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 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.
