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

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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Emergence of hypervirulent Pseudomonas aeruginosa pathotypically armed with co-expressed T3SS effectors ExoS and ExoU

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hLife 2023年第1期1卷 44-56页

作者： Yuqin Song Yongqi Mu Nai-Kei Wong Zhuo Yue Juan Li Min Yuan Xiong Zhu Jinshu Hu Gang Zhang Dawei Wei Chao Wang Weihui Wu Fang Bai Jie Feng State Key Laboratory of Microbial Resources Institute of MicrobiologyChinese Academy of SciencesBeijingChina Clinical Pharmacology Section Department of PharmacologyShantou University Medical CollegeGuangdongChina State Key Laboratory of Medicinal Chemical Biology Key Laboratory of Molecular Microbiology and Technology of the Ministry of EducationCollege of Life SciencesNankai UniversityTianjinChina State Key Laboratory for Infectious Diseases Prevention and Control Collaborative Innovation Center for Diagnosis and Treatment of Infectious DiseaseNational Institute for Communicable Disease Control and PreventionChinese Center for Disease Control and PreventionBeijingChina Department of Clinical Laboratory People’s Hospital of SanyaHainanChina Cangzhou Central Hospital HebeiChina College of Life Science University of Chinese Academy of SciencesBeijingChina

Pseudomonas aeruginosa is a significant pathogen mainly causing healthcare-associated infections(HAIs).Newly emerging high-risk clones of *** with elevated virulence profiles furtherly cause severe community-acquired infections(CAIs).Usually,it is not common for *** to co-carry exoU and exoS genes,encoding two type III secretion system(T3SS)*** pathogenicity mechanism of exoS+/exoU+strains of *** remains ***,we provide detailed evidence for a subset of hypervirulent *** strains,which abundantly co-express and secrete the T3SS effectors ExoS and *** exoS+/exoU+*** strains were available to cause both HAIs and *** CAI-associated strains could elicit severe inflammation and hemorrhage,leading to higher death rates in a murine acute pneumonia model,and had great virulence potential in establishing chronic infections,demonstrating hypervirulence when compared to PAO1(exoS+/exoU-)and PA14(exoS-/exoU+).Both ExoS and ExoU were co-expressed and co-secreted in abundance in exoS+/exoU+*** abundant protein secretion could boost exoS+/exoU+strains’potentials for cytotoxicity in vitro and pathogenicity in *** evidence indicates that exoU acquisition is likely mediated by horizontal gene transfer(HGT)of the pathogenicity island PAPI-2,while deletion of exoU was sufficient to mitigate virulence in the exoS+/exoU+***,bioinformatics analysis showed that such exoS+/exoU+*** strains turned out to be widely distributed across the ***,the research provide detailed evidence for the high virulence and epidemicity of exoS+/exoU+strains of ***,highlighting an urgent need for surveillance against these high-risk hypervirulent strains.

关键词： Hypervirulent Pseudomonas aeruginosa community-acquired infection type III secretion system(T3SS) co-expressed ExoS and ExoU pathogen surveillance

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Clinical efficacy and safety of moxifloxacin versus levofloxacin plus metronidazole for community-acquired pneumonia with aspiration factors

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Chinese Medical Journal 2014年第7期127卷 1201-1205页

作者： Sun Tieying Sun Li Wang Rongmei Ren Xiaoping Sui Dong-jiang Pu Chun Ren Yajuan Liu Ying Yang Zhuo Li Fengzhi Department of Respiratory and Critical Care Medicine Beijing Hospital of the Ministry of Health Beijing 100730 China Department of Respiratory Diseases Shaanxi Provincial People's Hospital Xi'an Shaanxi 710068China Department of Respiratory Diseases Air Force General HospitalPeople's Liberation Army Beijing 100142 China

Background community-acquired pneumonia （CAP） is a common infectious disease throughout the world and the incidence continues to grow as the population *** is an important pathogenic mechanism for pneumonia in the elderly and the management of patients with community-acquired pneumonia with aspiration factors is a major medical *** study aimed to assess whether moxifloxacin in comparison to levofloxacin plus metronidazole are effective and safe in the treatment of community-acquired pneumonia with aspiration *** In this prospective,multicenter,open-label,randomized controlled trial,77 patients with mild-to-moderate community-acquired pneumonia with aspiration factors were enrolled and randomly assigned to receive moxifloxacin or levofloxacin plus *** primary efficacy variables were clinical outcomes in evaluable patients at a follow-up visit 7 to 14 days after the end of *** Seven days after the end of therapy a clinical cure was achieved for 76.7％（23 of 37） of efficacy-evaluable patients in the moxifloxacin group and 51.7％（15 of 40） of patients in the levofloxacin plus metronidazole *** was a significant difference between the two groups （x2=4.002,P ＜0.05）.Bacteriological success rates were similar in the moxifloxacin group （93.3％） and levofloxacin plus metronidazole group （96.4％）,there was no significant difference between the two groups （P ＞0.05）.The overall adverse event rate was 10.8％（4/37） in the moxifloxacin group versus 17.5％（7/40） in the levofloxacin plus metronidazole group,there was no significant difference between the two groups （P＞0.05）.No serious adverse events were *** Moxifloxacin is effective and safe for treatment of community-acquired pneumonia with aspiration *** the regimen of moxifloxacin monotherapy is more convenient compared with levofloxacin plus metronidazole.

关键词： pneumonia community-acquired infection moxifloxacin levofloxacin metronidazole

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