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

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World Journal of Emergency Medicine 2020年第3期11卷 145-151页

作者： Zhong-shu Kuang Yi-lin Yang Wei Wei Jian-li Wang Xiang-yu Long Ke-yong Li Chao-yang Tong Zhan Sun Zhen-ju Song Department of Emergency Medicine Zhongshan HospitalFudan UniversityShanghai 200032China Department of Pharmacology University of Virginia School of Medicine CharlottesvilleVirginiaUSA

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.

关键词： community-acquired pneumonia Immunocompromised hosts Autoimmune disease Prognostic marker

Determinants of quinolone resistance in Escherichia coli causing community-acquired urinary tract infection in Bejaia,Algeria

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Asian Pacific Journal of Tropical Medicine 2014年第6期7卷 462-467页

作者： Yanat Betitra Vinuesa Teresa Vinas Miguel Touati Abdelaziz Laboratoire d'ecologie Microbiologie.Universite A/Mira de Bejaia Laboratory of Molecular Microbiology and Antibiotics Dept.Pathology and Experimental therapeutics.Medical SchoolUniversity of Barcelona

Objective:To investigate the mechanisms of quinolone resistance and the association with other resistance markers among Esherichia coli(E.coli) strains isolated from outpatient with urinary tract infection in north of Algeria.Methods:A total of 30 nalidixic acid-resistant E.coli isolates from outpatient with urinary tract infections from January 2010 to April 2011 in north of Algeria(Bejaia) were studied.Antimicrobial susceptibility was determined by disc diffusion assay,minimal inhibitory concentrations(MIC) of quinolone were determined by microdilution.Mutations in the Quinolone Resistance-Determining Region(QRDR) of gyra and parC genes and screening for qnr(A,B and S) and bla genes were done by PCK and UNA sequencing.Results:Most of the E.coli isolates(56.66%) were shown to carry mutations in gyrA and parC,igyra:Ser83Leu + Asp87Asn and parC:Ser80Iler.While.16.66 had only an alteration in gyrA:Ser83Leu.One isolate produced qnrB-like and two qnrS-like.Four isolates were CTXM-15 producers associated with TEM-1 producing in one case.Co-expression of bla_(LTV,M)_(15) and qnrB was determined in one E.coli isolate.Conclusions:Our findings suggested the community emergence of gyrA and parC alterations and Qnr determinants that contributed to the development and spread of fluoroquinolone resistance in Algerian E.coli isolates.

关键词： Escherichia coli community-acquired urinary tract infection QRDR Qnr ESBL

Atypical pathogens in community acquired pneumonia of Egyptian children

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Asian Pacific Journal of Tropical Medicine 2009年第2期2卷 1-8页

作者： Deraz TE El Sahriggy SA Shaheen MA Motawea AA Gomaa HE Fawzy SH Mohamed AA Pediatric Department Ain Shams Faculty of Medicine Pediatric Department National Research Center Clinical Pathology Department National Research Center Microbiology Department Ain Shams Faculty of Medicine Cairo 11371 Egypt

Objective:Diagnosis of atypical pathogens as an aetiology for community-acquired pneumonia(CAP) in children is a challenge world wide.The aim of this study was to detect the frequency of atypical pathogens as a cause of community-acquired pneumonia(CAP) in Egyptian children.Methods:From 50 children(with age ranged from 2 months to 12 years) hospitalized for community-acquired pneumonia;respiratory sputum samples were collected by induction or spontaneously.All samples were subjected to conventional cultures and Polymerase Chain Reaction(PCR) technique DNA extraction for identification of Mycoplasma,Chlamydia pneumoniae and Legionella pneumophila.Results;A definite pathogen was identified in 78%of the studied children;30% typical bacteria,8%Candida albicans and atypical bacteria in 40%of the pneumonic children.Chlamydia pneumoniae was isolated from 26%of the children while Mycoplasma pneumoniae was isolated from 14%, whereas Legionella pneumophilla was not isolated at all.Conclusion;Atypical pathogens are evident as a potential aetiology for community-acquired pneumonia in(13.3%) of young and(80%) of older Egyptian children.

关键词： Atypical pathogens community-acquired pneumonia Children Egypt

Clinical Utility of Procalcitonin for Differentiating between Cryptogenic Organizing Pneumonia and community-acquired Pneumonia

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International Journal of Clinical Medicine 2015年第6期6卷 372-376页

作者： Satoshi Takeda Nobuhiko Nagata Hiroyuki Miyazaki Takanori Akagi Taishi Harada Masaru Kodama Shinichiro Ushijima Takashi Aoyama Kentaro Wakamatsu Masaki Fujita Kentaro Watanabe Department of Respiratory Medicine Fukuoka University Chikushi Hospital Chikushino Japan Department of Respiratory Medicine National Hospital Organization Omuta Hospital Omuta Japan Department of Respiratory Medicine Faculty of Medicine Fukuoka University Fukuoka Japan

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.

关键词： Cryptogenic Organizing Pneumonia Procalcitonin community-acquired Pneumonia Computed Tomography

Corticosteroids and ICU Course of community acquired Pneumonia in Egyptian Settings

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Pharmacology & Pharmacy 2011年第2期2卷 73-81页

作者： Nirmeen A. Sabry Emad El-Din Omar 不详

Background: Pneumonia is the most common cause of community-acquired infection requiring ICU admission. 60-87% of patients with severe community acquired pneumonia (CAP) admitted to the ICU develops respiratory failure and require mechanical ventilation (MV). Objectives: To assess the efficacy and safety of adjunctive low dose hydrocortisone infusion treatment in Egyptian ICU patients with CAP. Methods: Hospitalized patients, clinically and radiologically diagnosed with CAP, were randomized to receive hydrocortisone 12.5 mg/h IV infusion for 7 days or placebo, along with antibiotics. The end-points of the study were improvement in PaO2:FIO2 (PaO2:FIO2 > 300 or ≥100 increase from study entry) and SOFA score by study day 8 and the development of delayed septic shock. Results: 80 patients were recruited, 40 of them received hydrocortisone and the remaining 40 received placebo. By study day 8, hydrocortisone treated patients showed a significant improvement in PaO2:FIO2 and chest radiograph score, and a significant reduction in C-reactive protein (CRP) levels, Sepsis-related Organ Failure Assessment (SOFA) score, and delayed septic shock compared to the control group. Hydrocortisone treatment was associated with a significant reduction in the duration of MV. However, hydrocortisone infusion did not show significant difference in the ICU mortality. Conclusions: adjunctive 7-day course of low dose hydrocortisone IV in patients with CAP hastens recovery of pneumonia and prevents the development of sepsis related complications with a significant reduction in duration of the mechanical ventilation.

关键词： community-acquired Pneumonia Corticosteroids Hydrocortisone Pneumonia

Role of Serum Procalcitonin Level in Differentiating between Pulmonary Tuberculosis and community-acquired Pneumonia

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International Journal of Clinical Medicine 2014年第15期5卷 902-909页

作者： Mohammad Shameem Mazhar Alam Shagufta Moin Rakesh Bhargava Zuber Ahmad Jamal Akhtar Department of Biochemistry Jawaharlal Nehru Medical College Aligarh Muslim University Aligarh India Department of Tuberculosis and Respiratory Diseases Jawaharlal Nehru Medical College Aligarh Muslim University Aligarh UP 202002 India

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.

关键词： Procalcitonin Tuberculosis community-acquired Pneumonia

Distribution of pathogens and their drug resistance in aged patients with community-acquired pneumonia

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China Medical Abstracts(Internal Medicine) 2019年第1期36卷 34-35页

作者：邱虹 Dept Respir Med 2nd HospShaoxing

Objective To investigate the distribution of pathogens and their drug resistance in elderly patients with community-acquired pneumonia. Methods A total of 222 elderly patients with community-acquired pneumonia admitte... 详细信息

关键词： community-acquired study

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

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World Journal of Emergency Medicine 2011年第4期2卷 272-278页

作者： Samuel George Campbell R. Andrew McIvor Vincent Joanis David Graydon Urquhar Department of Emergency Medicine Charles V Keating Emergency and Trauma Centre 1796 Summer St Halifax NovaScotia B3H3A7 Canada (Campbell SG Urquhart DG) T2127 Firestone Institute for Respiratory Health St. Joseph′sHealth Care Hamilton Hamilton ON. L8N 4A6 Canada (McIvor RA) Foothills Medical Centre 1403 - 29th Street N.W.University of Calgary Calgary Alberta Canada (Joanis V)

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.

关键词： community-acquired pneumonia Blood cultures

Imaging of community-acquired pneumonia: Roles of imaging examinations, imaging diagnosis of specific pathogens and discrimination from noninfectious diseases

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World Journal of Radiology 2014年第10期6卷 779-793页

作者： Atsushi Nambu Katsura Ozawa Noriko Kobayashi Masao Tago Department of Radiology Teikyo University Mizonokuchi Hospital Kawasaki City Kanagawa 213-8507 Japan Department of Internal Medicine Kofu Municipal Hospital Kofu City Yamanashi Prefecture 400-0832 Japan

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.

关键词： community-acquired pneumonia Computed tomography Infection Pneumonia Lung disease