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Dähne T, Bauer W, Essig A, Schaaf B, Barten-Neiner G, Spinner CD, Pletz MW, Rohde G, Rupp J, Witzenrath M, Panning M. Resurgence of common respiratory viruses in patients with community-acquired pneumonia (CAP)-A prospective multicenter study. J Clin Virol 2024; 173:105694. [PMID: 38781632 DOI: 10.1016/j.jcv.2024.105694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/26/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a major global cause of death and hospitalization. Bacteria or community-acquired viruses (CARVs) cause CAP. COVID-19 associated restrictions effectively reduced the circulation of CARVs. OBJECTIVES The aim of this study was to analyze the proportion of CARVs in adult patients with CAP from mid-2020 to mid-2023. Specifically, we aimed to compare the rate of influenza virus, SARS-CoV-2, and RSV detections in patients aged 18-59 years and ≥60 years. STUDY DESIGN We analyze the proportion of 21 community-acquired respiratory viruses (CARVs) and three atypical bacteria (Bordetella pertussis, Legionella pneumophila, and Mycoplasma pneumoniae) in nasopharyngeal swab samples using molecular multiplex methods within the prospective, multicentre, multinational study of the German study Group CAPNETZ. We used stringent inclusion criteria throughout the study. RESULTS We identified CARVs in 364/1,388 (26.2 %) patients. In detail, we detected SARS-CoV-2 in 210/1,388 (15.1 %), rhino-/enterovirus in 64/1,388 (4.6 %), influenza virus in 23/1,388 (1.6 %) and RSV in 17/1,388 (1.2 %) of all patients. We detected RSV and influenza more frequently in patients ≥60 years, especially in 22/23 compared to the previous season. None of the atypical bacteria were detected. CONCLUSIONS Beginning in 2023, we demonstrate a re-emergence of CARVs in CAP patients. Effective vaccines or specific antiviral therapies for more than two thirds of the detected viral infections are currently available. High detection rates of vaccine-preventable viruses in older age groups support targeted vaccination campaigns.
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Affiliation(s)
- Theo Dähne
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Bauer
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Essig
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany
| | | | - Grit Barten-Neiner
- CAPNETZ STIFTUNG, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Christoph D Spinner
- TUM School of Medicine and Health, Department of Clinical Medicine - Clinical Department for Internal Medicine II, University Medical Center, Technical University of Munich, Germany
| | - Mathias W Pletz
- CAPNETZ STIFTUNG, Hannover, Germany; Institute of Infectious Diseases and Infection Control, Jena University Hospital / Friedrich-Schiller-University Jena, Jena, Germany
| | - Gernot Rohde
- CAPNETZ STIFTUNG, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany; Department of Respiratory Medicine, Medical Clinic I, Goethe University Hospital, Frankfurt, Main, Germany
| | - Jan Rupp
- CAPNETZ STIFTUNG, Hannover, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Martin Witzenrath
- CAPNETZ STIFTUNG, Hannover, Germany; Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; German Center for Lung Research (DZL), Berlin, Germany
| | - Marcus Panning
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Ai L, Fang L, Zhou C, Liu B, Yang Q, Gong F. The impact of the COVID-19 pandemic on Staphylococcus aureus infections in pediatric patients admitted with community acquired pneumonia. Sci Rep 2024; 14:15737. [PMID: 38977804 PMCID: PMC11231152 DOI: 10.1038/s41598-024-66071-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
The COVID-19 pandemic has significantly transformed the infection spectrum of various pathogens. This study aimed to evaluate the impact of the COVID-19 pandemic on Staphylococcus aureus (S. aureus) infections among pediatric patients with community acquired pneumonia (CAP). We retrospectively reviewed pediatric CAP admissions before (from 2018 to 2019) and during (from 2020 to 2022) the COVID-19 pandemic. The epidemiology and antimicrobial resistance (AMR) profiles of S. aureus isolates were examined to assess the pandemic's effect. As a result, a total of 399 pediatric CAP patients with S. aureus infections were included. The positivity rate, gender, and age distribution of patients were similar across both periods. There was a marked reduction in respiratory co-infections with Haemophilus influenzae (H. influenzae) during the COVID-19 pandemic, compared to 2019. Additionally, there were significant changes in the resistance profiles of S. aureus isolates to various antibiotics. Resistance to oxacillin and tetracycline increased, whereas resistance to penicillin, gentamicin, and quinolones decreased. Notably, resistance to erythromycin significantly decreased in methicillin-resistant S. aureus (MRSA) strains. The number of S. aureus isolates, the proportion of viral co-infections, and the number of resistant strains typically peaked seasonally, primarily in the first or fourth quarters of 2018, 2019, and 2021. However, shifts in these patterns were noted in the first quarter of 2020 and the fourth quarter of 2022. These findings reveal that the COVID-19 pandemic has significantly altered the infection dynamics of S. aureus among pediatric CAP patients, as evidenced by changes in respiratory co-infections, AMR patterns, and seasonal trends.
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Affiliation(s)
- Ling Ai
- Department of General Practice, Yongchuan Hospital of Chongqing Medical University, No. 439, Xuanhua Street, Chongqing, 402160, China
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Liang Fang
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Chanjuan Zhou
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Beizhong Liu
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education,, Department of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Quan Yang
- Department of Radiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Fang Gong
- Department of General Practice, Yongchuan Hospital of Chongqing Medical University, No. 439, Xuanhua Street, Chongqing, 402160, China.
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China.
- Department of Pediatrics, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China.
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3
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Ai J, Wang H, Zhang H, Song J, Zhang Y, Lin K, Qu L, Zhang Y, Zhang S, Xiang Q, Geng J, Jin G, Song W, Zhang L, Hu X, Liu H, Yuan G, Jiang N, Zhou Y, Xu Y, Ying J, Wu J, Xing Y, Fang K, Yan H, Chen F, Xu T, Wang S, Qian Z, Zhang W. Alterations of pathogen transmission patterns and attenuated immune stimulation might be the cause of increased adult respiratory infections cases in 2023, results from a multi-center study in mainland China. Heliyon 2024; 10:e32304. [PMID: 38948033 PMCID: PMC11209019 DOI: 10.1016/j.heliyon.2024.e32304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
Background Several respiratory infections outbreaks have been observed in mainland China after reduction of non-pharmaceutical interventions. Other countries have seen increases in respiratory infections outside typical seasons post-COVID-19, warranting investigation into underlying causes. Methods We established monitoring networks for suspected respiratory infection in 14 tertiary hospitals nationwide. PCR for SARS-CoV-2, influenza A and B were performed on 3708 respiratory specimens and deep sequencing were conducted to identify co-infections or newly emerging microbes in 2023. Viral evolutionary analysis was completed. We retrospectively detected serum antibody level for various respiratory pathogens from 4324 adults without respiratory infections over 7 years to observe its dynamic curves. Findings SARS-CoV-2 and influenza A were the main pathogens during outbreaks in 2023, bacterial-virus and bacterial-bacterial co-infections were most detected, but community co-infections didn't significantly increase pneumonia incidence. Different SARS-CoV-2 and influenza variants were present in different outbreaks, and no novel pathogens were found. The epidemiological patterns of influenza A, COVID-19 and etc. were altered, exhibiting characteristics of being "staggered" compared to most global regions, and potentially led to "overlapping prevalence". Binding antibody testing showed regular fluctuation, without significant decrease against common respiratory pathogens in adults. Influenza A antibody stimulation was attenuated during the 2023 outbreak. Conclusions "Misaligned" alteration in seasonal respiratory disease patterns possibly caused combined epidemics, leading to cases spike in China, 2023. In adults, antibody levels didn't show significant decline, but reduced immune response to influenza during 2020-2023 emphasizes the need for consistent vaccination during pandemics.
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Affiliation(s)
- Jingwen Ai
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
- Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China
| | - Hongyu Wang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
| | - Haocheng Zhang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
- Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China
| | - Jieyu Song
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
| | - Yi Zhang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
| | - Ke Lin
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
| | - Lihong Qu
- Department of Infectious Disease, Shanghai East Hospital, Tongji University School of Medicine, No. 150, Jimo Road, Pudong New Area, Shanghai, China
| | - Yanliang Zhang
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, No. 157, Daming Road, Qinhuai District, Nanjing, China
- Nanjing Research Center for Infectious Diseases of Integrated Traditional Chinese and Western Medicine, Nanjing, China
| | - Shiliang Zhang
- The Fifth People's Hospital of Wuxi, No. 1215, Guangrui Road, Liangxi District, Wuxi, Jiangsu, China
| | - Qiyun Xiang
- The Third People's Hospital of Yichang City, No. 23, Gangyao Road, Xiling District, Yichang, Hubei, China
| | - Jiawei Geng
- Department of Infectious Diseases, The First People's Hospital of Yunnan Province, No. 157, Jinbi Road, Xishan District, Kunming, China
| | - Guangxia Jin
- Jining City Public Health Medical Center, No. 66, Chenyang Road, Rencheng District, Jining, Shandong, China
| | - Wei Song
- Department of General Practice, Jinyang Community Health Service Center, No. 121, Jin Yang Road, Pudong New Area, Shanghai, China
| | - Liaoyun Zhang
- Department of Infectious Diseases, The First Hospital of Shanxi Medical University, No. 85, Jiefang South Road, Taiyuan, China
| | - Xiaoli Hu
- Department of Infectious Disease, Heilongjiang Province Hospital, No. 82, Zhongshan Road, Xiangfang District, Harbin, Heilongjiang, China
| | - Hongyan Liu
- Liaoning Emergency Treatment and Innovation Center of Public Health Emergencies, The Sixth People's Hospital of Shenyang, No. 85, South Heping Street, Heping District, Shenyang, Liaoning, China
| | - Guanmin Yuan
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
| | - Ning Jiang
- School of Life Sciences Fudan University, No. 2005 Songhu Road, Yangpu District, Shanghai, China
| | - Yang Zhou
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
- Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China
| | - Yuanyuan Xu
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
- Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China
| | - Jun Ying
- Fudan University Library, No. 220, Handan Road, Yangpu District, Shanghai, China
| | - Jiqin Wu
- Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China
| | - Yajiao Xing
- Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China
| | - Kai Fang
- Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China
| | - Hui Yan
- Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China
| | - Feiying Chen
- Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China
| | - Tailin Xu
- Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China
| | - Sen Wang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
- Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China
| | - Zhaohui Qian
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wenhong Zhang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
- Shanghai Sci-Tech InnoCenter for Infection and Immunity, Room 201, No. 6, Lane 1220, Huashan Road, Changning District, Shanghai, China
- Institute of Infection and Health, Fudan University, Shanghai, China
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4
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Zhao N, Ren H, Zhang Y, Jiang Y, Deng J, Jiang L, Lu Z, Qin T. Enhancing pathogen description and antibiotic regimen selection in community-acquired pneumonia through RT-qPCR assays. Front Microbiol 2024; 15:1409065. [PMID: 38919501 PMCID: PMC11196416 DOI: 10.3389/fmicb.2024.1409065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Background Adults with community-acquired pneumonia (CAP) in China suffer high morbidity. CAP is caused by a multitude of pathogens; however, pathogen-directed clinical symptoms are often lacking. Therefore, patients lacking an accurate microbiological diagnosis are administered with empirical antimicrobials. Methods We collected bronchoalveolar lavage fluid, as well as clinical and laboratory data from 650 adult patients with CAP admitted to three hospitals in Hubei, Sichuan, and Zhejiang provinces in China. Specimens were cultured and tested using real-time reverse transcription qPCR (RT-qPCR) assays for the presence of 42 respiratory bacteria and viruses. CAP was investigated with respect to regions, genders, and age and patterns of infections or co-infections. Employing clinical guidelines adapted for diagnosis, we assessed retrospectively the appropriate pathogen-directed therapy and compared it with the initial empirical therapies. Results Our study identified that 21.38% (139/650) of the patients were classified as having Severe CAP (S-CAP), with a higher prevalence among males, older adults, and during the warm season. Bacterial pathogens were detected in 35.53% (231/650) of cases. K. pneumoniae, H. influenzae, and S. aureus were the most prevalent bacteria across different demographics and regions. Viral pathogens were found in 48.76% (317/650) of patients Epstein-Barr, Human rhinovirus, and Cytomegalovirus were the most common viruses. Co-infections were present in 24.31% (158/650) of cases, with viral-bacterial co-infections being the most frequent. The RT-qPCR demonstrated significantly higher detection rates for key pathogens compared to standard culture methods. It showed potential in optimizing antimicrobial prescriptions by allowing for de-escalation in 18.30% (95/518) of patients, among which reducing the number of excessive antibiotics mainly comprised decreasing the use of 2nd or 3rd generation cephalosporins (5.79%, 30/518) and β-lactamase inhibitor combinations. Conclusion The study highlights the significant burden of S-CAP, particularly among specific demographics and seasons. The prevalence of bacterial and viral pathogens, along with the high rate of co-infections, emphasizes the need for comprehensive diagnostic approaches. The RT-qPCR assays emerge as a superior diagnostic tool, offering enhanced pathogen detection capabilities and facilitating more precise antimicrobial therapy. This could lead to improved patient outcomes and contribute to the rational use of antimicrobials, addressing the growing concern of antibiotic resistance.
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Affiliation(s)
- Na Zhao
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hongyu Ren
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yingmiao Zhang
- The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Jiang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianping Deng
- Center for Disease Control and Prevention, Zigong, China
| | - Luxi Jiang
- Department of Respiratory Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Zhongxin Lu
- The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tian Qin
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Kato H, Kawaguchi Y, Saito K, Hamamoto S, Nakamura R, Ohashi K, Kondo S, Nakamura A, Morita A. Differences in the clinical presentation of necrotizing fasciitis depending on the causative pathogen. J Dermatol 2024. [PMID: 38863214 DOI: 10.1111/1346-8138.17325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/15/2024] [Accepted: 05/26/2024] [Indexed: 06/13/2024]
Abstract
Necrotizing fasciitis is a fatal, soft tissue infection of the skin that requires prompt treatment. Historically, most cases have been attributed to group A beta-hemolytic Streptococcus infection. However, in recent years, other bacteria have been identified as causing necrotizing fasciitis. In the current study, we analyzed cases of necrotizing fasciitis and examined the significant differences in symptoms caused by pathogenic bacteria. We included 79 patients (43 males and 36 females, mean age 65.4 years) diagnosed with necrotizing fasciitis who visited our hospital between April 2004 and July 2023. The patients were classified into five groups based on the identified pathogen: group A beta-hemolytic Streptococcus; group B beta-hemolytic streptococcus; group G beta-hemolytic Streptococcus; mixed infection, including anaerobic bacteria; and Staphylococcus (S) aureus. The clinical characteristics of patients, including treatment duration and laboratory values, were analyzed. Group G beta-hemolytic Streptococcus was more common in older patients (Bonferroni method, p < 0.05). Patients with S. aureus tended to be hyperglycemic (Bonferroni method, p < 0.05), had a higher rate of bacteremia (Fisher's direct probability test, p < 0.05), and had a longer treatment duration than the other examined groups (Bonferroni method, p = 0.0132). Although the five groups did not differ in the mortality rate, overall survival was shorter in the mixed infection group than in the other groups (log-rank test, p < 0.05). The legs were the most common site of infection in the non-mixed infection group; in the mixed infection group, the pubic area was identified as the most common site of infection, accompanied by a poor prognosis. Collectively, these findings suggest that necrotizing fasciitis can be characterized by pathogenic bacteria and that these characteristics may inversely predict the pathogen of origin.
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Affiliation(s)
- Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yohei Kawaguchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kenta Saito
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuzo Hamamoto
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryota Nakamura
- Department of Plastic and Reconstructive Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuki Ohashi
- Division of Infection Prevention & Control, Nagoya City University Hospital, Nagoya, Japan
| | - Shuhei Kondo
- Division of Infection Prevention & Control, Nagoya City University Hospital, Nagoya, Japan
| | - Atsushi Nakamura
- Division of Infection Prevention & Control, Nagoya City University Hospital, Nagoya, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Ai L, Fang L, Liu B, Zhou C, Gong F. Impact of the COVID-19 pandemic on Haemophilus influenzae infections in pediatric patients hospitalized with community acquired pneumonia. Sci Rep 2024; 14:12737. [PMID: 38830922 PMCID: PMC11148099 DOI: 10.1038/s41598-024-62728-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
The COVID-19 pandemic has altered the infection landscape for many pathogens. This retrospective study aimed to compare Haemophilus influenzae (H. influenzae) infections in pediatric CAP patients hospitalized before (2018-2019) and during (2020-2022) the COVID-19 pandemic. We analyzed the clinical epidemiology and antimicrobial resistance (AMR) patterns of H. influenzae from a tertiary hospital in southwest China. A total of 986 pediatric CAP patients with H. influenzae-associated infections were included. Compared to 2018, the positivity rate increased in 2019 but dropped significantly in 2020. Although it rose in the following 2 years, the rate in 2022 remained significantly lower than in 2019. Patients' age during the pandemic was significantly higher than in 2018 and 2019, while gender composition remained similar across both periods. Notably, there were significant changes in co-infections with several respiratory pathogens during the pandemic. Resistance rates of H. influenzae isolates to antibiotics varied, with the highest resistance observed for ampicillin (85.9%) and the lowest for cefotaxime (0.0%). Resistance profiles to various antibiotics underwent dramatic changes during the COVID-19 pandemic. Resistance to amoxicillin-clavulanate, cefaclor, cefuroxime, trimethoprim-sulfamethoxazole, and the proportion of multi-drug resistant (MDR) isolates significantly decreased. Additionally, MDR isolates, alongside isolates resistant to specific drugs, were notably prevalent in ampicillin-resistant and β-lactamase-positive isolates. The number of pediatric CAP patients, H. influenzae infections, and isolates resistant to certain antibiotics exhibited seasonal patterns, peaking in the winter of 2018 and 2019. During the COVID-19 pandemic, sharp decreases were observed in February 2020, and there was no resurgence in December 2022. These findings indicate that the COVID-19 pandemic has significantly altered the infection spectrum of H. influenzae in pediatric CAP patients, as evidenced by shifts in positivity rate, demographic characteristics, respiratory co-infections, AMR patterns, and seasonal trends.
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Affiliation(s)
- Ling Ai
- Department of General Practice, Yongchuan Hospital of Chongqing Medical University, No. 439, Xuanhua Street, Chongqing, 402160, China
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Liang Fang
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Beizhong Liu
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Department of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Chanjuan Zhou
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Fang Gong
- Department of General Practice, Yongchuan Hospital of Chongqing Medical University, No. 439, Xuanhua Street, Chongqing, 402160, China.
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China.
- Department of Pediatrics, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China.
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Cheng D, Tian R, Pan T, Yu Q, Wei L, Liyin J, Dai Y, Wang X, Tan R, Qu H, Lu M. High-performance lung-targeted bio-responsive platform for severe colistin-resistant bacterial pneumonia therapy. Bioact Mater 2024; 35:517-533. [PMID: 38404643 PMCID: PMC10885821 DOI: 10.1016/j.bioactmat.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/27/2024] Open
Abstract
Polymyxins are the last line of defense against multidrug-resistant (MDR) Gram-negative bacterial infections. However, this last resort has been threatened by the emergence of superbugs carrying the mobile colistin resistance gene-1 (mcr-1). Given the high concentration of matrix metalloproteinase 3 (MMP-3) in bacterial pneumonia, limited plasma accumulation of colistin (CST) in the lung, and potential toxicity of ionic silver (Ag+), we designed a feasible clinical transformation platform, an MMP-3 high-performance lung-targeted bio-responsive delivery system, which we named "CST&Ag@CNMS". This system exhibited excellent lung-targeting ability (>80% in lungs), MMP-3 bio-responsive release property (95% release on demand), and synergistic bactericidal activity in vitro (2-4-fold minimum inhibitory concentration reduction). In the mcr-1+ CST-resistant murine pneumonia model, treatment with CST&Ag@CNMS improved survival rates (70% vs. 20%), reduced bacteria burden (2-3 log colony-forming unit [CFU]/g tissue), and considerably mitigated inflammatory response. In this study, CST&Ag@CNMS performed better than the combination of free CST and AgNO3. We also demonstrated the superior biosafety and biodegradability of CST&Ag@CNMS both in vitro and in vivo. These findings indicate the clinical translational potential of CST&Ag@CNMS for the treatment of lung infections caused by CST-resistant bacteria carrying mcr-1.
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Affiliation(s)
- Decui Cheng
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Rui Tian
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Tingting Pan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Qiang Yu
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Li Wei
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jiaozhi Liyin
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Yunqi Dai
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Xiaoli Wang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Ruoming Tan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Min Lu
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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8
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Cilloniz C, Torres A. Diabetes Mellitus and Pneumococcal Pneumonia. Diagnostics (Basel) 2024; 14:859. [PMID: 38667504 PMCID: PMC11049506 DOI: 10.3390/diagnostics14080859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Currently, there are more than 500 million people suffering from diabetes around the world. People aged 65 years or older are the most affected by this disease, and it is estimated that approximately 96% of diabetes cases worldwide are type 2 diabetes. People with diabetes mellitus are at an increased risk of infections such as pneumonia, due to a series of factors that may contribute to immune dysfunction, including hyperglycemia, inhibition of neutrophil chemotaxis, impaired cytokine production, phagocytic cell dysfunction, altered T cell-mediated immune responses and the co-existence of chronic comorbidities. Rates of infection, hospitalization and mortality in diabetic patients are reported to be higher than in the general population. Research into the risk of infectious diseases such as pneumonia in these patients is very important because it will help improve their management and treatment.
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Affiliation(s)
- Catia Cilloniz
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Faculty of Health Sciences, Continental University, Huancayo 12001, Peru
| | - Antoni Torres
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Pulmonary Department, Hospital Clinic of Barcelona, C/Villarroel 170, 08036 Barcelona, Spain
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9
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Chen J, Wang Q, Zhong B, Zheng H, Wang D, Huang X, Liu L, Liu T. Activation of the RIG-I/MAVS Signaling Pathway during Human Adenovirus Type 3 Infection Impairs the Pro-Inflammatory Response Induced by Secondary Infection with Staphylococcus aureus. Int J Mol Sci 2024; 25:4178. [PMID: 38673764 PMCID: PMC11049948 DOI: 10.3390/ijms25084178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/25/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024] Open
Abstract
The exacerbation of pneumonia in children with human adenovirus type 3 (HAdV-3E) is secondary to a Staphylococcus aureus (S. aureus) infection. The influence of host-pathogen interactions on disease progression remains unclear. It is important to note that S. aureus infections following an HAdV-3E infection are frequently observed in clinical settings, yet the underlying susceptibility mechanisms are not fully understood. This study utilized an A549 cell model to investigate secondary infection with S. aureus following an HAdV-3E infection. The findings suggest that HAdV-3E exacerbates the S. aureus infection by intensifying lung epithelial cell damage. The results highlight the role of HAdV-3E in enhancing the interferon signaling pathway through RIG-I (DDX58), resulting in the increased expression of interferon-stimulating factors like MX1, RSAD2, and USP18. The increase in interferon-stimulating factors inhibits the NF-κB and MAPK/P38 pro-inflammatory signaling pathways. These findings reveal new mechanisms of action for HAdV-3E and S. aureus in secondary infections, enhancing our comprehension of pathogenesis.
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Affiliation(s)
| | | | | | | | | | | | - Li Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China; (J.C.); (Q.W.); (B.Z.); (H.Z.); (D.W.); (X.H.)
| | - Tiantian Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China; (J.C.); (Q.W.); (B.Z.); (H.Z.); (D.W.); (X.H.)
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10
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Pickens CI, Gao CA, Morales-Nebreda L, Wunderink RG. Microbiology of Severe Community-Acquired Pneumonia and the Role of Rapid Molecular Techniques. Semin Respir Crit Care Med 2024; 45:158-168. [PMID: 38196061 DOI: 10.1055/s-0043-1777770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
The microbiology of severe community acquired pneumonia (SCAP) has implications on management, clinical outcomes and public health policy. Therefore, knowledge of the etiologies of SCAP and methods to identify these microorganisms is key. Bacteria including Streptococcus pneumoniae, Staphylococcus aureus and Enterobacteriaceae continue to be important causes of SCAP. Viruses remain the most commonly identified etiology of SCAP. Atypical organisms are also important etiologies of SCAP and are critical to identify for public health. With the increased number of immunocompromised individuals, less common pathogens may also be found as the causative agent of SCAP. Traditional diagnostic tests, including semi-quantitative respiratory cultures, blood cultures and urinary antigens continue to hold an important role in the evaluation of patients with SCAP. Many of the limitations of the aforementioned tests are addressed by rapid, molecular diagnostic tests. Molecular diagnostics utilize culture-independent technology to identify species-specific genetic sequences. These tests are often semi-automated and provide results within hours, which provides an opportunity for expedient antibiotic stewardship. The existing literature suggests molecular diagnostic techniques may improve antibiotic stewardship in CAP, and future research should investigate optimal methods for implementation of these assays into clinical practice.
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Affiliation(s)
- Chiagozie I Pickens
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Catherine A Gao
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Luisa Morales-Nebreda
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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11
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Bekdas M, Saygi B, Kilinc YB, Kilinc E. Plasma levels of neurogenic inflammation related neuropeptides in pediatric patients with community-acquired pneumonia and their potential diagnostic value in distinguishing viral and bacterial pneumonia. Eur J Pediatr 2024; 183:1619-1627. [PMID: 38183438 PMCID: PMC11001734 DOI: 10.1007/s00431-023-05417-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/16/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Abstract
Neurogenic inflammation is involved in the development and progression of respiratory inflammatory diseases. However, its role in community-acquired pneumonia (CAP) remains unclear. We therefore aimed to investigate plasma levels of neurogenic inflammation-related neuropeptides, calcitonin gene-related peptide (CGRP), substance P (SP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY), and procalcitonin (PCT) in pediatric patients with CAP and to assess their diagnostic value in viral and bacterial/mixed pneumonia. A total of 124 pediatric patients with CAP (1 month-18 years old) and 56 healthy children of similar ages were prospectively enrolled. The patients were classified as viral (n = 99) and bacterial/mixed (n = 25) pneumonia. Plasma levels of the peptides were quantified by ELISA. ROC analysis was performed to evaluate possible diagnostic value of the peptides. While plasma levels of CGRP, VIP and PCT were significantly higher in patients with CAP than in the control group, respectively, NPY levels were significantly lower. Moreover, plasma levels of all neuropeptides and PCT were significantly higher in bacterial pneumonia patients compared to viral pneumonia patients. ROC analysis revealed that CGRP, SP and NPY had a diagnostic value in distinguishing viral and bacterial/mixed pneumonia. CONCLUSIONS Our findings suggest that these neuropeptides may be implicated in pediatric CAP. CGRP, SP and NPY together may be a promising candidate in distinguishing viral and bacterial/mixed pneumonia, however, for this, further studies are needed. WHAT IS KNOWN • Neurogenic inflammation contributes to the development and progression of respiratory inflammatory diseases such as chronic obstructive pulmonary disease and bronchial asthma. WHAT IS NEW • Plasma levels of neurogenic inflammation related neuropeptides calcitonin gene-related peptide, substance P, vasoactive intestinal peptide and neuropeptide Y are changed in pediatric community-acquired pneumonia. Calcitonin gene-related peptide, substance P and neuropeptide Y are promising candidates in distinguishing viral and bacterial/mixed pneumonia.
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Affiliation(s)
- Mervan Bekdas
- Department of Pediatrics, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Bilgi Saygi
- Department of Pediatrics, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | | | - Erkan Kilinc
- Department of Physiology, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey.
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12
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Feng Y, Zhang H, Zhang B, Zhou Y, Yuan H. Impact of normalized COVID-19 prevention and control measures on lower respiratory tract infection pathogenesis in hospitalized children. Front Public Health 2024; 12:1367614. [PMID: 38476493 PMCID: PMC10927715 DOI: 10.3389/fpubh.2024.1367614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Objective This study aimed to investigate the epidemiological characteristics of common pathogens contributing to childhood lower respiratory tract infections (LRTIs) in Xiangtan City, Hunan Province before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods A total of 11,891 enrolled patients, aged 1 month to 14 years, diagnosed with LRTIs and admitted to Xiangtan Central Hospital from January 2018 to December 2021 were retrospectively reviewed in this study. Specifically, the epidemiological characteristics of these pathogens before and during the COVID-19 pandemic were analyzed. Results There was a significant decrease in the number of children hospitalized with LRTIs during the COVID-19 pandemic (2020-2021) compared to data from 2018 to 2019 (before the COVID-19 pandemic). Of these cases, 60.01% (7,136/11,891) were male and 39.99% (4,755/11,891) were female. 78.9% (9,381/11,891) cases occurred in children under 4 years of age. The average pathogen detection rate among 11,891 hospitalized LRTIs children was 62.19% (7,395/11,891), with the average pathogen detection rate of 60.33% (4,635/7,682) and 65.57% (2,670/4,209) before and during COVID-19 pandemic, respectively. The detection rates of adenovirus (ADV), bordetella pertussis (BP) and moraxella catarrhalis (M. catarrhalis) decreased dramatically, while the detection rates of influenza viruses (IFV), parainfluenza viruses (PIV), respiratory syncytial virus (RSV), haemophilus influenzae (H. influenzae), streptococcus pneumoniae (S. pneumoniae), and staphylococcus aureus (S. aureus) increased significantly during the COVID-19 pandemic. Overall, RSV, mycoplasma pneumoniae (MP), H. influenzae, and IFV were the major pathogens causing LRTIs in hospitalized children before and during the COVID-19 pandemic. Conclusion Public health interventions for COVID-19 prevention are beneficial to reduce the incidence of LRTIs in children by limiting the prevalence of ADV, MP, BP, and M. catarrhalis, but which have limited restrictive effects on other common LRTIs-associated pathogens. Collectively, the data in this study comprehensively investigated the effects of COVID-19 pandemic on the epidemiological characteristics of respiratory pathogens, which will be beneficial for improving early preventive measures.
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Affiliation(s)
- Yuan Feng
- Department of Pediatrics, Xiangtan Central Hospital, Xiangtan, China
| | - Huaixiao Zhang
- Department of Pediatrics, Xiangtan Central Hospital, Xiangtan, China
| | - Bo Zhang
- Department of Pediatrics, Xiangtan Central Hospital, Xiangtan, China
| | - Yinfei Zhou
- Department of Pediatrics, Xiangtan Central Hospital, Xiangtan, China
| | - Haibin Yuan
- Department of Pediatrics, Xiangtan Central Hospital, Xiangtan, China
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13
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Godoy P, Soldevila N, Martínez A, Godoy S, Jané M, Torner N, Acosta L, Rius C, Domínguez À. Effectiveness of Influenza Vaccination and Early Antiviral Treatment in Reducing Pneumonia Risk in Severe Influenza Cases. Vaccines (Basel) 2024; 12:173. [PMID: 38400156 PMCID: PMC10891622 DOI: 10.3390/vaccines12020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Influenza vaccination may be effective in preventing influenza infection and may reduce the risk of influenza-associated pneumonia. The study aim was to evaluate the effect of influenza vaccination in preventing pneumonia when it failed to prevent influenza hospitalization. METHODS This was a case-control study comparing hospitalized cases of influenza with and without pneumonia in patients aged ≥18 years in 16 hospitals in Catalonia over 10 influenza seasons (2010-11 to 2019-20). Data on sociodemographic, virological characteristics, comorbidities, vaccination history, and antiviral treatment were collected and analysed. The crude odds ratio (OR) and adjusted OR (aOR) with the corresponding 95% confidence interval (CI) values were calculated. RESULTS In total, 5080 patients hospitalized for severe influenza were included, 63.5% (3224/5080) of whom had pneumonia-mostly men (56.8%; 1830/3224) and mostly in the ≥75 age group (39.3%; 1267/3224)-and of whom 14.0% died (451/3224). Virus A and virus B accounted for 78.1% (2518/3224) and 21.9% (705/3224) of influenza types, respectively. Starting antiviral treatment ≤48 h after symptom onset (aOR = 0.69; 95%CI: 0.53-0.90) and a history of seasonal influenza vaccination (aOR = 0.85; 95%CI: 0.72-0.98) were protective factors in developing pneumonia. CONCLUSIONS Adherence to seasonal influenza vaccination and starting antiviral treatment within 48 h of symptom onset can reduce pneumonia risk in severe influenza cases.
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Affiliation(s)
- Pere Godoy
- Institut de Recerca Biomédica de Lleida (IRBLleida), Universitat de Lleida, 25006 Lleida, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (N.S.); (A.M.); (M.J.); (N.T.); (C.R.); (À.D.)
| | - Núria Soldevila
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (N.S.); (A.M.); (M.J.); (N.T.); (C.R.); (À.D.)
- Departament de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Ana Martínez
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (N.S.); (A.M.); (M.J.); (N.T.); (C.R.); (À.D.)
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain
| | - Sofia Godoy
- Institut de Recerca Biomédica de Lleida (IRBLleida), Universitat de Lleida, 25006 Lleida, Spain;
- Institut Català de la Salut, 08007 Lleida, Spain
| | - Mireia Jané
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (N.S.); (A.M.); (M.J.); (N.T.); (C.R.); (À.D.)
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain
| | - Nuria Torner
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (N.S.); (A.M.); (M.J.); (N.T.); (C.R.); (À.D.)
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain
| | - Lesly Acosta
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain
| | - Cristina Rius
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (N.S.); (A.M.); (M.J.); (N.T.); (C.R.); (À.D.)
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | - Àngela Domínguez
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (N.S.); (A.M.); (M.J.); (N.T.); (C.R.); (À.D.)
- Departament de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain
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14
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Chang H, Li M, Wang Y, Cui L, Li T. Acute Effects of Low Temperatures and Cold Waves on Elderly Infectious Pneumonia Mortality - Jinan City, Shandong Province, China, 2014-2022. China CDC Wkly 2024; 6:77-82. [PMID: 38410531 PMCID: PMC10894711 DOI: 10.46234/ccdcw2024.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/17/2024] [Indexed: 02/28/2024] Open
Abstract
What is already known about this topic? The mortality rate due to pneumonia varies depending on the infectious agents present in a low- temperature environment. What is added by this report? This study aimed to examine the relationship between low temperatures and cold waves and the risk of mortality from infectious pneumonia in the elderly. The findings indicate a significant increase in the risk of infectious pneumonia, specifically bacterial pneumonia, during periods of low temperatures and cold waves. What are the implications for public health practice? This study presents compelling evidence that highlights the importance of proactive public responses to infectious pneumonia among the elderly population during periods of cold waves.
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Affiliation(s)
- Huiyun Chang
- Jinan Municipal Center for Disease Control and Prevention, Jinan Municipal Center for Disease Control and Prevention Affiliated to Shandong University, Jinan City, Shandong Province, China
- Chinese Filed Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mingjun Li
- Jinan Municipal Center for Disease Control and Prevention, Jinan Municipal Center for Disease Control and Prevention Affiliated to Shandong University, Jinan City, Shandong Province, China
| | - Ying Wang
- Jinan Municipal Center for Disease Control and Prevention, Jinan Municipal Center for Disease Control and Prevention Affiliated to Shandong University, Jinan City, Shandong Province, China
| | - Liangliang Cui
- Jinan Municipal Center for Disease Control and Prevention, Jinan Municipal Center for Disease Control and Prevention Affiliated to Shandong University, Jinan City, Shandong Province, China
| | - Tiantian Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
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15
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Xie N, Lin Y, Li P, Zhao J, Li J, Wang K, Yang L, Jia L, Wang Q, Li P, Song H. Simultaneous identification of DNA and RNA pathogens using metagenomic sequencing in cases of severe acute respiratory infection. J Med Virol 2024; 96:e29406. [PMID: 38373115 DOI: 10.1002/jmv.29406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/21/2024]
Abstract
Metagenomic next-generation sequencing (mNGS) is a valuable technique for identifying pathogens. However, conventional mNGS requires the separate processing of DNA and RNA genomes, which can be resource- and time-intensive. To mitigate these impediments, we propose a novel method called DNA/RNA cosequencing that aims to enhance the efficiency of pathogen detection. DNA/RNA cosequencing uses reverse transcription of total nucleic acids extracted from samples by using random primers, without removing DNA, and then employs mNGS. We applied this method to 85 cases of severe acute respiratory infections (SARI). Influenza virus was identified in 13 cases (H1N1: seven cases, H3N2: three cases, unclassified influenza type: three cases) and was not detected in the remaining 72 samples. Bacteria were present in all samples. Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii were detected in four influenza-positive samples, suggesting coinfections. The sensitivity and specificity for detecting influenza A virus were 73.33% and 95.92%, respectively. A κ value of 0.726 indicated a high level of concordance between the results of DNA/RNA cosequencing and SARI influenza virus monitoring. DNA/RNA cosequencing enhanced the efficiency of pathogen detection, providing a novel capability to strengthen surveillance and thereby prevent and control infectious disease outbreaks.
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Affiliation(s)
- Nana Xie
- AnHui Medical University, Hefei, China
- Chinese PLA Center for Disease Control and Prevention of PLA, Beijing, China
| | - Yanfeng Lin
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China
| | - Peihan Li
- Chinese PLA Center for Disease Control and Prevention of PLA, Beijing, China
| | - Jiachen Zhao
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Jinhui Li
- Chinese PLA Center for Disease Control and Prevention of PLA, Beijing, China
| | - Kaiying Wang
- Chinese PLA Center for Disease Control and Prevention of PLA, Beijing, China
| | - Lang Yang
- Chinese PLA Center for Disease Control and Prevention of PLA, Beijing, China
| | - Leili Jia
- Chinese PLA Center for Disease Control and Prevention of PLA, Beijing, China
| | - Quanyi Wang
- Beijing Center for Disease Prevention and Control, Beijing, China
- Beijing Research Center for Respiratory Infectious Diseases, Beijing, China
| | - Peng Li
- AnHui Medical University, Hefei, China
- Chinese PLA Center for Disease Control and Prevention of PLA, Beijing, China
| | - Hongbin Song
- AnHui Medical University, Hefei, China
- Chinese PLA Center for Disease Control and Prevention of PLA, Beijing, China
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16
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Zhang XL, Zhang X, Hua W, Xie ZD, Liu HM, Zhang HL, Chen BQ, Chen Y, Sun X, Xu Y, Shu SN, Zhao SY, Shang YX, Cao L, Jia YH, Lin LN, Li J, Hao CL, Dong XY, Lin DJ, Xu HM, Zhao DY, Zeng M, Chen ZM, Huang LS. Expert consensus on the diagnosis, treatment, and prevention of respiratory syncytial virus infections in children. World J Pediatr 2024; 20:11-25. [PMID: 38064012 PMCID: PMC10828005 DOI: 10.1007/s12519-023-00777-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/26/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the leading global cause of respiratory infections and is responsible for about 3 million hospitalizations and more than 100,000 deaths annually in children younger than 5 years, representing a major global healthcare burden. There is a great unmet need for new agents and universal strategies to prevent RSV infections in early life. A multidisciplinary consensus development group comprising experts in epidemiology, infectious diseases, respiratory medicine, and methodology aims to develop the current consensus to address clinical issues of RSV infections in children. DATA SOURCES The evidence searches and reviews were conducted using electronic databases, including PubMed, Embase, Web of Science, and the Cochrane Library, using variations in terms for "respiratory syncytial virus", "RSV", "lower respiratory tract infection", "bronchiolitis", "acute", "viral pneumonia", "neonatal", "infant" "children", and "pediatric". RESULTS Evidence-based recommendations regarding diagnosis, treatment, and prevention were proposed with a high degree of consensus. Although supportive care remains the cornerstone for the management of RSV infections, new monoclonal antibodies, vaccines, drug therapies, and viral surveillance techniques are being rolled out. CONCLUSIONS This consensus, based on international and national scientific evidence, reinforces the current recommendations and integrates the recent advances for optimal care and prevention of RSV infections. Further improvements in the management of RSV infections will require generating the highest quality of evidence through rigorously designed studies that possess little bias and sufficient capacity to identify clinically meaningful end points.
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Affiliation(s)
- Xian-Li Zhang
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China
| | - Xi Zhang
- Clinical Research Unit, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wang Hua
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China
| | - Zheng-De Xie
- Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Han-Min Liu
- Department of Pediatric Pulmonology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hai-Lin Zhang
- Department of Pediatric Pulmonology, the Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bi-Quan Chen
- Department of Infectious Disease, Anhui Provincial Children's Hospital, Hefei, China
| | - Yuan Chen
- Department of Pediatrics, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xin Sun
- Department of Pediatrics, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Yi Xu
- Department of Infectious Disease, Guangzhou Women and Children's Medicine Center, Guangzhou Medicine University, Guangzhou, China
| | - Sai-Nan Shu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shun-Ying Zhao
- Department of Respiratory Disease, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yun-Xiao Shang
- Department of Pediatric Respiratory, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Cao
- Respiratory Department, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yan-Hui Jia
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China
| | - Luo-Na Lin
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Chuang-Li Hao
- Department of Respirology, Children's Hospital of Soochow University, Suzhou, China
| | - Xiao-Yan Dong
- Department of Respiratory, Children's Hospital of Shanghai, Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dao-Jiong Lin
- Department of Infectious Disease, Hainan Women and Children's Medical Center, Haikou, China
| | - Hong-Mei Xu
- Department of Infectious Disease, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - De-Yu Zhao
- Department of Respiratory, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China.
| | - Zhi-Min Chen
- Department of Respiratory Diseases, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China.
| | - Li-Su Huang
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Binjiang District, Hangzhou, 310052, China.
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Di Pilato V, Pollini S, Miriagou V, Rossolini GM, D'Andrea MM. Carbapenem-resistant Klebsiella pneumoniae: the role of plasmids in emergence, dissemination, and evolution of a major clinical challenge. Expert Rev Anti Infect Ther 2024; 22:25-43. [PMID: 38236906 DOI: 10.1080/14787210.2024.2305854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/11/2024] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Klebsiella pneumoniae is a major agent of healthcare-associated infections and a cause of some community-acquired infections, including severe bacteremic infections associated with metastatic abscesses in liver and other organs. Clinical relevance is compounded by its outstanding propensity to evolve antibiotic resistance. In particular, the emergence and dissemination of carbapenem resistance in K. pneumoniae has posed a major challenge due to the few residual treatment options, which have only recently been expanded by some new agents. The epidemiological success of carbapenem-resistant K. pneumoniae (CR-Kp) is mainly linked with clonal lineages that produce carbapenem-hydrolyzing enzymes (carbapenemases) encoded by plasmids. AREAS COVERED Here, we provide an updated overview on the mechanisms underlying the emergence and dissemination of CR-Kp, focusing on the role that plasmids have played in this phenomenon and in the co-evolution of resistance and virulence in K. pneumoniae. EXPERT OPINION CR-Kp have disseminated on a global scale, representing one of the most important contemporary public health issues. These strains are almost invariably associated with complex multi-drug resistance (MDR) phenotypes, which can also include recently approved antibiotics. The heterogeneity of the molecular bases responsible for these phenotypes poses significant hurdles for therapeutic and diagnostic purposes.
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Affiliation(s)
- Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Simona Pollini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Vivi Miriagou
- Laboratory of Bacteriology, Hellenic Pasteur Institute, Athens, Greece
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
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18
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Zhang XB, He W, Gui YH, Lu Q, Yin Y, Zhang JH, Dong XY, Wang YW, Ye YZ, Xu H, Wang JY, Shen B, Gu DP, Wang LB, Wang Y. Current Mycoplasma pneumoniae epidemic among children in Shanghai: unusual pneumonia caused by usual pathogen. World J Pediatr 2024; 20:5-10. [PMID: 38231466 DOI: 10.1007/s12519-023-00793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/21/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Xiao-Bo Zhang
- Department of Respiratory Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Wen He
- Department of Respiratory Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Yong-Hao Gui
- State Key Laboratory of Genetic Engineering at School of Life Sciences, Institute of Reproduction & Development, Children's Hospital of Fudan University, Shanghai, China
| | - Quan Lu
- Department of Respiratory Medicine, Children's Hospital of Shanghai Jiao Tong University, Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian-Hua Zhang
- Department of Pediatric Respiratory, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiao-Yan Dong
- Department of Respiratory Medicine, Children's Hospital of Shanghai Jiao Tong University, Shanghai, China
| | - Ying-Wen Wang
- Department of Nursing, Children's Hospital of Fudan University, Shanghai, China
| | - Ying-Zi Ye
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Jia-Yu Wang
- NHC Key Laboratory of Neonatal Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Bing Shen
- Shanghai Shenkang Hospital Development Center, Shanghai, China
| | - Dan-Ping Gu
- Center for Medical Quality Control Management of Shanghai, Shanghai, China
| | - Li-Bo Wang
- Department of Respiratory Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
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He Q, Liu Y, Yin P, Gao Y, Kan H, Zhou M, Chen R, Li Y. Differentiating the impacts of ambient temperature on pneumonia mortality of various infectious causes: a nationwide, individual-level, case-crossover study. EBioMedicine 2023; 98:104854. [PMID: 38251462 PMCID: PMC10628343 DOI: 10.1016/j.ebiom.2023.104854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND It remains unknown how ambient temperature impact pneumonia of various infectious causes. METHODS Based on the national death registry covering all counties in Chinese mainland, we conducted an individual-level case-crossover study in China from 2013 to 2019. Exposures were assigned at residential addresses for each decedent. Conditional logistic regression model combined with distributed lag non-linear models were used to estimate the exposure-response associations. The attributable fractions due to non-optimum temperature were calculated after accounting for spatial and temporal patterns for the excess risks. FINDINGS The exposure-response curves were inversely J-shaped with both low and high temperature increasing the risks, and the effect of low temperature was stronger. Extremely low temperature was associated with higher magnitude of influenza-related pneumonia [relative risk (RR): 2.46, 95% confidence interval (CI): 1.62-3.74], than viral pneumonia (RR: 1.89, 95% CI: 1.55-2.30) and bacterial pneumonia (RR: 1.81, 95% CI: 1.56-2.09). The magnitudes of RRs associated with extremely high temperature were similar among the three categories of pneumonia. The mortality attributable fraction for influenza-related pneumonia (29.78%) was the highest. The effects were stronger in people of low education level or residence in the north. INTERPRETATION This nationwide study presents findings on the varied risk and burden of pneumonia mortality of various infectious causes, and highlights the susceptibility of influenza-related pneumonia to ambient low temperature. FUNDING This study is supported by the National Key Research and Development Program (2022YFC3702701), the Shanghai Municipal Science and Technology Commission (21TQ015) and Shanghai International Science and Technology Partnership Project (21230780200).
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Affiliation(s)
- Qinglin He
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Yunning Liu
- National Center for Chronic Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Peng Yin
- National Center for Chronic Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Ya Gao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Maigeng Zhou
- National Center for Chronic Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
| | - Yanming Li
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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20
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Yang Y, Li J, Huang S, Li J, Yang S. Impact of Infection Patterns on the Outcomes of Patients with Hematological Malignancies in Southwest China: A 10-Year Retrospective Case-Control Study. Infect Drug Resist 2023; 16:3659-3669. [PMID: 37313262 PMCID: PMC10259580 DOI: 10.2147/idr.s404927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
Background This study aimed to assess the effect of infection patterns on the outcomes of patients with hematological malignancies (HM) and to identify the determinants of in-hospital mortality. Methods A case-control study was retrospectively conducted in a tertiary teaching hospital in Chongqing, Southwest China from 2011 to 2020. Clinical characteristics, microbial findings, and outcomes of HM patients with infections were retrieved from the hospital information system. Chi-square or Fisher's exact test was adopted to test the significance of mortality rate. Kaplan-Meier survival analysis and Log rank test were applied to evaluate and compare the 30-day survival rates of those groups. Binary logistic regression, Cox proportional hazards regression, and receiver operating characteristic curves were used to investigate the determinants of in-hospital mortality. Results Of 1,570 enrolled participants, 43.63% suffered from acute myeloid leukemia, 69.62% received chemotherapy, and 25.73% had hematopoietic stem cell transplantation (HSCT). Microbial infection was documented in 83.38% of participants. Co-infection and septic shock were reported in 32.87% and 5.67% of participants, respectively. Patients with septic shock suffered a significantly lower 30-day survival rate, while those with distinct types of pathogens or co-infections had a comparable 30-day survival rate. The all-cause in-hospital mortality was 7.01% and higher mortality rate was observed in patients with allo-HSCT (7.20%), co-infection (9.88%), and septic shock (33.71%). Cox proportional hazards regression illustrated that elderly age, septic shock, and elevated procalcitonin (PCT) were independent predictors of in-hospital mortality. A PCT cut-off value of 0.24 ng/mL predicted in-hospital mortality with a sensitivity of 77.45% and a specificity of 59.80% (95% CI = 0.684-0.779, P<0.0001). Conclusion Distinct infectious patterns of HM inpatients were previously unreported in Southwest China. It was the severity of infection, not co-infection, source of infection, or type of causative pathogen that positively related to poor outcome. PCT guided early recognition and treatment of septic shock were advocated.
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Affiliation(s)
- Yali Yang
- Department of Laboratory Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Junjie Li
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Department of Laboratory Medicine, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Shifeng Huang
- Department of Laboratory Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Junnan Li
- Department of Hematology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Shuangshuang Yang
- Department of Laboratory Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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