study,the characteristics,usage and dosage,drug resistance mechanism,and treatment progress of anti-MP drugs for the treatment of RMPP in children were reviewed.Collectively,our findings provided ideas for the treatment of children with RMPP using anti-MP drugs.

儿童重症肺炎支气管肺泡灌洗液的病原菌及药敏试验分析

目的了解儿童重症肺炎支气管肺泡灌洗液(BALF)的病原菌及药敏试验情况。方法选取该院2021年1月至2023年4月收治的100例重症肺炎患儿作为研究对象,对所有患儿进行支气管镜肺泡灌洗,并分析其BALF病原菌及药敏试验情况。结果100例患儿BALF中共培养出病原菌131株,革兰阴性菌98株(74.81%),革兰阳性球菌33株(25.19%),其中流感嗜血杆菌(25.19%)、肺炎链球菌(21.37%)占比较高,卡他布兰汉菌(15.27%)、肺炎克雷伯菌(11.45%)其次。重症肺炎患儿BALF中前4位病原菌主要以<1岁(97.37%)、1~3岁(96.88%)占比较高,>3~7岁(94.12%)、>7~14岁(92.31%)相对较少。各年龄BALF中流感嗜血杆菌、卡他布兰汉菌、肺炎克雷伯菌分布情况比较,差异均无统计学意义(P>0.05);各年龄BALF中肺炎链球菌分布情况比较,差异有统计学意义(P<0.05)。20株流感嗜血杆菌对四环素、阿莫西林-克拉维酸、头孢噻肟、复方磺胺甲噁唑均较敏感,对氯霉素敏感性其次,对氨苄西林、头孢克洛、头孢呋辛耐药性均较高;15株卡他布兰汉菌对头孢噻肟较敏感,对氨苄西林耐药性最高;8株肺炎克雷伯菌对头孢噻肟较敏感,对氨苄西林、头孢呋辛、氯霉素耐药性均较高,对阿莫西林-克拉维酸、四环素耐药性其次;20株肺炎链球菌对万古霉素、氯霉素均较敏感,对青霉素G、泰利霉素敏感性其次,对复方磺胺甲噁唑耐药性较高,对四环素、头孢噻肟、克林霉素耐药性其次。结论儿童重症肺炎BALF中病原菌以流感嗜血杆菌、肺炎链球菌多见,且0~3岁患儿病原菌占比高于>3~14岁,临床应合理用药以预防耐药菌株产生。

2型糖尿病合并感染患者肺炎克雷伯菌分布及预后影响因素分析

目的:探讨2型糖尿病(T2DM)合并感染患者肺炎克雷伯菌(KP)分布及预后影响因素分析。方法:选择226例T2DM患者为研究对象,根据是否合并KP感染分为未感染组(n=170)和感染组(n=56),分析T2DM患者感染的危险因素。收集T2DM合并感染患者KP标本,记录标本来源并进行菌种鉴定和药敏试验,并对所有菌株进行多位点序列(MLST)分型,记录预后情况。结果:基础疾病、抗生素使用、侵入性操作、血清白蛋白(ALB)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)为影响T2DM发生感染的危险因素(均P<0.05)。T2DM合并感染患者体内分离56株肺炎克雷伯菌,肺炎克雷伯菌在痰液中的占比最高为44.62%,其次为尿液19.64%,血液中占比16.07%,脓液中占比12.5%,其他标本占比7.14%。56株KP总耐药率最高为氨苄西林,最低为亚胺培南,痰液标本中KP对头孢呋辛、头孢哌酮、庆大霉素耐药率高于非痰液标本,非痰液标本中KP对头孢他啶高于痰液标本(均P<0.05)。56株肺炎克雷伯菌MLST分型共发现42个ST型,ST-20型、36型、65型、347型、660型各2株,分别占3.57%,23型4株占7.14%,ST-17、25、29、35、37、45、86、189、208、211、218、322、355、412、490、519、557、595、726、776、1049、1092、1103、1319、1569、1916、2059、3014、3140、3536、4023、4194、4262、4412、4857型各1株,分别占1.78%,其他ST型7株占比12.5%。56例T2DM合并KP感染患者预后良好患者52例,预后不良患者4例,预后良好率为92.86%。结论:T2DM合并感染患者KP主要分布在痰液和尿液中,基础疾病、抗生素使用、侵入性操作、ALB、HbA1c、FPG是影响KP感染发生危险因素,T2DM合并KP感染患者根据药敏结果选择用药,有利于患者预后。