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Methicillin-resistant Staphylococcus aureus pneumonia in diabetics: a single-center, retrospective analysis

Chinese Medical Journal 2019年第12期132卷 1429-1434页

作者： Qiu-Rui Zhang Hong Chen Bing Liu Min Zhou Department of Respiratory and Critical Care Medicine Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Institute of Respiratory Diseases Shanghai Jiao Tong University School of MedicineShanghai 200025China

Background: Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is an important issue with significant morbidity and mortality in clinical practice, especially in diabetes mellitus (DM). Studies focusing on S. aureus pneumonia in DM is limited, we sought to make a relatively comprehensive exploration of clinical characteristics, antimicrobial resistance, and risk factors for mortality of S. aureus pneumonia in DM and non-diabetics mellitus (non-DM). Methods: A retrospective study was conducted in Ruijin Hospital from 2014 to 2017. The characteristics of DM and non-DM patients were assessed, including demographics, comorbidities, using of invasive mechanical ventilation, Hemoglobin A1c (HbA1C), confusion, urea, respiratory rate, blood pressure, age ≥65 years (CURB-65) score, length of hospital stay, clinical outcomes, antimicrobial susceptibility. Independent risk factors for mortality were identified by univariate and multivariate logistic regression analysis. Results: A total of 365 patients with S. aureus pneumonia were included in our study, including 144 with DM and 221 non-DM. DM patients were more susceptible to MRSA infection (65.3% vs. 56.1%, P > 0.05), suffered from much severer pneumonia with a higher CURB-65 score, invasive mechanical ventilation rate (46.5% vs. 28.1%, P 0.05);almost all DM patients had higher antimicrobial resistance than non-DM patients, the DM group had a higher coinfection rate (47.2% vs. 45.7%, P > 0.05), and Acinetobacter baumannii was the most common bacterium in DM, while Klebsiella pneumoniae ranked first in patients with non-DM. Independent risk factors for pneumonia-related mortality were MRSA and CURB-65. Higher HbA1c levels were linked to a higher MRSA infection and co-infection rate and more severe pneumonia, leading to an increase in mortality. Conclusions: DM patients with poor glucose control are more susceptible to MRSA infection. They suffer from higher antimicr

关键词： Methicillin-resistant S. aureus pneumonia Diabetics mellitus Co-infection Risk factor HbA1c

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Mycoplasma pneumoniae pneumonia in hospitalized children diagnosed at acute stage by paired sera

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Chinese Medical Journal 2010年第23期123卷 3444-3450页

作者： LIU Chun-ling WANG Gui-qiang ZHANG Bo XU Hua HU Liang-ping HE Xiao-feng WANG Jun-hua ZHANG Jun-hong LIU Xiao-yu WEI Ming LIU Zhen-ye Department of Infectious Disease Air Force General Hospital of Chinese People's Liberation Army Beijing 100142 China Department of Respiration Air Force General Hospital of Chinese People's Liberation Army Beijing 100142 China Department of Pediatrics Air Force General Hospital of Chinese People's Liberation Army Beijing 100142 China Department of Infection Control Air Force General Hospital of Chinese People's Liberation Army Beijing 100142 China Department of Cardiology Air Force General Hospital of Chinese People's Liberation Army Beijing 100142 China Department of Infectious Diseases and Center for Liver Diseases Peking University First Hospital Beijing 100034 China Consulting Center of Biomedical Statistics Academy of MilitaryMedical Sciences Beijing 100850 China

Background Mycoplasma pneumoniae （M. pneumoniae） is a frequent cause of respiratory tract infections. However,there is deficient knowledge about the clinical manifestations of M. pneumoniae infection. We described the clinical and laboratory findings of M. pneumoniae pneumonia in hospitalized children who were all diagnosed by a ≥ fourfold increase in antibody *** M. pneumoniae antibodies were routinely detected in children admitted with acute respiratory infection during a one-year period. The medical history was re-collected from children whose M. pneumoniae antibody titer increased≥fourfold at the bedside by a single person, and their frozen paired serum samples were measured again for the *** antibody *** Of the 635 children whose sera were detected for the M. pneumoniae antibody, paired sera were obtained from 82 and 29.3% （24/82） showed a ≥ fourfold increase in antibody titer. There were 24 cases, nine boys and 15 girls, aged from two to 14 years, whose second serum samples were taken on day 9 at the earliest after symptom onset; the shortest interval was three days. All children presented with a high fever （≥38.5℃） and coughing. Twenty-one had no nasal obstruction or a runny nose, and five had mild headaches which all were associated with the high fever. The disease was comparatively severe if the peak temperature was ＞39.5℃. All were diagnosed as having pneumonia through chest X-rays. Four had bilateral or multilobar involvement and their peak temperatures were all ≤ 39.5℃. None of the children had difficulty in breathing and all showed no signs of *** The second serum sample could be taken on day 9 at the earliest after symptom onset meant that paired sera could be used for the clinical diagnosis of M. pneumoniae pneumonia in children at the acute stage. M. pneumoniae is a lower respiratory tract pathogen. Extrapulmonary complications were rare and minor in our study. High peak temperature （＞39.5℃） is correlated

关键词： mycoplasma pneumonia children serum antibodies

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Muscular tissue desaturation and pneumonia in patients receiving lung cancer surgery:a cohort study

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Chinese Medical Journal 2023年第1期136卷 65-72页

作者： Wei Zhao Caijuan Zhang Dongliang Mu Fan Cui Huiqun Jia Department of Anesthesiology The Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050000China Department of Anesthesiology Peking University First HospitalBeijing 100034China Department of Anesthesiology Tangshan Gongren HospitalTangshanHebei 063000China

Background:Post-operative pneumonia(POP)is a common complication of lung cancer surgery,and muscular tissue oxygenation is a root cause of post-operative ***,the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically *** study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer ***:This cohort study enrolled patients(≥55 years)who had undergone lobectomy with one-lung *** tissue oxygen saturation(SmtO_(2))was monitored in the forearm(over the brachioradialis muscle)and upper thigh(over the quadriceps)using a tissue *** minimum SmtO_(2)was the lowest intra-operative measurement at any time *** tissue desaturation was defined as a minimum baseline SmtO_(2)of15 *** area under or above the threshold was the product of the magnitude and time of *** primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic *** secondary outcome was the correlation between SmtO_(2)in the forearm and that in the ***:We enrolled 174 *** overall incidence of muscular desaturation(defined as SmtO_(2)pneumonia than those without desaturation(28.0%[23/82]vs.12.0%[11/92];P=0.008).The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia(odds ratio:2.995,95%confidence interval:1.080-8.310,P=0.035)after adjusting for age,American Society of Anesthesiologists status,Assess Respiratory Risk in Surgical Patients in Catalonia score,smoking,use of peripheral nerve block,propofol,and study ***:Muscular tissue desaturation,de

关键词： Association Lung neoplasms Muscular tissue oxygenation One-lung ventilation Post-operative complications pneumonia Propofol Oxygen saturation

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Qiangzhi Decoction(羌跖汤) Protects Mice from Influenza A pneumonia through Inhibition of Inflammatory Cytokine Storm

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Chinese Journal of Integrative Medicine 2015年第5期21卷 376-383页

作者：朱海燕黄海史训龙周伟周珮颜乾麟朱宏光鞠佃文 Department of Biosynthesis School of PharmacyFudan University Institute of Chinese Medicine Tongji University Shanghai Medical College Fudan University

Objective： To investigate the preventive effects of Qiangzhi Decoction （羌跖汤, QZD） on influenza A pneumonia through inhibition of inflammatory cytokine storm in vivo and in vitro. Methods： One hundred ICR mice were randomly divided into the virus control, the Tamiflu control and the QZD high-, medium-, and low-dose groups. Mice were infected intranasally with influenza virus （H1N1） at 10 median lethal dose （LDso）. QZD and Tamiflu were administered intragastrically twice daily from day 0 to day 7 after infection. The virus control group was treated with distilled water alone under the same condition. The number of surviving mice was recorded daily for 14 days after viral infection. The histological damage and viral replication and the expression of inflammatory cytokines were monitored. Additionally, the suppression capacity on the secretion of regulated on activation normal T cells expressed and secreted （RANTES） and tumor necrosis factor-α （TNF-α ） in epithelial and macrophage cell-lines were evaluated. Results： Compared with the virus control group, the survival rate of the QZD groups significantly improved in a dose-dependent manner （P〈0.05）, the viral titers in lung tissue was inhibited （P〈0.05）, and the production of inflammatory cytokines interferon-γ （IFN- α ）, interleukin-6 （IL-6）, TNF-α, and intercellular adhesion molecule-1 （ICAM-1） were suppressed （P〈0.05）. Meanwhile, the secretion of RANTETS and TNF-α by epithelial and macrophage cell-lines was inhibited with the treatment of QZD respectively in vitro （P〈0.05）. Conclusions： The preventive effects of QZD on influenza virus infection might be due to its unique cytokine inhibition mechanism. QZD may have significant therapeutic potential in combination with antiviral drugs.

关键词： herbal medicine influenza A virus antiviral activity pneumonia inflammatory cytokine Chinesemedicine

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Effect of Qingfei Mixture (清肺合剂) on Pediatric Mycoplasma pneumoniae pneumonia with Phlegm Heat Obstructing Fei (Lung) Syndrome

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Chinese Journal of Integrative Medicine 2017年第9期23卷 681-688页

作者： YANG Ai-jun XI Kun YAO Yan-qing DING Ying-xue YANG Li-jun CUI Hong Department of Pediatrics Beijing Friendship HospitalCapital Medical UniversityBeijing100050China

Objective： To explore the effect and mechanism of Qingfei Mixture （清肺合剂）, a Chinese medicine, in treating mycoplasma pneumonia （MP） in MP patients and rat model. Methods： A total of 46 MP children with phlegm heat obstructing Fei （Lung） syndrome were randomly assigned to two groups by the method of random number table, with 23 children in each group. The control group was treated with intravenous infusion of azithromycin; the treatment group received intravenous infusion of azithromycin and oral administration of Qingfei Mixture. The treatment course was 7 days. Major symptoms and minor symptoms were observed and scored before and after treatments. A rat model of MP was also established. A total of 120 wistar rats were randomly divided into 5 groups： a normal group, infection group, Qingfei Mixture treatment group, azithromycin treatment group, and Qingfei Mixture ＋ azithromycin treatment group. Each group contained 24 rats, from which every 6 were euthanatized 1, 3, 7 and 14 days after infection. MP DNA in pulmonary tissue homogenates was detected using real-time fluorescence quantitative polymerase chain reaction. Pathology was assessed after hematoxylin （HE） staining and lung tissue pathology scores were determined in pulmonary tissue. Transmission electron microscopic detection and electronic image analysis were performed on lung tissue 3 days after infection. Intedeukin （IL）-17 was detected in serum using enzymelinked immunosorbent assay （ELISA） 7 days after infection. Results： In the clinical study, both control and the treatment group showed improved results on removing symptoms of phlegm heat syndrome compared to the control group （P〈0.05）. In animal experiments, On the 7th day after MP infection, as detected by electron microscopy, the pulmonary capillary basement membranes of the azithromycin ＋ Qingfei Mixture treatment group were much thinner than those of the azithromycin or Qingfei mixture treatment groups （P〈0.05）. The level of serum IL-17 in the azith

关键词： mycoplasma pneumoniae pneumonia azithromycin Qingfei Mixture children Chinese medicine

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Analysis of clinical efficacy of different initial antimicrobial treatment in healthcare associated pneumonia patients in emergency department

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Chinese Medical Journal 2014年第10期127卷 1814-1819页

作者： Cao Guohui Chen Xuyan Wu Sheng Department of Emergency Medicine Peking University First Hospital Beijing 100034 China

Background Community acquired pneumonia （CAP） is one of the most common infectious disease in emergency *** 2005 the concept of healthcare associated pneumonia （HCAP） was proposed by the ATS/IDSA *** clinical features and microbiology of HCAP are different from CAP,however,the initial antimicrobial treatment is still *** aimed to compare the clinical efficacy between HCAP patients treated initially with HCAP guidelineconcordant antimicrobial agents and those with CAP guideline-concordant antimicrobial *** We conducted a retrospective observational study on HCAP patients who were admitted to emergency department between December 2011 and December *** were divided into 2 groups according to their different initial antimicrobial *** compared clinical features,distribution of pathogen,severity,days and spending on intravenous antimicrobial,length and charge of hospitalization and clinical outcomes,and meanwhile analyzed the clinical efficacy as *** Of the 125 HCAP patients,55 patients received CAP guideline-concordant antimicrobial agents and 70 received HCAP *** major pathogens were Klebsiella pneumoniae,methicillin-resistant staphylococcus aureus （MRSA）,Pseudomonas aeruginosa and Escherichia coll The 2 groups were similar at baseline,including old age,comorbidities,pneumonia Severity Index scores,APACHE scores,and length of intravenous antimicrobial use and hospitalization duration,and in-hospital *** efficacy rate occurred in 70.0％ of HCAP agent patients and 50.9％ of CAP agent patients （P=0.029）.Antimicrobial charge and total hospital charge for HCAP agent patients were significantly higher than that for CAP agent *** Initial treatment of HCAP patients in emergency department with HCAP guideline-concordant antimicrobial could increase clinical efficacy rate,as well as antimicrobial charge and total hospital charge,but was not associated with shortening the l

关键词： pneumonia health care drug resistance treatment efficacy

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Qingkailing Injection(清开灵注射液)for Treatment of Children pneumonia Induced by Respiratory Syncytial Virus:A Meta-Analysis of Rando mized Controlled Trials

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Chinese Journal of Integrative Medicine 2018年第4期24卷 288-295页

作者： HE Shuai LI Wen-shi LUO Ya-jun YE Chen-li ZHANG Zhong-yi Department of Pharmacy Zhujiang Hospital of Southern Medical University

Objective： To evaluate the efficacy and safety of Qingkailing Injection（清开灵注射液, QKL） for treatment of children pneumonia caused by respiratory syncytial virus（RSV）. Methods： Randomized clinical trials（RCTs） comparing QKL with ribavirin injection in the treatment of children pneumonia induced by RSV were searched in Pub Med, Science Direct, Cochrane Library, Chinese VIP database, CNKI and Wanfang databases from their inception to March 2014. Meta-analyses were performed using RevMan 5.2 software. The methodological quality of the selected RCTs was evaluated by the Modified Jadad Score. The primary outcome measures were effective rate and the secondary outcomes were relief time of fever and cough. Results： Seven RCTs with 992 cases published from 2008 to 2013 were identified. The meta-analysis results indicated that QKL was more effective in cure rate [risk ratios（RR）=1.32, 95% CI（1.17, 1.50）, P〈0.01], total effective rate [RR=1.07, 95% CI（1.02, 1.13）, P=0.009] and less fever clearance time [mean difference=–0.73, 95% CI（–1.22, –0.23）, P=0.004], compared with ribavirin injection in the treatment of RSV-induced children pneumonia. No dead case was reported in all trials. There were 3 trials mentioned adverse events, 2 reported no obvious adverse event occurred while 1 reported adverse events described as skin hypersensitivity, elevation of ALT, a mild abnormal of hepatic and renal function in both QKL and ribavirin group. Conclusions： QKL was an effective and relatively safe option for the treatment of RSV-induced children pneumonia. These therapeutic effects were promising but need to be interpreted with caution due to variations in the treatment and methodological weakness in the studies.

关键词： Qingkailing Injection respiratory syncytial virus ribavirin pneumonia children respiratory tract infection meta-analysis randomized controlled trials Chinese medicine

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Identification of a novel coronavirus causing severe pneumonia in human:a descriptive study

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Chinese Medical Journal 2020年第9期133卷 1015-1024页

作者： Li-Li Ren Ye-Ming Wang Zhi-Qiang Wu Zi-Chun Xiang Li Guo Teng Xu Yong-Zhong Jiang Yan Xiong Yong-Jun Li Xing-Wang Li Hui Li Guo-Hui Fan Xiao-Ying Gu Yan Xiao Hong Gao Jiu-Yang Xu Fan Yang Xin-Ming Wang Chao Wu Lan Chen Yi-Wei Liu Bo Liu Jian Yang Xiao-Rui Wang Jie Dong Li Li Chao-Lin Huang Jian-Ping Zhao Yi Hu Zhen-Shun Cheng Un-Lin Liu Zhao-Hui Qian Chuan Qin Qi Jin Bin Cao Jian-Wei Wang National Health Commission of the People’s Republic of China Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory Institute of Pathogen BiologyChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Department of Pulmonary and Critical Care Medicine Center of Respiratory MedicineNational Clinical Research Center for Respiratory DiseasesChina-Japan Friendship HospitalBeijing 100029China Institute of Respiratory Medicine Chinese Academy of Medical SciencesPeking Union Medical CollegeBeijing 100029China National Health Commission of the People’s Republic of China Key Laboratory of Systems Biology of Pathogens Institute of Pathogen BiologyChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Vision Medicals Co. LtdGuangzhouGuangdong 510000China Hubei Provincial Center for Disease Control and Prevention WuhanHubei 430079China Wuhan Center for Disease Control and Prevention WuhanHubei 430022China Clinical and Research Center of Infectious Diseases Beijing Ditan HospitalCapital Medical UniversityBeijing 100015China Institute of Clinical Medical Sciences China-Japan Friendship HospitalBeijing 100029China Institute of Laboratory Animal Science Chinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100021China Department of Basic Medical Sciences Tsinghua University School of MedicineBeijing 100084China Wuhan Jinyintan Hospital WuhanHubei 430022China Department of Pulmonary and Critical Care Medicine Tongji HospitalTongji Medical CollegeHuazhong University of Sciences and TechnologyWuhanHubei 430030China Department of Pulmonary and Critical Care Medicine The Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430014China Department of Respiratory Medicine Zhongnan Hospital of Wuhan UniversityWuhanHubei 430071China

Background:Human infections with zoonotic coronaviruses(CoVs),including severe acute respiratory syndrome(SARS)-CoV and Middle East respiratory syndrome(MERS)-CoV,have raised great public health concern ***,we report a novel batorigin CoV causing severe and fatal pneumonia in ***:We collected clinical data and bronchoalveolar lavage(BAL)specimens from five patients with severe pneumonia from Wuhan Jinyintan Hospital,Hubei province,*** acids of the BAL were extracted and subjected to next-generation *** isolation was carried out,and maximum-likelihood phylogenetic trees were ***:Five patients hospitalized from December 18 to December 29,2019 presented with fever,cough,and dyspnea accompanied by complications of acute respiratory distress *** radiography revealed diffuse opacities and *** of these patients *** results revealed the presence of a previously unknownβ-CoV strain in all five patients,with 99.8%to 99.9%nucleotide identities among the *** isolates showed 79.0%nucleotide identity with the sequence of SARS-CoV(GenBank NC_004718)and 51.8%identity with the sequence of MERS-CoV(GenBank NC_019843).The virus is phylogenetically closest to a bat SARS-like CoV(SL-ZC45,GenBank MG772933)with 87.6%to 87.7%nucleotide identity,but is in a separate ***,these viruses have a single intact open reading frame gene 8,as a further indicator of bat-origin ***,the amino acid sequence of the tentative receptor-binding domain resembles that of SARS-CoV,indicating that these viruses might use the same ***:A novel bat-borne CoV was identified that is associated with severe and fatal respiratory disease in humans.

关键词： Bat-origin Coronavirus Zoonotic transmission pneumonia Etiology Next-generation sequencing

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Role of immunodeficiency in Acinetobacter baumannii associated pneumonia in mice

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Chinese Medical Journal 2020年第18期133卷 2161-2169页

作者： Ai-Ran Liu Wen-Jing Du Jian-Feng Xie Jing-Yuan Xu Ying-Zi Huang Hai-Bo Qiu Yi Yang Department of Critical Care Medicine Zhong-Da HospitalSchool of MedicineSoutheast UniversityNanjingJiangsu 210009China Department of Critical Care Medicine Xuzhou Central HospitalXuzhouJiangsu 221009China

Background:Acinetobacter baumannii(***)has become one of the most important opportunistic pathogens inducing nosocomial pneumonia and increasing mortality in critically ill patients *** interaction between *** infection and immune response can influence the prognosis of *** related *** target of the present study was to investigate the role of immunodeficiency in *** induced ***:Male BALB/c mice were randomly divided into the normal immunity control(NIC)group,normal immunity infection(NIA)group,immune compromised control(CIC)group,and immune compromised infection(CIA)group(n=15 for each group).Intraperitoneal injection of cyclophosphamide and intranasal instillation of *** solution were used to induce compromised immunity and murine pneumonia,*** mice were sacrificed at 6 and 24 h later and the specimens were collected for further ***-day mortality of mice was also ***:After *** stimulation,the recruitment of neutrophils in mice with normal immunity increased sharply(P=0.030 at 6 h),while there was no significant raise of neutrophil counts in mice with compromised immune condition(P=0.092 at 6 h,P=0.772 at 24 h).The Th cell polarization presented with pulmonary interleukin(IL)-4 and interferon(IFN)-γlevel in response to the *** in CIA group were significantly depressed in comparison with in NIA group(IFN-γ:P=0.003 at 6 h;P=0.001 at 24 h;IL-4:Ppneumonia in mice with compromised immunity caused more early stage death,more severe histopathological impairment in ***:*** could frustrate the immune response in immunocompromised conditions,and this reduced immune response is related to more severe lung injury and wors

关键词： Acinetobacter baumannii Compromised immunity Dendritic cells Helper T cell Neutrophilic granulocytes pneumonia

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Etiology and antimicrobial resistance of community-acquired pneumonia in adult patients in China

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Chinese Medical Journal 2012年第17期125卷 2967-2972页

作者： TAO Li-li HU Bi-jie HE Li-xian WEI Li XIE Hong-mei WANG Bao-qing LI Hua-ying CHEN Xue-hua ZHOU Chun-mei DENG Wei-wu Department of Respiratory Medicine Zhongshan Hospital Fudan University Shanghai 200032. China Department of Respiratory Medicine Taishan Medical University Affiliated Hospital Taian Shandong 271000 China Department of Respiratory Medicine Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200025 China

Background Appropriate antimicrobial therapy of community-acquired pneumonia （CAP） is mainly based on the distribution of etiology and antimicrobial resistance of major pathogens. We performed a prospective observational study of adult with CAP in 36 hospitals in China. Methods Etiological pathogens were isolated in each of the centers, and all of the isolated pathogens were sent to Zhongshan Hospital for antimicrobial susceptibility tests using agar dilution. Results A total of 593 patients were enrolled in this study, and 242 strains of bacteria were isolated from 225 patients. Streptococcus pneumoniae （79/242, 32.6%） was the most frequently isolated pathogen, followed by Haemophilus influenzae （55/242, 22.7%） and Klebsiella pneumoniae （25/242, 10.3%）. Totally 527 patients underwent serological tests for atypical pathogens; Mycoplasma pneumoniae and Chlamydia pneumoniae infections were identified in 205 （38.9%） and 60 （11.4%） patients respectively. Legionella pneumophila infections were identified in 4.0% （13/324） of patients. The non-susceptibility rate of isolated Streptococcus pneumoniae to erythromycin and penicillin was 63.2% and 19.1% respectively. Six patients died from the disease, the 30-day mortality rate was 1.1% （6/533）. Conclusions The top three bacteria responsible for CAP in Chinese adults were Streptococcus pneumonia, Haemophilus influenza and Klebsiella pneumonia. There was also a high prevalence of atypical pathogens and mixed pathogens. The resistance rates of the major isolated pathogens were relatively low except for the high prevalence of macrolide resistance in Streptococcus pneumoniae.

关键词： community-acquired infection pneumonia etiology antimicrobial drug resistance epidemiology

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