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Jiang Y, Dou H, Xu B, Xu B, Zhou W, Wang H, Ge L, Hu Y, Han X, Qin X, Li J, Ye L, Wu L, Zuo H, Zhang Q, Liu L, Hu W, Shao J, Yin Q, Han L, Fu X, Dong X, Dong Y, Fu Y, Zhao M, Sun Q, Huo J, Liu D, Liu W, Li Y, Wang Y, Xin D, Shen K. Macrolide resistance of Mycoplasma pneumoniae in several regions of China from 2013 to 2019. Epidemiol Infect 2024; 152:e75. [PMID: 38634450 PMCID: PMC11094376 DOI: 10.1017/s0950268824000323] [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: 08/25/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 04/19/2024] Open
Abstract
This paper retrospectively analysed the prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) in some parts of China. Between January 2013 and December 2019, we collected 4,145 respiratory samples, including pharyngeal swabs and alveolar lavage fluid. The highest PCR-positive rate of M. pneumoniae was 74.5% in Beijing, the highest resistance rate was 100% in Shanghai, and Gansu was the lowest with 20%. The highest PCR-positive rate of M. pneumoniae was 74.5% in 2013, and the highest MRMP was 97.4% in 2019; the PCR-positive rate of M. pneumoniae for adults in Beijing was 17.9% and the MRMP was 10.48%. Among the children diagnosed with community-acquired pneumonia (CAP), the PCR-positive and macrolide-resistant rates of M. pneumoniae were both higher in the severe ones. A2063G in domain V of 23S rRNA was the major macrolide-resistant mutation, accounting for more than 90%. The MIC values of all MRMP to erythromycin and azithromycin were ≥ 64 μg/ml, and the MICs of tetracycline and levofloxacin were ≤ 0.5 μg/ml and ≤ 1 μg/ml, respectively. The macrolide resistance varied in different regions and years. Among inpatients, the macrolide-resistant rate was higher in severe pneumonia. A2063G was the common mutation, and we found no resistance to tetracycline and levofloxacin.
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Affiliation(s)
- Yue Jiang
- Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Haiwei Dou
- Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bo Xu
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Baoping Xu
- Beijing Children’s Hospital, Capital Medical University, China National Clinical Research Center of Respiratory Diseases, National Center for Children’s Health, Beijing, China
| | - Wei Zhou
- Peking University Third Hospital, Beijing, China
| | - Hong Wang
- Civil Aviation General Hospital, Beijing, China
| | - Lixia Ge
- China Meitan General Hospital, Beijing, China
| | - Yinghui Hu
- New Century International hospital for Children, Beijing, China
| | - Xiaohua Han
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Xuanguang Qin
- Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Jing Li
- Beijing Changping District Integrated Traditional Chinese and Western Medicine Hospital, Beijing, China
| | - Leping Ye
- Peking University First Hospital, Beijing, China
| | - Liqun Wu
- Dongfang Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Huimin Zuo
- The First Hospital of Tsinghua University, Beijing, China
| | - Qi Zhang
- China-Japan Friendship Hospital, Beijing, China
| | - Ling Liu
- Peking University Third Hospital, Beijing, China
| | - Wenjuan Hu
- Civil Aviation General Hospital, Beijing, China
| | - Junyan Shao
- China Meitan General Hospital, Beijing, China
| | - Qiaomian Yin
- New Century International hospital for Children, Beijing, China
| | - Lina Han
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoyan Fu
- Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Xiaopei Dong
- Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Yan Dong
- Beijing Changping District Integrated Traditional Chinese and Western Medicine Hospital, Beijing, China
| | - Yulin Fu
- Beijing Changping District Integrated Traditional Chinese and Western Medicine Hospital, Beijing, China
| | | | - Qing Sun
- Peking University First Hospital, Beijing, China
| | - Jingwei Huo
- Dongfang Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Die Liu
- China-Japan Friendship Hospital, Beijing, China
| | - Wenkao Liu
- Beijing Changping District Integrated Traditional Chinese and Western Medicine Hospital, Beijing, China
| | - Yunjuan Li
- New Century International hospital for Children, Beijing, China
| | - Yang Wang
- New Century International hospital for Children, Beijing, China
| | - Deli Xin
- Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kunling Shen
- Beijing Children’s Hospital, Capital Medical University, China National Clinical Research Center of Respiratory Diseases, National Center for Children’s Health, Beijing, China
- Shenzhen Children′s Hospital, Shenzhen, Guangdong Province, China
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Leoni D, Encina B, Rello J. Managing the oncologic patient with suspected pneumonia in the intensive care unit. Expert Rev Anti Infect Ther 2017; 14:943-60. [PMID: 27573637 DOI: 10.1080/14787210.2016.1228453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Solid cancer patients are frequently admitted in intensive care units for critical events. Improving survival rates in this setting is considered an achievable goal today. Respiratory failure is the main reason for admission, representing a primary target for research. AREAS COVERED This review presents a diagnostic and therapeutic algorithm for pneumonia and other severe respiratory events in the solid cancer population. It aims to increase awareness of the risk factors and the different etiologies in this changing scenario in which neutropenia no longer seems to be a decisive factor in poor outcome. Bacterial pneumonia is the leading cause, but opportunistic diseases and non-infectious etiologies, especially unexpected adverse effects of radiation, biological drugs and monoclonal antibodies, are becoming increasingly frequent. Options for respiratory support and diagnostics are discussed and indications for antibiotics in the management of pneumonia are detailed. Expert commentary: Prompt initiation of critical care to facilitate optimal decision-making in the management of respiratory failure, early etiological assessment and appropriate antibiotic therapy are cornerstones in management of severe pneumonia in oncologic patients.
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Affiliation(s)
- D Leoni
- a Infectious Disease Department , Tor Vergata University Hospital, University of 'La Sapienza' , Rome , Italy.,b Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS) , Vall d'Hebron Institute of Research , Barcelona , Spain
| | - B Encina
- b Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS) , Vall d'Hebron Institute of Research , Barcelona , Spain
| | - J Rello
- b Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS) , Vall d'Hebron Institute of Research , Barcelona , Spain.,c Centro de Investigación Biomédica En Red - Enfermedades Respiratorias (CIBERES) , Vall d'Hebron Institute of Research , Barcelona , Spain.,d Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
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Waites KB, Xiao L, Liu Y, Balish MF, Atkinson TP. Mycoplasma pneumoniae from the Respiratory Tract and Beyond. Clin Microbiol Rev 2017; 30:747-809. [PMID: 28539503 PMCID: PMC5475226 DOI: 10.1128/cmr.00114-16] [Citation(s) in RCA: 350] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mycoplasma pneumoniae is an important cause of respiratory tract infections in children as well as adults that can range in severity from mild to life-threatening. Over the past several years there has been much new information published concerning infections caused by this organism. New molecular-based tests for M. pneumoniae detection are now commercially available in the United States, and advances in molecular typing systems have enhanced understanding of the epidemiology of infections. More strains have had their entire genome sequences published, providing additional insights into pathogenic mechanisms. Clinically significant acquired macrolide resistance has emerged worldwide and is now complicating treatment. In vitro susceptibility testing methods have been standardized, and several new drugs that may be effective against this organism are undergoing development. This review focuses on the many new developments that have occurred over the past several years that enhance our understanding of this microbe, which is among the smallest bacterial pathogens but one of great clinical importance.
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Affiliation(s)
- Ken B Waites
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Li Xiao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yang Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China, and Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | | | - T Prescott Atkinson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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The solithromycin journey-It is all in the chemistry. Bioorg Med Chem 2016; 24:6420-6428. [PMID: 27595539 DOI: 10.1016/j.bmc.2016.08.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/05/2016] [Accepted: 08/20/2016] [Indexed: 02/07/2023]
Abstract
The macrolide class of antibiotics, including the early generation macrolides erythromycin, clarithromycin and azithromycin, have been used broadly for treatment of respiratory tract infections. An increase of treatment failures of early generation macrolides is due to the upturn in bacterial macrolide resistance to 48% in the US and over 80% in Asian countries and has led to the use of alternate therapies, such as fluoroquinolones. The safety of the fluoroquinolones is now in question and alternate antibiotics for the outpatient treatment of community acquired bacterial pneumonia are needed. Telithromycin, approved in 2003, is no longer used owing to serious adverse events, collectively called the 'Ketek effects'. Telithromycin has a side chain pyridine moiety that blocks nicotinic acetylcholine receptors. Blockade of these receptors is known experimentally to cause the side effects seen with telithromycin in patients use. Solithromycin is a new macrolide, the first fluoroketolide, which has been tested successfully in two Phase 3 trials and is undergoing regulatory review at the FDA. Solithromycin is differentiated from telithromycin chemically and biologically in that its side chain is chemically different and does not significantly block nicotinic acetylcholine receptors. Solithromycin was well tolerated and effective in clinical trials.
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Pereyre S, Goret J, Bébéar C. Mycoplasma pneumoniae: Current Knowledge on Macrolide Resistance and Treatment. Front Microbiol 2016; 7:974. [PMID: 27446015 PMCID: PMC4916212 DOI: 10.3389/fmicb.2016.00974] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 06/06/2016] [Indexed: 11/16/2022] Open
Abstract
Mycoplasma pneumoniae causes community-acquired respiratory tract infections, particularly in school-aged children and young adults. These infections occur both endemically and epidemically worldwide. M. pneumoniae lacks cell wall and is subsequently resistant to beta-lactams and to all antimicrobials targeting the cell wall. This mycoplasma is intrinsically susceptible to macrolides and related antibiotics, to tetracyclines and to fluoroquinolones. Macrolides and related antibiotics are the first-line treatment of M. pneumoniae respiratory tract infections mainly because of their low MIC against the bacteria, their low toxicity and the absence of contraindication in young children. The newer macrolides are now the preferred agents with a 7-to-14 day course of oral clarithromycin or a 5-day course of oral azithromycin for treatment of community-acquired pneumonia due to M. pneumoniae, according to the different guidelines worldwide. However, macrolide resistance has been spreading for 15 years worldwide, with prevalence now ranging between 0 and 15% in Europe and the USA, approximately 30% in Israel and up to 90–100% in Asia. This resistance is associated with point mutations in the peptidyl-transferase loop of the 23S rRNA and leads to high-level resistance to macrolides. Macrolide resistance-associated mutations can be detected using several molecular methods applicable directly from respiratory specimens. Because this resistance has clinical outcomes such as longer duration of fever, cough and hospital stay, alternative antibiotic treatment can be required, including tetracyclines such as doxycycline and minocycline or fluoroquinolones, primarily levofloxacin, during 7–14 days, even though fluoroquinolones and tetracyclines are contraindicated in all children and in children < 8 year-old, respectively. Acquired resistance to tetracyclines and fluoroquinolones has never been reported in M. pneumoniae clinical isolates but reduced susceptibility was reported in in vitro selected mutants. This article focuses on M. pneumoniae antibiotic susceptibility and on the development and the evolution of acquired resistance. Molecular detection of resistant mutants and therapeutic options in case of macrolide resistance will also be assessed.
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Affiliation(s)
- Sabine Pereyre
- USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, Univ. BordeauxBordeaux, France; USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, INRABordeaux, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de BordeauxBordeaux, France
| | - Julien Goret
- USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, Univ. BordeauxBordeaux, France; USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, INRABordeaux, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de BordeauxBordeaux, France
| | - Cécile Bébéar
- USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, Univ. BordeauxBordeaux, France; USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, INRABordeaux, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de BordeauxBordeaux, France
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Brown RJ, Macfarlane-Smith L, Phillips S, Chalker VJ. Detection of macrolide resistant Mycoplasma pneumoniae in England, September 2014 to September 2015. ACTA ACUST UNITED AC 2016; 20:30078. [PMID: 26675545 DOI: 10.2807/1560-7917.es.2015.20.48.30078] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/03/2015] [Indexed: 11/20/2022]
Abstract
Mycoplasma pneumoniae infection can cause pneumonia, particularly in children. Global increase in macrolide-resistant M. pneumoniae is of concern due to limited therapeutic options. We describe the detection of macrolide resistance-conferring mutations in 9.3% of 43 clinical specimens where M. pneumoniae was detected in England and Wales from September 2014‒September 2015. This study aims to impact by highlighting the presence of macrolide resistance in M. pneumoniae positive patients, promoting increased clinical vigilance.
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Affiliation(s)
- Rebecca J Brown
- Bacteriology Reference Department, Public Health England (PHE), London, United Kingdom
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Brown RJ, Nguipdop-Djomo P, Zhao H, Stanford E, Spiller OB, Chalker VJ. Mycoplasma pneumoniae Epidemiology in England and Wales: A National Perspective. Front Microbiol 2016; 7:157. [PMID: 26909073 PMCID: PMC4754400 DOI: 10.3389/fmicb.2016.00157] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 01/29/2016] [Indexed: 11/13/2022] Open
Abstract
Investigations of patients with suspected Mycoplasma pneumoniae infection have been undertaken in England since the early 1970s. M. pneumoniae is a respiratory pathogen that is a common cause of pneumonia and may cause serious sequelae such as encephalitis and has been documented in children with persistent cough. The pathogen is found in all age groups, with higher prevalence in children aged 5–14 years. In England, recurrent epidemic periods have occurred at ~4-yearly intervals. In addition, low-level sporadic infection occurs with seasonal peaks from December to February. Voluntarily reports from regional laboratories and hospitals in England from 1975 to 2015 were collated by Public Health England for epidemiological analysis. Further data pertaining cases of note and specimens submitted to Public Health England from 2005 to 2015 for confirmation, molecular typing is included.
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Affiliation(s)
- Rebecca J Brown
- Public Health EnglandLondon, UK; Department of Child Health, University Hospital Wales, Cardiff University School of MedicineCardiff, UK
| | - Patrick Nguipdop-Djomo
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine London, UK
| | | | | | - O Brad Spiller
- Department of Child Health, University Hospital Wales, Cardiff University School of Medicine Cardiff, UK
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Taylor-Robinson D. Diagnosis and antimicrobial treatment of Mycoplasma genitalium infection: sobering thoughts. Expert Rev Anti Infect Ther 2015; 12:715-22. [PMID: 24834454 DOI: 10.1586/14787210.2014.919220] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The discovery of Mycoplasma genitalium in 1980-1981 eventually led to it becoming recognized as an important cause of non-gonococcal urethritis in men and also some genital tract diseases in women. Subsequent to the original isolation, further attempts failed over the next decade and reliable detection only became possible with the use of nucleic acid amplification techniques. Although tetracyclines, particularly doxycycline, were the first choice for treatment of non-gonococcal urethritis prior to the finding of M. genitalium, they were unsatisfactory for the treatment of M. genitalium-associated disease; the organisms were often not eliminated leading, for example, to chronic urethritis. However, the introduction of azithromycin, used as single-dose therapy for chlamydial infections, resulted in clearance of the mycoplasmal organisms from the genital tract and clinical recovery without the development of chronic disease. Nevertheless, such success was short-lived as M. genitalium, through mutation, began to develop resistance to azithromycin and M. genitalium mutants also began to circulate in some populations. In an attempt to counteract this, clinicians should give extended therapy, and in the future, microbiologists, using real-time PCRs, might be able to determine the existence of resistant strains in the local population and so advise on the most appropriate antibiotic. Other than azithromycin, there are a few options, moxifloxacin being one, although the recently reported resistance to this antibiotic is disturbing. In the short to medium term, combination therapy and/or the advent of a new antibiotic might abate the spread of resistance, but in the long term, there is potential for increasing prevalence of untreatable M. genitalium disease. In the future, attempts to develop a vaccine and, of equal importance, one to Chlamydia trachomatis, would not be out of place.
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Affiliation(s)
- David Taylor-Robinson
- Section of Infectious Diseases, Wright-Fleming Institute, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
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Gautier-Bouchardon AV, Ferré S, Le Grand D, Paoli A, Gay E, Poumarat F. Overall decrease in the susceptibility of Mycoplasma bovis to antimicrobials over the past 30 years in France. PLoS One 2014; 9:e87672. [PMID: 24503775 PMCID: PMC3913625 DOI: 10.1371/journal.pone.0087672] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/28/2013] [Indexed: 11/18/2022] Open
Abstract
Mycoplasma (M.) bovis is frequently implicated in respiratory diseases of young cattle worldwide. Today, to combat M. bovis in Europe, only antimicrobial therapy is available, but often fails, leading to important economical losses. The antimicrobial susceptibility of M. bovis is not covered by antimicrobial resistance surveillance networks. The objectives of this study were to identify resistances that were acquired over the last 30 years in France and to determine their prevalence within contemporary strains. The minimum inhibition concentration (MIC) values of 12 antimicrobials, considered active on M. bovis, were compared, using an agar dilution method, between 27 and 46 M. bovis isolates respectively obtained in 1978-1979 and in 2010-2012 from 73 distinct respiratory disease outbreaks in young cattle all over France. For eight antimicrobials, resistances were proven to be acquired over the period and expressed by all contemporary strains. The increase of the MIC value that inhibited 50% of the isolates (MIC50) was: i) substantial for tylosin, tilmicosin, tulathromycin and spectinomycin, from 2 to >64, 2 to >128, 16 to 128 and 4 to >64 µg/mL, respectively, ii) moderate for enrofloxacin, danofloxacin, marbofloxacin and oxytetracycline, from 0.25 to 0.5, 0.25 to 0.5, 0.5 to 1, 32 to >32 µg/mL, respectively. No differences were observed for gamithromycin, tildipirosin, florfenicol and valnemulin with MIC50 of 128, 128, 8, <0.03 µg/mL, respectively. If referring to breakpoint MIC values published for respiratory bovine pathogens, all contemporary isolates would be intermediate in vivo for fluoroquinolones and resistant to macrolides, oxytetracycline, spectinomycin and florfenicol.
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Affiliation(s)
- Anne V. Gautier-Bouchardon
- ANSES, Laboratoire de Ploufragan/Plouzané, Unité Mycoplasmologie-Bactériologie, Ploufragan, France
- Université Européenne de Bretagne, Rennes, France
| | - Séverine Ferré
- ANSES, Laboratoire de Ploufragan/Plouzané, Unité Mycoplasmologie-Bactériologie, Ploufragan, France
- Université Européenne de Bretagne, Rennes, France
| | - Dominique Le Grand
- ANSES, Laboratoire de Lyon, UMR Mycoplasmoses des Ruminants, Lyon, France
- Université de Lyon, VetAgro Sup, UMR Mycoplasmoses des Ruminants, Marcy L’Etoile, France
| | - Agnès Paoli
- ANSES, Laboratoire de Lyon, UMR Mycoplasmoses des Ruminants, Lyon, France
- Université de Lyon, VetAgro Sup, UMR Mycoplasmoses des Ruminants, Marcy L’Etoile, France
| | - Emilie Gay
- ANSES, Laboratoire de Lyon, Unité Epidémiologie, Lyon, France
| | - François Poumarat
- ANSES, Laboratoire de Lyon, UMR Mycoplasmoses des Ruminants, Lyon, France
- Université de Lyon, VetAgro Sup, UMR Mycoplasmoses des Ruminants, Marcy L’Etoile, France
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Wang XF, Liu JP, Shen KL, Ma R, Cui ZZ, Deng L, Shang YX, Zhao DY, Wang LB, Wan LY, Sun YQ, Li YN, Jiang ZY, Xu H, Li XM, Wu ZQ, Liu ZL, Hu YH, Huang Y, He CH, Zhang H, Jiang YH, Liu H, Wang Z. A cross-sectional study of the clinical characteristics of hospitalized children with community-acquired pneumonia in eight eastern cities in China. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:367. [PMID: 24364897 PMCID: PMC3880031 DOI: 10.1186/1472-6882-13-367] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 12/16/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Community-acquired pneumonia in children is common in China. To understand current clinical characteristics and practice, we conducted a cross-sectional study to analyze quality of care on childhood pneumonia in eight eastern cities in China. METHODS Consecutive hospital records between January 1, 2010 and December 31, 2010 were collected from 13 traditional Chinese medicine (TCM) and western medicine (WM) hospitals in February, May, August, and November (25 cases per season, 100 cases over the year), respectively. A predesigned case report form was used to extract data from the hospital medical records. RESULTS A total of 1298 cases were collected and analyzed. Symptoms and signs upon admission at TCM and WM hospitals were cough (99.3% vs. 98.6%), rales (84.8% vs. 75.0%), phlegm (83.3% vs. 49.1%), and fever (74.9% vs. 84.0%) in frequency. Patients admitted to WM hospitals had symptoms and signs for a longer period prior to admission than patients admitted to TCM hospitals. Testing to identify etiologic agents was performed in 1140 cases (88.4%). Intravenous antibiotics were administered in 99.3% (595/598) of cases in TCM hospitals and in 98.6% (699/700) of cases in WM hospitals. Besides, Chinese herbal extract injection was used more frequently in TCM hospitals (491 cases, 82.1%) than in WM hospitals (212 cases, 30.3%) (p < 0.01). At discharge, 818 cases (63.0%) were clinically cured, with a significant difference between the cure rates in TCM (87.6%) and WM hospitals (42.0%) (OR = 9.8, 95% confidence interval (CI): 7.3 ~ 12.9, p < 0.01). Pathogen and previous medical history were more likely associated with the disappearance of rales (OR = 7.2, 95% CI: 4.8 ~ 10.9). Adverse effects were not reported from the medical records. CONCLUSIONS Intravenous use of antibiotics is highly prevalent in children with community-acquired pneumonia regardless of aetiology. There was difference between TCM and WM hospitals with regard to symptom profile and the use of antibiotics. Intravenous use of herbal injection was higher in TCM hospitals than in WM hospitals. Most of the cases were diagnosed based on clinical signs and symptoms without sufficient confirmation of aetiology. Audit of current practice is urgently needed to improve care.
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Affiliation(s)
- Xue-Feng Wang
- Department of Pediatrics, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Huanggu District, Shenyang, Liaoning 110032, China
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Beisanhuan Dong Road, Chaoyang District, Beijing 100029, China
| | - Kun-Ling Shen
- Department of Respiratory Medicine, Beijing Children’s Hospital, 56 Nanlishi Road, Xicheng District, Beijing 100045, China
| | - Rong Ma
- First Teaching Hospital of Tianjin University of TCM, 314 Anshan Xi Road, Nankai District, Tianjin 300193, China
| | - Zhen-Ze Cui
- Department of Respiratory Medicine, Dalian Children’s Hospital, 154 Zhongshan Road, Xigang District, Dalian, Liaoning 116012, China
| | - Li Deng
- Department of Respiratory Medicine, Guangzhou Women and Children’s Medical Center, 318 Renminzhong Road, Yuexiu District, Guangzhou, Guangdong 510623, China
| | - Yun-Xiao Shang
- Department of Pediatric Respiratory Medicine, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning 110004, China
| | - De-Yu Zhao
- Department of Pediatric Respiratory Medicine, Nanjing Children’ Hospital, 72 Guangzhou Road, Nanjing, Jiangsu 210008, China
| | - Li-Bo Wang
- Department of Pediatric Respiratory Medicine, Children’s Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai 201102, China
| | - Li-Ya Wan
- Department of Pediatric Respiratory Medicine, Tianjin Children’s Hospital, 225 Machang Road, Hexi District, Tianjin 300074, China
| | - Yi-Qiu Sun
- Department of Pediatrics, Jiangsu Provincial Hospital of TCM, 155 Hanzhong Road, Nanjing, Jiangsu 210029, China
| | - Yan-Ning Li
- Department of Pediatrics, Affiliated Hospital of Shandong University of TCM, 42 Wenhua Xi Road, Jinan, Shandong 250011, China
| | - Zhi-Yan Jiang
- Department of Pediatrics, Longhua Hospital of Shanghai University of TCM, 725 South Wanping Road, Shanghai 200032, China
| | - Hua Xu
- Department of Pediatrics, Affiliated Hospital of Guangzhou University of TCM, 16 Baiyun Jichang Road, Guangzhou, Guangdong 510405, China
| | - Xin-Min Li
- First Teaching Hospital of Tianjin University of TCM, 314 Anshan Xi Road, Nankai District, Tianjin 300193, China
| | - Zhen-Qi Wu
- Department of Pediatrics, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Huanggu District, Shenyang, Liaoning 110032, China
| | - Zhao-Lan Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Beisanhuan Dong Road, Chaoyang District, Beijing 100029, China
| | - Ying-Hui Hu
- Department of Respiratory Medicine, Beijing Children’s Hospital, 56 Nanlishi Road, Xicheng District, Beijing 100045, China
| | - Yan Huang
- Department of Respiratory Medicine, Dalian Children’s Hospital, 154 Zhongshan Road, Xigang District, Dalian, Liaoning 116012, China
| | - Chun-Hui He
- Department of Respiratory Medicine, Guangzhou Women and Children’s Medical Center, 318 Renminzhong Road, Yuexiu District, Guangzhou, Guangdong 510623, China
| | - Han Zhang
- Department of Pediatric Respiratory Medicine, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning 110004, China
| | - Yong-Hong Jiang
- Department of Pediatrics, Longhua Hospital of Shanghai University of TCM, 725 South Wanping Road, Shanghai 200032, China
| | - Hua Liu
- Department of Pediatrics, Affiliated Hospital of Guangzhou University of TCM, 16 Baiyun Jichang Road, Guangzhou, Guangdong 510405, China
| | - Zi Wang
- Department of Pediatrics, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Huanggu District, Shenyang, Liaoning 110032, China
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Mycoplasmas and their host: emerging and re-emerging minimal pathogens. Trends Microbiol 2013; 21:196-203. [DOI: 10.1016/j.tim.2013.01.003] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/14/2013] [Accepted: 01/18/2013] [Indexed: 01/22/2023]
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