【摘要】 目的 分析ICU患者院内下呼吸道感染的细菌分布情况,为临床用药提供依据。方法 对成都市第六人民医院2006年1月—2009年6月566例ICU院内下呼吸道感染患者的痰培养标本结果进行回顾性调查分析。结果 共分离出371株病原菌,其中革兰阴性杆菌235株,占63.34%;革兰阳性球菌62株,占16.71%;真菌74株,占19.95%。药敏结果显示,对常规青霉素类基本耐药,亚胺培南—西司他丁、美罗培南耐药菌株少见,对万古霉素耐药菌株尚未出现。结论 加强ICU呼吸道感染的病原菌监测极为必要,对临床抗生素的合理使用具有指导意义。
Objective To investigate the relations between the human beta defensin-2 (HBD-2) and systemic inflammatory responses in patients with lower respiratory tract infection（LRTI）. Methods Eighty-one patients with confirmed LRTI including community-acquired pneumonia，acute exacerbation of chronic obstructive pulmonary disease or concurrent lung infection，and bronchiectasis concurrent infection were enrolled，and twenty healthy volunteers were included as control. Plasma concentrations of HBD-2，IL-1β，and IL-8 were assayed with ELISA method in all patients and controls. Furthermore the patients were divided into three groups according to the onset of disease:,ie.group A （shorter than 7 days），group B （7 to 14 days），and group C （more than 14 days）. The differences between these groups were compared. Correlation between HBD-2 and IL-1β or IL-8 concentrations was analyzed. Results HBD-2，IL-1β，white blood cell （WBC） of the peripheral blood in the patients with LRTI were all significantly higher than those in the healthy controls. HBD-2 and IL-1β increased in group A and group B，and decreased in group C comparing to the control group （Plt;0.05 respectively）. There was no significant difference of IL-8 in group A，B and C. HBD-2 showed a positive linear correlation with IL-1β （r=0.313，P=0.030） and no correlation with IL-8（Pgt;0.05）. Conclusions The plasma HBD-2 concentration is increased in LRTI patients，which may be a biomarker of systemic inflammation in the early or relative early course of LRTI.
ObjectiveThe aim of this study was to assess the disease burden of non-COVID-19 lower respiratory infection (LRI) in China during the period 1990−2021, particularly during the period 2019−2021. MethodsData on the burden of disease for LRI in China were obtained from the GBD 2021 database. A Joinpoint regression model was used to describe the changes in disease burden trends of LRI in China from 1990 to 2021, and the results are presented in terms of average annual percentage change (AAPC). ResultsIn 2021, the age-standardized incidence rate of LRI in China was 2 853.31/100 000, the age-standardized rate of DALY was 347.67/100 000, and the age-standardized mortality rate was 14.03/100 000. Compared with 1990, the AAPC were −2.13%, −6.89% and −4.10% respectively. In contrast, during the COVID-19 pandemic, both showed a decreasing and then increasing trend, except for the age-standardized incidence rate, which showed a decreasing trend. Children under 5 years of age have experienced the greatest reduction in the burden of disease over the past decades, while the burden of disease has increased in absolute terms for the elderly over 70 years of age. Compared with 1990, the disease burden of LRI in China due to each pathogenic microorganism has decreased. And during 2019−2021, all pathogens showed an increasing trend, except for ASMR caused by influenza (APC=−55.21%) and respiratory syncytial virus (APC=−53.35%). In 2021, the primary attributable risk factors for LRI mortality in China shifted from household air pollution due to solid fuels, childhood underweight, and childhood stunting in 1990 to ambient particulate matter pollution, smoking, and secondhand smoke. ConclusionThe disease burden of LRIs in China showed an overall decreasing trend from 1990 to 2021, but with large variations between age groups and pathogens. During the two years following the outbreak of the COVID-19 pandemic, the incidence of LRI in China, along with the disease burden caused by influenza and respiratory syncytial virus, significantly declined. Over the past few decades, the attributable risk factors for mortality and DALYs have undergone substantial changes. To address this phenomenon, targeted measures should be implemented to reduce the burden of LRI on the population caused by air pollution and smoking.
Objective To study the incidence and etiological distribution of lower respiratory tract infection (LRTI) after airway metal stent implantation in patients with malignant central airway obstruction (MCAO). Methods The clinical data of 149 patients with MCAO who underwent airway metal stent implantation in Department of Pulmonary and Critical Care Medicine of Hunan Provincial People's Hospital from April 2014 to April 2021 were selected for a retrospective study. The incidence of LRTI after treatment was counted. According to whether LRTI occurred after operation, they were divided into infected group and uninfected group. The clinical data of the two groups were compared and the influencing factors of LRTI were analyzed. Sputum samples and/or bronchoalveolar lavage fluid samples from patients infected with LRTI were collected for pathogen detection and drug susceptibility test, and the distribution and drug resistance of main pathogens were analyzed. Results A total of 149 patients who met the criteria were included in this study and the incidence of LRTI was 21.48%. People in the infected group was older than that in the uninfected one, and the proportion of people with a history of smoking, chemoradiotherapy, covered metal stents, and stent-related granulation tissue proliferation was higher, and the proportion of people with postoperative standardized aerosol inhalation was lower (P<0.05). Age, smoking history, chemoradiotherapy, covered metal stents, stent-related granulation tissue hyperplasia and postoperative standardized aerosol inhalation were all influencing factors of LRTI in these patients (P<0.05). A total of 38 pathogens were detected in 32 patients with LRTI. Gram negative bacteria, gram positive bacteria and fungi accounted for 68.42% (26/38), 21.05% (8/38) and 10.53% (4/38) respectively. Pseudomonas aeruginosa, the main Gram-negative bacteria, had no resistance to tobramycin, gentamicin and amikacin, but had high resistance to compound sulfamethoxazole, tigecycline and ampicillin; Klebsiella pneumoniae had low resistance to tobramycin, amikacin and tigecycline, and high resistance to cefotaxime, ciprofloxacin and cefepime; the main Gram-positive Staphylococcus aureus had no drug resistance to vancomycin, linezolid, compound sulfamethoxazole and quinuptin/dafuptin, but had high drug resistance to tetracycline, penicillin G, levofloxacin, oxacillin and ciprofloxacin; the main fungi Candida albicans showed no resistance to fluconazole, itraconazole, voriconazole, 5-fluorocytosine and amphotericin B. These results of pathogenic detection and drug susceptibility test contributed to the improvement of the rational application rate of antibiotics. Conclusions LRTI occurs in about a quarter of patients with MCAO after airway metal stent implantation. The pathogens are mainly Pseudomonas aeruginosa and Staphylococcus aureus. Antimicrobial treatment should be based on the results of etiological detection and drug susceptibility test.
Objective To explore the distribution of bacteria among community acquired lower respiratory tract infection (LRTI) inpatients with underlying chronic respiratory tract diseases.Methods The clinical data，sputum culture and drug susceptibility results of 212 community acquired LRTI patients who were hospitalized during the period 2001-2005 were retrospectively analyzed.All patients had various underlying chronic respiratory tract diseases.Results A total of 229 strains of pathogens were detected，with the majority being gram negative bacteria.In pathogens of acute exacerbation of chronic obstructive pulmonary disease，gram negative bacteria occupied 73.9%.And Pseudomonas aeruginosa and Klebsiella pneumoniae were the most common pathogens，with each occupying 18.2% and 13.6% respectively.Gram positive bacteria occupied 23.8%，mainly Staphylococcus aureus (10.2%) and Streptococcus pneumoniae (9.1%).In patients with bronchiectasis exacerbated by bacterial infection，86.2% were caused by gram negative bacteria，the top three being，in descending order，Pseudomonas aeruginosa (27.5%)，Haemophilus parainfluenzae (13.7%)，and Haemophilus influenzae (11.8%).Bronchiectasis was the major risk factor of getting Pseudomonas aeruginosa infection (OR=5.590，95%CI 2.792~11.192).The risk factors of getting Acinetobacter baumanii infection were antacid usage within 1 month (OR=9.652，95%CI 2.792~11.192) and hypoalbuminemia (OR=2.679，95%CI 1.108~6.476).For enterobacters infections，including Klebsiella pneumoniae，Enterobacter cloacae and Escherichia coli，the risk factors were antibiotic usage within 1 month (OR=4.236，95%CI 1.982~9.057)，having renal diseases (OR=4.305，95%CI 1.090~17.008) and diabetes mellitus (OR=2.836，95%CI 1.339~6.009).Conclusions Gram negative bacteria were the main pathogens of community acquired LRTI in hospitalized patients with underlying chronic respiratory tract diseases.The pathogens were influenced by underlying diseases，severity of diseases and drug usage history of patients.
Objective To investigate the clinical features of lower respiratory tract infection caused by hypermastigote. Methods The clinical manifestations, chest imaging characteristics, fiber bronchoscopic and etiological test results were analyzed in 16 patients with hypermastigote infection in lower respiratory tract. Results In 16 patients with hypermastigote infection in lower respiratory tract, fever were present in all the cases, cough in 15 cases, night sweat in 12 cases, wheezing in 3 cases, and eosinophilia in 3 cases.Alive hypermastigotes were found in respiratory tract secretion in all the 16 cases. Bacterial culture of respiratory tract secretion yielded positive results in 8 of 16 cases. Chest imaging showed infiltrations in several lobes and segments or a large opacity with fuzzy patches. Bronchoscopy showed an acute inflammation in the respiratory tract lumen. Prognosis was good with the therapy of Metronidazole. Conclusions Detection of hypermastigote infection in lower respiratory tract have a definite clinical significance in Shenzhen area. Mixed infection is common in hypermastigote infection of lower respiratory tract.
Objective To evaluate the efficacy and safety of domestic ambroxol hydrochloride injection in the treatment of lower respiratory tract infection. Methods A total of 120 patients with respiratory tract infections were included and randomized into the treatment group (ambroxol hydrochloride injection 30mg, iv, q12h) and the control group (mucosolvan ampoule 30mg, iv, q12h). The duration of treatment was 6 days. Results 118 patients completed the trial, 59 in each group. From Day 1 to Day 6, the severity scores of cough, sputum amount, difficulty in expectoration and rales were similar between the two groups (Pgt;0.05), but a significant difference was observed in the nature of sputum (Plt;0.05). The total effective rates of the treatment group and the control group were 96.6% (FAS analysis and PP analysis) or 93.3% (FAS analysis), and 94.9% (PP analysis), respectively. There was no significant difference between the two groups (Pgt;0.05). The incidence of adverse effects was comparable between the two groups (1.7% vs. 0%, Pgt;0.05), and no severe adverse effect was observed. Conclusion The efficacy of domestic ambroxol hydrochloride injection in the treatment of lower respiratory infection was equal to that of mucosolvan ampoule, and it can even further improve the nature of sputum. Ambroxol hydrochloride was as safe as mucosolvan ampoule.
ObjectiveTo investigate the efficacy of macrolide antibiotics on patients with lower respiratory tract infection. MethodsA total of 146 patients with lower respiratory tract infections were selected from January 2011 to January 2014 in the Department of Respiratory Medicine of our hospital and divided into low risk and high risk group. Based on the clinical characteristics of the patients, low risk treatment plan was erythromycin capsule 0.25 g once, 3 times/day plus compound liquorice mixture, followed by clarithromycin 0.25 g once, 2-3 times/day plus compound liquorice mixture or clarithromycin 0.25 g once, 2-3 times/day plus compound liquorice mixture; high risk group treatment was macrolide antibiotics (erythromycin, clarithromycin) 0.25 g once, 3 times/day and second generation cephalosporins (cefaclor or cefuroxime) 0.25 g once, 3 times/day plus compound liquorice decoction. ResultsThe clinical seven-day curing rate was 54.1%, and the total effective rate was 93.1%. For low risk treatment regimen, the sevenday curing rate was 63.6%, and the total effective rate was 94.9%; for high risk treatment regimen, the seven-day curing rate was 34.0%, and the total effective rate was 89.4%. Acute bronchitis had high curing rate which was 70.1%. ConclusionMacrolide antibiotics (erythromycin, clarithromycin) oral administration in the treatment of lower respiratory tract infection is reliable and effective, which is worth promoting in clinical application.
ObjectiveTo investigate the distribution and drug resistance of pathogens in neonates with lower respiratory tract infection, and provide evidence for clinical rational antibiotic use. MethodsA retrospective analysis on 998 strains isolated from 5 486 sputum samples during January 1, 2009 to December 31, 2012 collected from hospitalized neonates was performed. ResultsOf the 998 isolated strains, the common pathogens were Klebsiella pneumoniae (23.1%), Escherichia coli (E. coli) (21.2%), Staphylococcus aureus (19.4%), and Enterobacter cloacae (8.4%). Klebsiella pneumonia, E. coli and Enterobacter cloacae were generally resistant to penicillin, but enzyme inhibitors could reduce the resistance rate. A large proportion of Klebsiella pneumonia was resistant to the third generation cephalosporins (78.4%), while E. coli and Enterobacter cloacae had a lower resistance rate (46.7% and 46.5%, respectively). There were 7 strains (3.0%) of Klebsiella pneumoniae and 1 (1.2%) strain of Enterobacter cloacae resistant to imipenem. Twenty-three strains (13.6%) of Klebsiella pneumoniae, 1 strain (0.7%) of E.coli and 1 strain (2.5%) of Enterobacter cloacae were resistant to ertapenem. A total of 97.0% of Staphylococcus aureus was resistant to penicillin, but only 11.0% was resistant to oxacillin, and all the isolates were sensitive to vancomycin. ConclusionGram negative bacteria are the common pathogens in the hospitalized neonates in our hospital. Klebsiella pneumonia, E. coli and Staphylococcus aureus are the common pathogens. The common pathogens show a high resistant level to antibiotics. Clinicians should evaluate the potential pathogens of infections based on the results presented in our study, in order to select antibiotics rationally when treating infections.