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Xie D, Chen Q, Zhang Y, Zhao Q, Zang Z, Wu H, Ye C, Song S, Yang L, Yao Q. Development and validation of a prediction model for postoperative pneumonia in patients who received spinal surgery: A retrospective study. Heliyon 2024; 10:e29845. [PMID: 38707354 PMCID: PMC11068526 DOI: 10.1016/j.heliyon.2024.e29845] [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: 09/22/2023] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives To develop and validate a risk prediction model by identifying the preoperative factors associated with an increased risk of pneumonia after spinal surgery. Methods This study included patients with spinal disease from two hospitals between January 2021 and June 2023. The patients were divided into the training and validation sets, which were categorized as postoperative pneumonia (POP) or non-POP, respectively. This study identified the independent risk variables for POP using a multivariate logistic regression analysis. A nomogram prediction model was developed and validated using risk factors, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) to assess predictive performance. Results Following exclusion, 2223 patients from Changzheng Hospital were enrolled in the training set and 357 patients from the No. 905 Hospital of PLA Navy were enrolled in the validation set. Univariate and multivariate logistic regression analyses revealed that operation time, American Society of Anesthesiologists (ASA) grade, smoking, non-wearing of medical masks, lack of preoperative respiratory training, chronic obstructive pulmonary disease (COPD), underlying diseases, and spinal section were risk factors for POP development in patients with spinal diseases. The area under the ROC curve of the training set was 0.950, whereas that of the validation set was 0.879. The model calibration curves demonstrated good agreement, and the DCA indicated a high expected net benefit value. Conclusion The POP risk prediction model has high accuracy and efficiency in predicting POP in patients with spinal diseases. POP development is influenced by factors such as operation length, ASA grade, smoking, non-wearing of medical masks, lack of preoperative respiratory training, COPD, underlying diseases, and lumbar surgery.
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Affiliation(s)
- Dong Xie
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
- Department of Orthopaedics, No. 905 Hospital of PLA Navy, Shanghai, 200052, China
| | - Qing Chen
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Yao Zhang
- Department of Orthopaedics, No. 905 Hospital of PLA Navy, Shanghai, 200052, China
| | - Qi Zhao
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Zusheng Zang
- Department of Orthopaedics, No. 905 Hospital of PLA Navy, Shanghai, 200052, China
| | - Hao Wu
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Cheng Ye
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Shaochen Song
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
- Department of Orthopaedics, No. 905 Hospital of PLA Navy, Shanghai, 200052, China
| | - Lili Yang
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
- Department of Orthopaedics, No. 905 Hospital of PLA Navy, Shanghai, 200052, China
| | - Qiuju Yao
- Department of Respiratory Medicine, No. 905 Hospital of PLA Navy, Shanghai, 200052, China
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Lorente L, Sabater-Riera J, Rello J. Surveillance and prevention of healthcare-associated infections: best practices to prevent ventilator-associated events. Expert Rev Anti Infect Ther 2024; 22:317-332. [PMID: 38642072 DOI: 10.1080/14787210.2024.2345877] [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: 02/12/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Ventilator associated pneumonia (VAP) leads to an increase in morbidity, mortality, and healthcare costs. In addition to increased evidence from the latest European and American guidelines (published in 2017 and 2022, respectively), in the last two years, several important clinical experiences have added new prevention tools to be included to improve the management of VAP. AREAS COVERED This paper is a narrative review of new evidence on VAP prevention. We divided VAP prevention measures into pharmacological, non-pharmacological, and ventilator care bundles. EXPERT OPINION Most of the effective strategies that have been shown to decrease the incidence of complications are easy to implement and inexpensive. The implementation of care bundles, accompanied by educational measures and a multidisciplinary team should be part of optimal management. In addition to ventilator care bundles for the prevention of VAP, it could possibly be beneficial to use ventilator care bundles for the prevention of noninfectious ventilator associated events.
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Affiliation(s)
- Leonardo Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Spain
| | - Joan Sabater-Riera
- IDIBELL, Hospitalet de Llobregat, Spain, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Jordi Rello
- CRIPS (Clinical Research in Pneumonia & Sepsis); Vall d'Hebron Institute of Research, Barcelona, Spain
- Formation, Recherche, Evaluation (FOREVA), CHU Nîmes, Nîmes, France
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain
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Zhang D, Zhang Y, Yang S. Non-linear relationship between preoperative albumin-globulin ratio and postoperative pneumonia in patients with hip fracture. Int J Orthop Trauma Nurs 2024; 54:101098. [PMID: 38608342 DOI: 10.1016/j.ijotn.2024.101098] [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: 11/25/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND AND OBJECTIVE Postoperative pneumonia (POP) is the leading cause of death among patients with hip fractures. Simple and cost-effective markers can be used to assess the risk of these patients. This study aims to investigate the association between POP and preoperative albumin-globulin ratio (AGR) in patients with hip fractures. METHODS A retrospective analysis was conducted on data from 1417 hip fracture patients admitted to the Department of Orthopaedics at the hospital. Generalized additive and logistic regression models were used to determine both linear and non-linear associations between preoperative AGR and POP. A two-piece regression model was employed to determine the threshold effect. RESULTS The study included 1417 participants, with a mean age of 77.57 (8.53) years and 26.96% (382/1417) male patients. The prevalence of POP was 6.21%. Following full covariate adjustment, each unit increase in AGR was associated with a 79% reduction in the incidence of POP (OR, 0.23; 95% CI: 0.08-0.63; P = 0.0046). The inflection point was found to be 1.33 using a two-piecewise regression model. For each unit increase in AGR on the left side of the inflection point, the incidence of POP decreased by 93% (OR, 0.07; 95%CI: 0.02-0.34; P = 0.0010). However, there was no statistically significant correlation on the right side of the inflection point (OR, 0.84; 95% CI: 0.17-4.10; P = 0.8287). CONCLUSION There exists a non-linear association between preoperative AGR and the incidence of POP in elderly hip fracture patients. When AGR is less than 1.33, the incidence of POP is negatively correlated with AGR. However, there is no correlation when AGR is greater than 1.33.
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Affiliation(s)
- Daxue Zhang
- School of Nursing, Anhui Medical University, Hefei, China; Teaching Office, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yu Zhang
- Department of Orthopedics, Zhejiang Hospital, Hangzhou, China
| | - Shiwei Yang
- School of Nursing, Anhui Medical University, Hefei, China; Teaching Office, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.
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Zhu G, Wang X, Cao X, Yang C, Wang B, Ang Y, Duan M. The effect of different endotracheal tube cuff pressure monitoring systems on postoperative sore throat in patients undergoing tracheal intubation: a randomized clinical trial. BMC Anesthesiol 2024; 24:115. [PMID: 38528475 PMCID: PMC10962134 DOI: 10.1186/s12871-024-02499-5] [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: 08/01/2023] [Accepted: 03/15/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Postoperative sore throat (POST) is an unpleasant outcome that can occur as a result of tracheal intubation in adults. Increased pressure from the endotracheal tube (ETT) cuff often leads to local mucosal injury, resulting in sore throat. The purpose of this study was to compare the effect of two different ETT cuff pressure monitoring systems vs. no cuff pressure monitoring on the incidence and severity of POST in adults. METHODS One hundred and fourteen ASA I-III patients of either gender, aged 18-65 years, and undergoing surgery requiring endotracheal intubation were included in this study. Patients were randomized into three groups: control (C), cuff pressure gauge (G), and automated cuff controller (A). The ETT cuff pressure was not monitored intraoperatively in group C but was monitored using a cuff pressure gauge and an automated cuff controller in groups G and A, respectively. Postoperatively, patients were assessed at 2, 24, and 48 h for the presence and severity of POST, hoarseness and cough. RESULTS One hundred and eleven patients completed the study. POST occurred in 40.5% of the patients in group G (n = 37) (p = 0.013) and 23.7% of the patients in group A (n = 38) (p < 0.001) within 48 h after surgery, compared to 69.4% in group C (n = 36). There were no significant differences in hoarseness, coughing, and dysphagia across the groups at any time. When comparing groups A and C, individuals in group A exhibited a lower occurrence of significant (grade ≥ 2) POST and hoarseness (10.5% vs. 41.7%, p = 0.002; 26.3% vs. 58.3%, p = 0.005). The incidence of significant cough and dysphagia did not differ substantially across the patient groups within 48 h after surgery. POST scores in group A at 2, 24 h postoperatively were both 0 (0-0), which was significantly lower than those in group C (1 (0-2) at 2 h, p < 0.001 ; 1 (0-1) at 24 h, p = 0.001). POST in group G at 2 h postoperatively was graded as 0 (0-1.5) which was milder than group C (P = 0.024). The severity of hoarseness in group A with scores of 0 (0-2) was superior to that in group C (2 (0-2), p = 0.006) at 2 h postoperatively. CONCLUSIONS In conclusion, the findings of this study indicated that the occurrence of POST can be reduced by using either the cuff pressure gauge approach or the automated cuff controller method. The automated cuff controller monitoring can potentially decrease the severity of POST and hoarseness. TRIAL REGISTRATION Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.
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Affiliation(s)
- Guangli Zhu
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, Jiangsu Province, 210002, China
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210019, China
| | - Xuan Wang
- Women's Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210004, China
| | - Xinyu Cao
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, Jiangsu Province, 210002, China
| | - Chongya Yang
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, Jiangsu Province, 210002, China
| | - Bin Wang
- Department of Anesthesiology, Jinling College affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210002, China
| | - Yang Ang
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, Jiangsu Province, 210002, China
| | - Manlin Duan
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China.
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, Jiangsu Province, 210002, China.
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210019, China.
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Wang X, Zhao Y, Zhao J, Deng L. Neutrophil-lymphocyte ratio on first and third postoperative days: associated with severe pneumonia in aneurysmal subarachnoid hemorrhage patients undergoing surgeries. Neurosurg Rev 2024; 47:70. [PMID: 38277044 DOI: 10.1007/s10143-024-02295-2] [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: 11/06/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024]
Abstract
Severe postoperative pneumonia can increase the risk of poor outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). We aimed to explore the associations of preoperative or postoperative inflammatory markers calculated from blood cell counts with severe pneumonia. This retrospective study was conducted at the First Affiliated Hospital of Yangtze University from January 2019 to June 2023. The associations of neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and systemic inflammation response index (SIRI) with severe pneumonia were analyzed. There were 159 patients with pneumonia and 21 patients without pneumonia. There were 41 patients with severe pneumonia and 118 patients with non-severe pneumonia. The multivariate logistic regression analysis showed that NLR on the first postoperative (OR = 2.574, 95%CI: 1.035-6.403, p = 0.042) and third postoperative days (OR = 4.296, 95%CI: 1.699-10.860, p = 0.002) were associated with severe pneumonia in aSAH patients. Among patients ≥ 60 years, SIRI on the preoperative day (OR = 7.430, 95%CI: 1.443-38.251, p = 0.016) and NLR on the third postoperative day (OR = 4.748, 95%CI: 1.286-17.801, p = 0.020) were associated with severe pneumonia. Among patients < 60 years, NLR on the first postoperative day (OR = 24.149, 95%CI: 3.476-167.747, p = 0.001) was associated with severe pneumonia. The NLR on the first and third postoperative days were possibly associated with severe pneumonia in aneurysmal subarachnoid hemorrhage patients undergoing clipping or embolization surgeries. Dynamic detection of NLR during early perioperative period may help clinicians to predict the development of severe pneumonia.
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Affiliation(s)
- Xian Wang
- Department of Pharmacy, The First Affiliated Hospital of Yangtze University, Jingzhou, 434000, China
| | - Yongfeng Zhao
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, 434000, China
| | - Jian Zhao
- Department of Neurosurgery, The Neurointensive Care Unit, The First Affiliated Hospital of Yangtze University, Jingzhou, 434000, China
| | - Li Deng
- Medical Department, The First Affiliated Hospital of Yangtze University, Jingzhou, 434000, China.
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Gan W, Chen Z, Tao Z, Li W. Constructing a Nomogram Model to Estimate the Risk of Ventilator-Associated Pneumonia for Elderly Patients in the Intensive Care Unit. Adv Respir Med 2024; 92:77-88. [PMID: 38392034 PMCID: PMC10885902 DOI: 10.3390/arm92010010] [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: 12/13/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) causes heavy losses in terms of finances, hospitalization, and death for elderly patients in the intensive care unit (ICU); however, the risk is difficult to evaluate due to a lack of reliable assessment tools. We aimed to create and validate a nomogram to estimate VAP risk to provide early intervention for high-risk patients. METHODS Between January 2016 and March 2021, 293 patients from a tertiary hospital in China were retrospectively reviewed as a training set. Another 84 patients were enrolled for model validation from April 2021 to February 2022. Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis were employed to select predictors, and a nomogram model was constructed. The calibration, discrimination, and clinical utility of the nomogram were verified. Finally, a web-based online scoring system was created to make the model more practical. RESULTS The predictors were hypoproteinemia, long-term combined antibiotic use, intubation time, length of mechanical ventilation, and tracheotomy/intubation. The area under the curve (AUC) was 0.937 and 0.925 in the training and validation dataset, respectively, suggesting the model exhibited effective discrimination. The calibration curve demonstrated high consistency with the observed result and the estimated values. Decision curve analysis (DCA) demonstrated that the nomogram was clinically applicable. CONCLUSIONS We have created a novel nomogram model that can be utilized to anticipate VAP risk in elderly ICU patients, which is helpful for healthcare professionals to detect patients at high risk early and adopt protective interventions.
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Affiliation(s)
- Wensi Gan
- Department of Infection Control, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou 325001, China
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, and Center for Clinical Big Data and Statistics, The Second Hospital Affiliated to Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Zhihui Chen
- School of Public Health, Zhejiang University, Hangzhou 310058, China
| | - Zhen Tao
- Department of Intensive Care Unit, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou 325001, China
| | - Wenyuan Li
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, and Center for Clinical Big Data and Statistics, The Second Hospital Affiliated to Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China
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Li X, Feng D, Zhou J, Wu W, Zheng W, Gan W, Jiang M, Li H, Peng X, Zhang T. Metabolomics Method in Understanding and Sensitizing Carbapenem-Resistant Acinetobacter baumannii to Meropenem. ACS Infect Dis 2024; 10:184-195. [PMID: 37991817 PMCID: PMC10788854 DOI: 10.1021/acsinfecdis.3c00480] [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: 09/10/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAB) strains are prevalent worldwide and represent a major threat to public health. However, treatment options for infections caused by CRAB are very limited as they are resistant to most of the commonly used antibiotics. Consequently, understanding the mechanisms underlying carbapenem resistance and restoring bacterial susceptibility to carbapenems hold immense importance. The present study used gas chromatography-mass spectrometry (GC-MS)-based metabolomics to investigate the metabolic mechanisms of antibiotic resistance in clinically isolated CRAB. Inactivation of the pyruvate cycle and purine metabolism is the most typical characteristic of CRAB. The CRAB exhibited a reduction in the activity of enzymes involved in the pyruvate cycle, proton motive force, and ATP levels. This decline in central carbon metabolism resulted in a decrease in the metabolic flux of the α-ketoglutarate-glutamate-glutamine pathway toward purine metabolism, ultimately leading to a decline in adenine nucleotide interconversion. Exogenous adenosine monophosphate (AMP) and adenosine triphosphate (ATP) enhance the killing efficacy of Meropenem against CRAB. The combination of ATP and Meropenem also has a synergistic effect on eliminating CRAB persisters and the biofilm, as well as protecting mice against peritonitis-sepsis. This study presents a novel therapeutic modality to treat infections caused by CRAB based on the metabolism reprogramming strategy.
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Affiliation(s)
- Xia Li
- Department
of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital
of Sun Yat-sen University, Institute of
Respiratory Diseases of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China
| | - Dingyun Feng
- Department
of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital
of Sun Yat-sen University, Institute of
Respiratory Diseases of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China
| | - Jianxia Zhou
- Department
of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital
of Sun Yat-sen University, Institute of
Respiratory Diseases of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China
| | - Wenbin Wu
- Department
of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital
of Sun Yat-sen University, Institute of
Respiratory Diseases of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China
| | - Wenzheng Zheng
- Department
of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital
of Sun Yat-sen University, Institute of
Respiratory Diseases of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China
| | - Wenlei Gan
- Department
of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital
of Sun Yat-sen University, Institute of
Respiratory Diseases of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China
| | - Ming Jiang
- Institute
of Animal Science, Guangdong Academy of
Agricultural Sciences, Guangzhou 510640, People’s
Republic of China
| | - Hui Li
- School
of Life Sciences, Sun Yat-sen University, Guangzhou 510275, People’s Republic of China
| | - Xuanxian Peng
- School
of Life Sciences, Sun Yat-sen University, Guangzhou 510275, People’s Republic of China
| | - Tiantuo Zhang
- Department
of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital
of Sun Yat-sen University, Institute of
Respiratory Diseases of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China
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Han D, Yu F, Zhang D, Yang Q, Shen R, Zheng S, Chen Y. Applicability of Bronchoalveolar Lavage Fluid and Plasma Metagenomic Next-Generation Sequencing Assays in the Diagnosis of Pneumonia. Open Forum Infect Dis 2024; 11:ofad631. [PMID: 38269051 PMCID: PMC10807993 DOI: 10.1093/ofid/ofad631] [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: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 01/26/2024] Open
Abstract
Background Metagenomic next-generation sequencing (mNGS) provides innovative solutions for predicting complex infections. A comprehensive understanding of its strengths and limitations in real-world clinical settings is necessary to ensure that it is not overused or misinterpreted. Methods Two hundred nine cases with suspected pneumonia were recruited to compare the capabilities of 2 available mNGS assays (bronchoalveolar lavage fluid [BALF] mNGS and plasma mNGS) to identify pneumonia-associated DNA/RNA pathogens and predict antibiotic resistance. Results Compared to clinical diagnosis, BALF mNGS demonstrated a high positive percent agreement (95.3%) but a low negative percent agreement (63.1%). Plasma mNGS revealed a low proportion of true negatives (30%) in predicting pulmonary infection. BALF mNGS independently diagnosed 65.6% (61/93) of coinfections and had a remarkable advantage in detecting caustic, rare, or atypical pathogens. Pathogens susceptible to invasive infection or bloodstream transmission, such as Aspergillus spp, Rhizopus spp, Chlamydia psittaci, and human herpesviruses, are prone to be detected by plasma mNGS. BALF mNGS tests provided a positive impact on the diagnosis and treatment of 128 (61.2%) patients. Plasma mNGS, on the other hand, turned out to be more suitable for diagnosing patients who received mechanical ventilation, developed severe pneumonia, or developed sepsis (all P < .01). BALF mNGS was able to identify resistance genes that matched the phenotypic resistance of 69.4% (25/36) of multidrug-resistant pathogens. Conclusions Our data reveal new insights into the advantages and disadvantages of 2 different sequencing modalities in pathogen identification and antibiotic resistance prediction for patients with suspected pneumonia.
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Affiliation(s)
- Dongsheng Han
- Department of Laboratory Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, Zhejiang, China
- Institute of Laboratory Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fei Yu
- Department of Laboratory Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, Zhejiang, China
- Institute of Laboratory Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dan Zhang
- Department of Laboratory Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, Zhejiang, China
- Institute of Laboratory Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qing Yang
- Department of Laboratory Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ruting Shen
- Huzhou Wuxing District People’s Hospital, Clinical Laboratory, Huzhou, Zhejiang, China
| | - Shufa Zheng
- Department of Laboratory Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, Zhejiang, China
- Institute of Laboratory Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yu Chen
- Department of Laboratory Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, Zhejiang, China
- Institute of Laboratory Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Zhao Y, Wang X, Ren H, Yao Y. Systemic inflammation response index (SIRI) on the 3rd postoperative day are associated with severe pneumonia in cerebral hemorrhage patients: A single-center retrospective study. Medicine (Baltimore) 2023; 102:e35587. [PMID: 37904408 PMCID: PMC10615502 DOI: 10.1097/md.0000000000035587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/20/2023] [Indexed: 11/01/2023] Open
Abstract
Inflammatory response was involved in the progression of cerebral hemorrhage. We sought to explore the associations of easily obtained inflammatory indicators including blood cell counts and the ratios of different blood cells counts with pneumonia and severe pneumonia in cerebral hemorrhage patients. We carried 1 retrospective study including 200 patients with cerebral hemorrhage and surgeries. The associations of neutrophils, lymphocytes, monocytes, platelets, systemic immune inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) with pneumonia and severe pneumonia in cerebral hemorrhage patients were estimated by univariate analysis and multivariate logistic regression model. Among the 200 patients included, there were a total of 163 (81.5%) had pneumonia after surgeries. Among 163 cerebral hemorrhage patients with pneumonia, 60 (36.8%) cases were evaluated as severe pneumonia. The level of SIRI on the 1st postoperative day in patients with severe pneumonia was higher than non-severe pneumonia (10.89 ± 12.10 × 109/L vs 7.14 ± 9.76 × 109/L, P = .003). The level of SIRI on the 3rd postoperative day in patients with severe pneumonia was more significantly higher (7.98 ± 7.46 × 109/L vs 4.10 ± 3.74 × 109/L, P < .001). The results of multivariate analysis showed that SIRI level on the 3rd postoperative day (>6.5 × 109/L) was associated with severe pneumonia in cerebral hemorrhage patients (OR: 4.409, 95% CI: 1.799-10.806, P = .001). SIRI was possibly a superior predictor for severe pneumonia in cerebral hemorrhage patients compared with other inflammatory indicators. On the one hand, we intend to validate the cutoff value of SIRI for predicting severe pneumonia in larger samples and multicenter studies. On the other hand, we also intend to use this index to guide the choice of antibacterial drugs in order to better benefit patients.
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Affiliation(s)
- Yongfeng Zhao
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Xian Wang
- Department of Pharmacy, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Hongbo Ren
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Yuan Yao
- Department of Neurosurgery, The First Affiliated Hospital of Yangtze University, Jingzhou, China
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Lv Q, Zhang X, Guo K, Hu D, Deng Z. Risk Factors for Pulmonary Infection and Nursing Interventions Post-Tracheostomy in Patients with Spinal Cord Injury. Infect Drug Resist 2023; 16:6691-6701. [PMID: 37854469 PMCID: PMC10581007 DOI: 10.2147/idr.s418894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023] Open
Abstract
Objective We analyzed the characteristics and risk factors for pulmonary infection in patients with spinal cord injury who underwent tracheostomy and propose measures to help in early detection and intervention to reduce mortality and improve prognosis. Methods We collected data retrospectively from January 1, 2018, to December 31, 2022. The inclusion criteria were: Patients aged 18 years or more with a spinal cord injury who underwent tracheostomy, were treated with mechanical ventilation for over 48 hours, and were diagnosed as having a pulmonary infection. Sputum samples were cultured and analyzed. Results 101 cases of pulmonary infection were analyzed, and the incidence was 32.17%. Diabetes (OR 2.302, 95% CI 1.285-3.972), hypoproteinemia (OR 1.992, 95% CI 1.125-3.101), administration of glucocorticoids (OR 2.934, 95% CI 1.412-4.661), ASIA grade A (OR 3.672, 95% CI 1.988-5.046), mechanical ventilation for ≥ 6 days (OR 2.108, 95% CI 1.385-4.751), and length of hospital stay for ≥ 20 days (OR 2.137, 95% CI 1.092-3.842) were risk factors for pulmonary infection in patients with spinal cord injury post-tracheostomy. Among 213 pathogenic bacteria, 52 (51.48%) were Gram-negative and 24 (23.76%) were Gram-positive. Klebsiella pneumoniae (15.84%) and Staphylococcus aureus (8.91%) were the most common pathogenic bacteria. The mortality rate of patients with gram-positive infection was higher than that of patients with gram-negative infection. K. pneumoniae and S. aureus were sensitive to cefoperazone, meropenem, and levofloxacin. Conclusion Pulmonary infection is a complication post-tracheostomy in patients with spinal cord injury. Diabetes, hypoproteinemia, administration of glucocorticoids, mechanical ventilation for ≥ 6 days, length of hospital stay for ≥ 20 days were risk factors for pulmonary infection. Pulmonary infection was mainly caused by gram-negative bacteria. Timely and effective measures for managing risk factors are essential for improving the prognosis of pulmonary infection post-tracheostomy in patients with spinal cord injuries.
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Affiliation(s)
- Qin Lv
- Department of Emergency, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, 050051, People’s Republic of China
| | - Xinliang Zhang
- Department of Emergency, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, 050051, People’s Republic of China
| | - Kucun Guo
- Department of Emergency, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, 050051, People’s Republic of China
| | - Dezheng Hu
- Department of Emergency, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, 050051, People’s Republic of China
| | - Zhuojun Deng
- Department of General Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, 050000, People’s Republic of China
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Lan J, Wei Y, Zhu Y, Zhang Y, Zhang S, Mo L, Wei D, Lei Y. Risk Factors for Post-Operative Pulmonary Infection in Patients With Brain Tumors: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2023; 24:588-597. [PMID: 37582199 PMCID: PMC10516234 DOI: 10.1089/sur.2023.130] [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] [Indexed: 08/17/2023] Open
Abstract
Background: This study aims to analyze the risk factors for post-operative pulmonary infection in patients with brain tumors by meta-analysis to provide a reference for its prevention. Methods: PubMed, Embase, Web of Science, Cochrane Library, Ovid, and four Chinese databases (CNKI, SinoMed, VIP, and Wanfang databases) were searched for studies covering risk factors of pulmonary infection in patients with brain tumors, limited to the duration from the dates of inception of the respective databases to December 31, 2022. The Newcastle-Ottawa scale was used to assess the evidence. A meta-analysis of the factors affecting the incidence of pulmonary infection was performed using Revman 5.4 software. Results: Twelve studies were selected, covering 35,615 patients with brain tumors, among whom pulmonary infection occurred in 1,635 cases with an accumulated incidence of 4.6%, including 38 related risk factors. Meta-analysis results indicated: history of chronic pulmonary disease (odds ratio [OR], 5.74; 95% confidence interval [CI], 1.34-24.51; p = 0.02], diabetes mellitus (OR, 1.58; 95% CI, 1.29-1.95; p < 0.0001), history of cardiovascular disease (OR, 3.97; 95% CI, 2.18-7.24; p < 0.00001), age ≥60 years (OR, 1.55; 95% CI, 1.12-2.15; p = 0.009)], operation time ≥3 hours (OR, 1.03; 95% CI, 1.00-1.05; p = 0.03], Glasgow Coma Scale (GCS) score <13 (OR, 3.5; 95% CI, 1.90-6.46; p < 0.0001), and the American Society of Anesthesiologists classification (ASA) ≥3 (OR, 2.03; 95% CI, 1.68-2.46; p < 0.00001) as independent risk factors. Conclusions: History of chronic pulmonary disease, diabetes mellitus, history of cardiovascular disease, age ≥60 years, operation time ≥3 hours, GCS score <13, and the ASA grade ≥3 are independent risk factors for post-operative pulmonary infection in patients with brain tumors, which nursing staff should be aware of.
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Affiliation(s)
- Jiangling Lan
- Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Yan Wei
- Guangxi Medical University, Nanning, Guangxi, China
| | - Yin Zhu
- Guangxi Medical University, Nanning, Guangxi, China
| | - YuJiao Zhang
- Guangxi Medical University, Nanning, Guangxi, China
| | | | - LiGen Mo
- Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - DanDan Wei
- Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Yi Lei
- Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
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Lu R, Yang H, Peng W, Tang H, Li Y, Lin F, Zhou A, Pan P. Serum Krebs von den Lungen-6 is associated with in-Hospital mortality of patients with severe Community-Acquired Pneumonia: A retrospective cohort study. Clin Chim Acta 2023; 548:117524. [PMID: 37633319 DOI: 10.1016/j.cca.2023.117524] [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: 03/19/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Currently, no ideal biomarker can accurately stratify the risk of patients with severe community-acquired pneumonia (SCAP). This study aimed to evaluate the role of serum Krebs von den Lungen-6 (sKL-6) in predicting in-hospital mortality in adults with SCAP. METHODS In this retrospective cohort study, 249 severe pneumonia adult patients were recruited between 6 May 2021 to 30 April 2023 in Xiangya Hospital of Central South University. The sKL-6 level within 48 h of admission was measured, and the primary outcome assessed was in-hospital mortality. Multivariable logistic regression analysis was performed to calculate adjusted odds ratios (OR) with 95% confidence intervals (CI). Survival curves were plotted and subgroup analyses were conducted, stratified by relevant covariates. RESULTS A total of 249 patients were included in the study,with 124 patients having normal sKL-6 levels, and 125 patients having abnormal sKL-6 levels. The overall in-hospital mortality rate was 28.9% (72 out of 249 patients). Univariate and multivariate logistic regression analysis revealed that the patients with abnormal sKL-6 levels had a higher risk of in-hospital mortality compared to those with normal sKL-6 levels, both in the total SCAP patient population (OR: 5.38, 95%CI: 2.41-12.01, P < 0.001) and the non-COVID-19 SCAP patients subgroup (OR: 8.12, 95%CI: 3.16-20.84, P < 0.001). Subgroup and interaction analyses confirmed the stability of the relationship between sKL-6 levels and in-hospital mortality(P for interaction > 0.05). Kaplan-Meier survival curves showed that patients with abnormal sKL-6 levels had a higher in-hospital mortality rate than those with normal sKL-6 levels (P < 0.05). However, the results of restricted cubic spline plots(RCS) analysis demonstrated a nonlinear association between sKL-6 levels (as a continuous variable) and in-hospital mortality in patients with SCAP. Similar results were observed in non-COVID-19 SCAP patients. Furthermore, the receiver operating characteristic curve (ROC) analysis revealed that sKL-6 had superior predictive performance compared to existing biomarkers (e.g., APACHE-II, SOFA, BUN/Cr, PCT, and D-dimer) for in-hospital mortality in non-COVID-19 SCAP patients. CONCLUSION sKL-6 is a practical and useful biomarker for predicting in-hospital mortality in patients with SCAP.
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Affiliation(s)
- Rongli Lu
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, Hunan 410008, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, PR China
| | - Hang Yang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, Hunan 410008, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, PR China
| | - Wenzhong Peng
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, Hunan 410008, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, PR China
| | - Haiyun Tang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi Li
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, Hunan 410008, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, PR China
| | - Fengyu Lin
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, Hunan 410008, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, PR China
| | - Aiyuan Zhou
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, Hunan 410008, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, PR China.
| | - Pinhua Pan
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, Hunan 410008, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, PR China.
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Yuan X, Xie L, Shi Z, Zhou M. Application of mNGS in the study of pulmonary microbiome in pneumoconiosis complicated with pulmonary infection patients and exploration of potential biomarkers. Front Cell Infect Microbiol 2023; 13:1200157. [PMID: 37545858 PMCID: PMC10403237 DOI: 10.3389/fcimb.2023.1200157] [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: 04/04/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Background Pneumoconiosis patients have a high prevalence of pulmonary infections, which can complicate diagnosis and treatment. And there is no comprehensive study of the microbiome of patients with pneumoconiosis. The application of metagenomic next-generation sequencing (mNGS) fills the gap to some extent by analyzing the lung microbiota of pneumoconiosis population while achieving accurate diagnosis. Methods We retrospectively analyzed 44 patients with suspected pneumoconiosis complicated with pulmonary infection between Jan 2020 and Nov 2022. Bronchoalveolar lavage fluid (BALF) specimens from 44 patients were collected and tested using the mNGS technology. Results Among the lung microbiome of pneumoconiosis patients with complicated pulmonary infection (P group), the most frequently detected bacteria and fungi at the genus level were Streptococcus and Aspergillus, at the species level were Streptococcus pneumoniae and Aspergillus flavus, respectively, and the most frequently detected DNA virus was Human gammaherpesvirus 4. There was no significant difference in α diversity between the P group and the non-pneumoconiosis patients complicated with pulmonary infection group (Non-P group) in pulmonary flora, while P< 0.01 for β diversity analysis, and the differential species between the two groups were Mycobacterium colombiense and Fusobacterium nucleatum. In addition, we monitored a high distribution of Malassezia and Pneumocystis in the P group, while herpes virus was detected in the majority of samples. Conclusions Overall, we not only revealed a comprehensive lung microbiome profile of pneumoconiosis patients, but also compared the differences between their microbiome and that of non-pneumoconiosis complicated with pulmonary infection patients. This provides a good basis for a better understanding of the relationship between pneumoconiosis and microorganisms, and for the search of potential biomarkers.
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Affiliation(s)
- Xingya Yuan
- Department of Respiratory Medicine, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Linshen Xie
- Department of Respiratory Medicine, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Min Zhou
- Department of Respiratory Medicine, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Sun G, Liu W, Zheng Q, Shan Q, Hou H. Ratio of procalcitonin/Simpson's dominance index predicted the short-term prognosis of patients with severe bacterial pneumonia. Front Cell Infect Microbiol 2023; 13:1175747. [PMID: 37465762 PMCID: PMC10350521 DOI: 10.3389/fcimb.2023.1175747] [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: 02/28/2023] [Accepted: 06/12/2023] [Indexed: 07/20/2023] Open
Abstract
Objective The aim of this study was to explore the predictive value of the ratio of procalcitonin (PCT) in serum to Simpson's dominance index (SDI) in bronchoalveolar lavage fluid (BALF), in short-term prognosis of patients with severe bacterial pneumonia (SBP). Methods This is a retrospective review of case materials of 110 patients with SBP who selected BALF metagenomic next-generation sequencing technique in the intensive care unit (ICU) of the Affiliated Hospital of Yangzhou University from January 2019 and July 2022. Based on the acute physiology and chronic health status score II, within 24 h after admission to the ICU, patients were divided into a non-critical group (n = 40) and a critical group (n = 70). Taking death caused by bacterial pneumonia as the endpoint event, the 28-day prognosis was recorded, and the patients were divided into a survival group (n = 76) and a death group (n = 34). The SDI, PCT, C-reactive protein (CRP), PCT/SDI, and CRP/SDI were compared and analyzed. Results Compared with the non-critical group, the critical group had a higher PCT level, a greater PCT/SDI ratio, a longer ventilator-assisted ventilation time (VAVT), and more deaths in 28 days. Compared with the survivors, the death group had a higher PCT level, a lower SDI level, and a greater PCT/SDI ratio. The SDI level was significantly negatively correlated with the VAVT (r = -0.675, p < 0.05), while the PCT level, ratio of PCT/SDI, and ratio of CRP/SDI were remarkably positively correlated with VAVT (r = 0.669, 0.749, and 0.718, respectively, p < 0.05). The receiver operating characteristic (ROC) curves analysis showed that the area under ROC curves of PCT/SDI predicting patient death within 28 days was 0.851, followed by PCT + SDI, PCT, SDI, and CRP/SDI (0.845, 0.811, 0.778, and 0.720, respectively). The sensitivity and specificity of PCT/SDI for predicting death were 94.1% and 65.8%, respectively, at the optimal value (11.56). Cox regression analysis displayed that PCT/SDI (HR = 1.562; 95% CI: 1.271 to 1.920; p = 0.039) and PCT (HR = 1.148; 95% CI: 1.105 to 1.314; p = 0.015) were independent predictors of death in patients. Conclusion The ratio of PCT/SDI was a more valuable marker in predicting the 28-day prognosis in patients with SBP.
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Affiliation(s)
- Guoxian Sun
- Department of Infection Control, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Weili Liu
- Department of Critical Care Unit, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Qingbin Zheng
- Department of Critical Care Unit, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Qing Shan
- Department of Infection Control, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Hongling Hou
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
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Alnimr A. Antimicrobial Resistance in Ventilator-Associated Pneumonia: Predictive Microbiology and Evidence-Based Therapy. Infect Dis Ther 2023:10.1007/s40121-023-00820-2. [PMID: 37273072 DOI: 10.1007/s40121-023-00820-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) is a serious intensive care unit (ICU)-related infection in mechanically ventilated patients that is frequent, as more than half of antibiotics prescriptions in ICU are due to VAP. Various risk factors and diagnostic criteria for VAP have been referred to in different settings. The estimated attributable mortality of VAP can go up to 50%, which is higher in cases of antimicrobial-resistant VAP. When the diagnosis of pneumonia in a mechanically ventilated patient is made, initiation of effective antimicrobial therapy must be prompt. Microbiological diagnosis of VAP is required to optimize timely therapy since effective early treatment is fundamental for better outcomes, with controversy continuing regarding optimal sampling and testing. Understanding the role of antimicrobial resistance in the context of VAP is crucial in the era of continuously evolving antimicrobial-resistant clones that represent an urgent threat to global health. This review is focused on the risk factors for antimicrobial resistance in adult VAP and its novel microbiological tools. It aims to summarize the current evidence-based knowledge about the mechanisms of resistance in VAP caused by multidrug-resistant bacteria in clinical settings with focus on Gram-negative pathogens. It highlights the evidence-based antimicrobial management and prevention of drug-resistant VAP. It also addresses emerging concepts related to predictive microbiology in VAP and sheds lights on VAP in the context of coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Amani Alnimr
- Department of Microbiology, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
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Han J, Li D, Rao Y, Wang G. Bundle management strategy in reducing hospital-acquired pneumonia in hospitalized patients with mental disorders. Front Psychiatry 2023; 14:1184999. [PMID: 37333920 PMCID: PMC10272589 DOI: 10.3389/fpsyt.2023.1184999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction The incidence of hospital-acquired pneumonia (HAP) is high in the medical setting for mental disorders. To date, effective measurements for preventing HAP in hospitalized mental disorder patients are unavailable. Methods This study was conducted at the Large-Scale Mental Health Center of Renmin Hospital of Wuhan University (Wuhan, China) in two phases: baseline phase (January 2017-December 2019) and intervention phase (May 2020-April 2022). In the intervention phase, the HAP bundle management strategy was implemented in the Mental Health Center, and the data on HAP were collected continuously for analysis. Results A total of 18,795 and 9,618 patients were included in the baseline and intervention phases, respectively. The age, gender, ward admitted to, type of mental disorder, and Charlson comorbidity index did not differ significantly. After intervention, the rate of HAP occurrence decreased from 0.95 to 0.52% (P < 0.001). Specifically, the HAP rate decreased from 1.70 to 0.95% (P = 0.007) in the closed ward and from 0.63 to 0.35% (P = 0.009) in the open ward. The HAP rate in the subgroups was higher in patients with schizophrenia spectrum disorders (1.66 vs. 0.74%) and organic mental disorders (4.92 vs. 1.41%), and in those ≥65 years old (2.82 vs. 1.11%) but decreased significantly after intervention (all P < 0.05). Conclusion The implementation of the HAP bundle management strategy reduced the occurrence of HAP in hospitalized patients with mental disorders.
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Affiliation(s)
- Jingjing Han
- Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Dan Li
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yan Rao
- Animal Biosafety Level III Laboratory at the Center for Animal Experiment, Wuhan University School of Medicine, Wuhan, Hubei, China
| | - Gaohua Wang
- Insititute of Neuropsychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Han Y, Zuo Y, Luo Z, Ju M, Hua J, He B, Wu Y, Zhang J. Positive sputum culture of Candida spp . as a risk factor for 30-day mortality in patients with hospital-acquired pneumonia: A propensity-score matched retrospective clinical study. CHINESE MEDICAL JOURNAL PULMONARY AND CRITICAL CARE MEDICINE 2023; 1:113-118. [PMID: 39170823 PMCID: PMC11332850 DOI: 10.1016/j.pccm.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Indexed: 08/23/2024]
Abstract
Background Candida species (Candida spp.) are commonly isolated microorganisms from lower respiratory tract (LRT) specimens of patients with hospital-acquired pneumonia (HAP); however, the clinical significance remains controversial. This study aimed to investigate the correlation between Candida spp. in the LRT and the clinical features and prognosis of HAP. Methods This retrospective analysis included eligible patients with HAP from the database of a prospective study carried out between 2018 and 2019 in nine Chinese hospitals. Data on demographics, clinical characteristics, and prognosis were collected and analyzed. Propensity score matching (PSM) was used to balance the baseline characteristics. Results A total of 187 HAP patients were enrolled. After PSM of severity score, 27 cases with positive sputum culture of Candida spp. were compared with the control group at a ratio of 1:1. The Candida-positive group had more bacterial isolates in blood culture than the Candida-negative group (39.1% [9/23] vs. 7.7% [2/26],χ 2 = 6.928, effect size [ES] = 0.38, 95% CI: 0.12-0.61, P = 0.008). The proportion of patients with chronic lung diseases was significantly higher in the Candida-positive group (55.6% [15/27] vs. 22.2% [6/27],χ 2 = 6.312, ES = 0.34, 95% CI: 0.07-0.59, P = 0.012). The 30-day prognosis of HAP was significantly different between the two groups (80.8% [21/26] vs. 38.5% [10/26],χ 2 = 9.665, ES = 0.43, 95% CI: 0.19-0.66, P = 0.002). Univariable logistic regression analysis showed that LRT Candida spp. colonization was a risk factor for 30-day mortality of HAP (OR = 6.720, 95% CI: 1.915-23.577, P = 0.003). Conclusions Candida spp. in the LRT was associated with 30-day mortality of HAP. Patients with chronic underlying lung diseases tend to have Candida spp. colonization.
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Affiliation(s)
- Yaopin Han
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yihui Zuo
- Department of Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Minjie Ju
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jianlan Hua
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Binfeng He
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yixing Wu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Yadollahi M, Shams AH, Norouzi M, Feizi M. Evaluation of the Risk Factors of Nosocomial Pneumonia and the Prevalence of Antibiotic Resistance in Trauma Patients in Need of Immediate Intervention. Surg Infect (Larchmt) 2023; 24:358-365. [PMID: 36946788 DOI: 10.1089/sur.2022.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Background: Pneumonia is the most common nosocomial infection reported worldwide in intensive care units. This study aimed to evaluate the risk factors of nosocomial pneumonia and the frequency of antibiotic resistance in trauma patients who need immediate intervention. Patients and Methods: This prospective cohort study was conducted in Shahid Rajaei Trauma Hospital in Shiraz between 2020 and 2021. All the trauma patients who needed immediate intervention (levels 1 and 2 based on the Canadian Emergency Department Triage and Acuity Scale) and had no symptoms of infection were included. Patients who were discharged or died before 48 hours were excluded. Results: The results demonstrated that major trauma (Injury Severity Score [ISS] ≥16), intubation, and use of invasive mechanical ventilation increase nosocomial pneumonia and death rate. The most common causes of nosocomial infections were Acinetobacter baumannii (23%) and coagulase-negative staphylococcus (18.5%). The highest levels of antibiotic resistance were related to cefoxitin, erythromycin, ciprofloxacin, and trimethoprim-sulfamethoxazole. Conclusions: Major trauma, intubation, and invasive mechanical ventilation were the effective factors in the development of nosocomial pneumonia. Continuous monitoring for mentioned risk factors and strict surveillance of antibiotic prescription can decrease the prevalence of nosocomial infections and subsequent deaths.
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Affiliation(s)
- Mahnaz Yadollahi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Hossein Shams
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Norouzi
- Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Monireh Feizi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Xia G, Sun S, Zhou S, Li L, Li X, Zou G, Huang C, Li J, Zhang Z. A new model for predicting the outcome and effectiveness of drug therapy in patients with severe fever with thrombocytopenia syndrome: A multicenter Chinese study. PLoS Negl Trop Dis 2023; 17:e0011158. [PMID: 36877734 PMCID: PMC10019728 DOI: 10.1371/journal.pntd.0011158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 03/16/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND There are a few models for predicting the outcomes of patients with severe fever with thrombocytopenia syndrome (SFTS) based on single-center data, but clinicians need more reliable models based on multicenter data to predict the clinical outcomes and effectiveness of drug therapy. METHODOLOGY/PRINCIPAL FINDINGS This retrospective multicenter study analyzed data from 377 patients with SFTS, including a modeling group and a validation group. In the modeling group, the presence of neurologic symptoms was a strong predictor of mortality (odds ratio: 168). Based on neurologic symptoms and the joint indices score, which included age, gastrointestinal bleeding, and the SFTS virus viral load, patients were divided into double-positive, single-positive, and double-negative groups, which had mortality rates of 79.3%, 6.8%, and 0%, respectively. Validation using data on 216 cases from two other hospitals yielded similar results. A subgroup analysis revealed that ribavirin had a significant effect on mortality in the single-positive group (P = 0.006), but not in the double-positive or double-negative group. In the single-positive group, prompt antibiotic use was associated with reduced mortality (7.2% vs 47.4%, P < 0.001), even in individuals without significant granulocytopenia and infection, and early prophylaxis was associated with reduced mortality (9.0% vs. 22.8%, P = 0.008). The infected group included SFTS patients with pneumonia or sepsis, while the noninfected group included patients with no signs of infection. The white blood cell count and levels of C-reactive protein and procalcitonin differed significantly between the infection and non-infection groups (P = 0.020, P = 0.011, and P = 0.003, respectively), although the absolute difference in the medians were small. CONCLUSIONS/SIGNIFICANCE We developed a simple model to predict mortality in patients with SFTS. Our model may help to evaluate the effectiveness of drugs in these patients. In patients with severe SFTS, ribavirin and antibiotics may reduce mortality.
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Affiliation(s)
- Guomei Xia
- Institute of Clinical Virology, Department of Infectious Diseases, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shanshan Sun
- Institute of Clinical Virology, Department of Infectious Diseases, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shijun Zhou
- Institute of Clinical Virology, Department of Infectious Diseases, The Second Hospital of Anhui Medical University, Hefei, China
| | - Lei Li
- Department of Infectious Diseases, Anhui Provincial Hospital of Anhui Medical University, Hefei, China
| | - Xu Li
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guizhou Zou
- Institute of Clinical Virology, Department of Infectious Diseases, The Second Hospital of Anhui Medical University, Hefei, China
| | - Cheng Huang
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, China
| | - Jun Li
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, China
| | - Zhenhua Zhang
- Institute of Clinical Virology, Department of Infectious Diseases, The Second Hospital of Anhui Medical University, Hefei, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, China
- * E-mail:
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20
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Rawson TM, Antcliffe DB, Wilson RC, Abdolrasouli A, Moore LSP. Management of Bacterial and Fungal Infections in the ICU: Diagnosis, Treatment, and Prevention Recommendations. Infect Drug Resist 2023; 16:2709-2726. [PMID: 37168515 PMCID: PMC10166098 DOI: 10.2147/idr.s390946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/22/2023] [Indexed: 05/13/2023] Open
Abstract
Bacterial and fungal infections are common issues for patients in the intensive care unit (ICU). Large, multinational point prevalence surveys have identified that up to 50% of ICU patients have a diagnosis of bacterial or fungal infection at any one time. Infection in the ICU is associated with its own challenges. Causative organisms often harbour intrinsic and acquired mechanisms of drug-resistance, making empiric and targeted antimicrobial selection challenging. Infection in the ICU is associated with worse clinical outcomes for patients. We review the epidemiology of bacterial and fungal infection in the ICU. We discuss risk factors for acquisition, approaches to diagnosis and management, and common strategies for the prevention of infection.
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Affiliation(s)
- Timothy M Rawson
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Hammersmith Hospital, London, UK
- Centre for Antimicrobial Optimisation, Imperial College London, Imperial College London, London, UK
- David Price Evan’s Group in Infectious Diseases and Global Health, Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Correspondence: Timothy M Rawson, Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Hammersmith Hospital, Du Cane Road, London, W12 0NN, United Kingdom, Email
| | - David B Antcliffe
- Centre for Antimicrobial Optimisation, Imperial College London, Imperial College London, London, UK
- Division Anaesthesia, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Richard C Wilson
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Hammersmith Hospital, London, UK
- Centre for Antimicrobial Optimisation, Imperial College London, Imperial College London, London, UK
- David Price Evan’s Group in Infectious Diseases and Global Health, Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | | | - Luke S P Moore
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Hammersmith Hospital, London, UK
- Chelsea & Westminster NHS Foundation Trust, London, UK
- North West London Pathology, Imperial College Healthcare NHS Trust, London, UK
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21
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Muacevic A, Adler JR, Alghamdi R, Alsharif R, Kurdi L, Kamfar S, Alzahrani F, Maimani L. Risk Factors of Hospital-Acquired Pneumonia Among Hospitalized Patients With Cardiac Diseases. Cureus 2023; 15:e34253. [PMID: 36726767 PMCID: PMC9886362 DOI: 10.7759/cureus.34253] [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] [Accepted: 01/26/2023] [Indexed: 01/28/2023] Open
Abstract
Background To our knowledge, no studies have been done in Saudi Arabia to determine the risk factors of hospital-acquired pneumonia (HAP) among hospitalized cardiac patients. This study aimed to assess these risk factors. Methods A retrospective study was done at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Five hundred hospitalized patients diagnosed with pre-existing cardiovascular disease (CVD) were included. A checklist was used to collect data about patients' demographic characteristics; BMI; smoking and alcohol abuse; type of cardiac disease; other chronic diseases; exposure to immunosuppressives; chemotherapy and radiotherapy in the last six months; glucocorticoid use; application of ventilator; initial, follow-up chest X-ray results; pneumonia vaccination status; nasogastric tube use; general anesthesia received; use of loop diuretics; presence of pulmonary diseases; levels of WBC, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP); results of blood and respiratory cultures; number of hospitalizations and intensive care unit (ICU) admissions in the last six months; and Richmond Agitation and Sedation Scale (RASS) score. Results The prevalence of pneumonia was 7%. Females; patients with autoimmune diseases who were exposed to immunosuppressives or glucocorticoids; those with an initial or second abnormal chest X-ray; patients who used nasogastric tube, had pulmonary disease, and had high levels of WBC, ESR, or CRP; and patients hospitalized for more than two times had a significantly higher percentage of having pneumonia. Abnormal second chest X-ray, high ESR, and more than two times of hospitalization within the last six months were the risk factors of pneumonia on multivariate logistic regression analysis. Conclusion Better prevention and intervention programs are needed to assess the risk factors of pneumonia among admitted cardiac patients.
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22
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Lau VI, Xie F, Fowler RA, Rochwerg B, Johnstone J, Lauzier F, Marshall JC, Basmaji J, Henderson W, Khwaja K, Loubani O, Niven DJ, Zarychanski R, Arabi YM, Cartin-Ceba R, Thabane L, Heels-Ansdell D, Cook DJ. Health economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (E-PROSPECT): a cost-effectiveness analysis. Can J Anaesth 2022; 69:1515-1526. [PMID: 36289153 DOI: 10.1007/s12630-022-02335-9] [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: 04/27/2022] [Revised: 06/06/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We sought to compare the cost-effectiveness of probiotics and usual care with usual care without probiotics in mechanically ventilated, intensive care unit patients alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT). METHODS We conducted a health economic evaluation alongside the PROSPECT randomized control trial (October 2013-March 2019). We adopted a public healthcare payer's perspective. Forty-four intensive care units in three countries (Canada/USA/Saudi Arabia) with adult critically ill, mechanically ventilated patients (N = 2,650) were included. Interventions were probiotics (Lactobacillus rhamnosus GG) vs placebo administered enterally twice daily. We collected healthcare resource use and estimated unit costs in 2019 United States dollars (USD) over a time horizon from randomization to hospital discharge/death. We calculated incremental cost-effectiveness ratios (ICERs) comparing probiotics vs usual care. The primary outcome was incremental cost per ventilator-associated pneumonia (VAP) event averted; secondary outcomes were costs per Clostridioides difficile-associated diarrhea (CDAD), antibiotic-associated diarrhea (AAD), and mortality averted. Uncertainty was investigated using nonparametric bootstrapping and sensitivity analyses. RESULTS Mean (standard deviation [SD]) cost per patient was USD 66,914 (91,098) for patients randomized to probiotics, with a median [interquartile range (IQR)] of USD 42,947 [22,239 to 76,205]. By comparison, for those not receiving probiotics, mean (SD) cost per patient was USD 62,701 (78,676) (median [IQR], USD 41,102 [23,170 to 75,140]; incremental cost, USD 4,213; 95% confidence interval [CI], -2,269 to 10,708). Incremental cost-effectiveness ratios for VAP or AAD events averted, probiotics were dominated by usual care (more expensive, with similar effectiveness). The ICERs were USD 1,473,400 per CDAD event averted (95% CI, undefined) and USD 396,764 per death averted (95% CI, undefined). Cost-effectiveness acceptability curves reveal that probiotics were not cost-effective across wide ranges of plausible willingness-to-pay thresholds. Sensitivity analyses did not change the conclusions. CONCLUSIONS Probiotics for VAP prevention among critically ill patients were not cost-effective. Study registration data www. CLINICALTRIALS gov (NCT01782755); registered 4 February 2013.
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Affiliation(s)
- Vincent I Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. .,Department of Critical Care, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 Street, Edmonton, AB, Canada.
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Programs for Health Economics and Outcomes Measures, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jennie Johnstone
- Department of Infection Prevention and Control, Sinai Health, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - François Lauzier
- Departments of Medicine, Anesthesiology & Critical Care, Université Laval, Quebec, QC, Canada
| | - John C Marshall
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - John Basmaji
- Division of Critical Care Medicine, Department of Medicine, Western University, London, ON, Canada
| | - William Henderson
- Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kosar Khwaja
- Departments of Surgery and Critical Care Medicine, McGill University, Montreal, QC, Canada
| | - Osama Loubani
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ryan Zarychanski
- Sections of Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Yaseen M Arabi
- Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Rodrigo Cartin-Ceba
- Division of Pulmonary Medicine and Critical Care, Department of Critical Care, Mayo Clinic, Phoenix, AZ, USA
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
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23
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Zhang J, Cheng Q, Huang Y, Fan H, Lai G, Mu X, Sha W, She D, Shen N, Su X, Xu J, Ye F, Tian X, Zhang T, Zhou H, Liu Y, He L, Xiao H, He B, Shi Y, Zhang X, Cao B, Qu J. Executive summary of Chinese expert consensus for topical application of anti-microbial agents for lower respiratory tract infection in adults. Chin Med J (Engl) 2022; 135:2653-2655. [PMID: 36574216 PMCID: PMC9945566 DOI: 10.1097/cm9.0000000000002472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qijian Cheng
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yi Huang
- Department of Pulmonary and Critical Care Medicine, Shanghai Changhai hospital, Navy Medical University, Shanghai 200433, China
| | - Hong Fan
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Guoxiang Lai
- Department of Respiratory and Critical Care Medicine, The Second Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350003, China
| | - Xiangdong Mu
- Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Wei Sha
- Department of Pulmonary Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Danyang She
- Department of Pulmonary and Critical Care Medicine, The First Medical Center of the General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Ning Shen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Xin Su
- Department of Pulmonary and Critical Care Medicine, Nanjing Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Jinfu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Xinlun Tian
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100032, China
| | - Tiantuo Zhang
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Hua Zhou
- Department of Pulmonary Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Youning Liu
- Department of Pulmonary and Critical Care Medicine, The General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Lixian He
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Heping Xiao
- Department of Pulmonary Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Bei He
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Yi Shi
- Department of Pulmonary and Critical Care Medicine, Nanjing Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Xiangyan Zhang
- Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Capital Medical University, Beijing 100029, China
| | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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24
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Zha L, Li X, Ren Z, Zhang D, Zou Y, Pan L, Li S, Chen S, Tefsen B. Pragmatic Comparison of Piperacillin/Tazobactam versus Carbapenems in Treating Patients with Nosocomial Pneumonia Caused by Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae. Antibiotics (Basel) 2022; 11:antibiotics11101384. [PMID: 36290042 PMCID: PMC9598608 DOI: 10.3390/antibiotics11101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
The effectiveness of piperacillin/tazobactam for managing nosocomial pneumonia caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is unknown. To answer this question, we conducted a retrospective cohort study in two tertiary teaching hospitals of patients admitted between January 2018 and July 2021 with a diagnosis of nosocomial pneumonia caused by ESBL-producing K. pneumoniae receiving either piperacillin/tazobactam or carbapenems within 24 h from the onset of pneumonia for at least 72 h. Clinical outcomes, including 28-day mortality and 14-day clinical and microbiological cure, were analyzed. Of the 136 total patients, 64 received piperacillin/tazobactam and 72 received carbapenems. The overall 28-day mortality was 19.1% (26/136). In the inverse probability of treatment weighted cohort, piperacillin/tazobactam therapy was not associated with worse clinical outcomes, as the 28-day mortality (OR, 0.82, 95% CI, 0.23–2.87, p = 0.748), clinical cure (OR, 0.94, 95% CI, 0.38–2.35, p = 0.894), and microbiological cure (OR, 1.10, 95% CI, 0.53–2.30, p = 0.798) were comparable to those of carbapenems. Subgroup analyses also did not demonstrate any statistical differences. In conclusion, piperacillin/tazobactam could be an effective alternative to carbapenems for treating nosocomial pneumonia due to ESBL-producing K. pneumoniae when the MICs are ≤8 mg/L.
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Affiliation(s)
- Lei Zha
- Intensive Care Unit, Conch Hospital of Anhui Medical University, Wuhu 241000, China
- Department of Biological Sciences, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK
- Correspondence: (L.Z.); (B.T.)
| | - Xiang Li
- Postgraduate School, Wannan Medical College, Wuhu 241000, China
| | - Zhichu Ren
- Postgraduate School, Wannan Medical College, Wuhu 241000, China
| | - Dayan Zhang
- Postgraduate School, Wannan Medical College, Wuhu 241000, China
| | - Yi Zou
- Postgraduate School, Wannan Medical College, Wuhu 241000, China
| | - Lingling Pan
- Cardiology Department, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China
| | - Shirong Li
- Pulmonary and Critical Care Department, The Second People’s Hospital of Wuhu, Wuhu 241000, China
| | - Shanghua Chen
- Intensive Care Unit, The Second People’s Hospital of Wuhu, Wuhu 241000, China
| | - Boris Tefsen
- Department of Molecular Microbiology, Utrecht University, 3584 CH Utrecht, The Netherlands
- Natural Sciences, Ronin Institute, Montclair, NJ 07043, USA
- Correspondence: (L.Z.); (B.T.)
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25
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Clinical value of serum sTREM-1 and HBP levels in combination with traditional inflammatory markers in diagnosing hospital-acquired pneumonia in elderly. BMC Infect Dis 2022; 22:773. [PMID: 36195852 PMCID: PMC9531631 DOI: 10.1186/s12879-022-07758-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background The clinical presentation of hospital-acquired pneumonia (HAP) in older patients is often complex and non-specific, posing a diagnostic challenge. This study evaluates the value of serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and heparin-binding protein (HBP) in combination with traditional inflammatory markers procalcitonin (PCT) and C-reactive protein (CRP) in diagnosing HAP in older patients. Methods Thirty-eight elderly male patients with HAP (≥ 80 years old) and 46 age-matched controls, who were hospitalized for other reasons than HAP, were enrolled. The serum sTREM-1, HBP, PCT and CRP levels were measured by ELISA on the first day after enrollment. In addition, routine blood test, blood gas, sputum analysis, clinical pulmonary infection score (CPIS) assessment, and chest X-ray were performed, and the correlations with HAP were analyzed. Results The serum sTREM-1 (n = 38, 170.75 ± 158.33 pg/ml), HBP (2.08 ± 0.50), PCT (9.44 ± 17.73) and CRP (79.63 ± 71.37) were all significantly higher in the HAP group, when compared to the control group (P < 0.05). Furthermore, the values were positively correlated with the CPIS. The ROC curve analysis revealed that the AUC for sTREM-1 (0.667) and HBP (0.711) were lower, when compared to that for PCT (AUC = 0.839) and CRP (AUC = 0.840). The combination of PCT and CRP with sTREM-1 (AUC = 0.927) or HBP (AUC = 0.930) had the highest AUC values. Conclusion Serum sTREM-1, HBP, PCT and CRP can all be used as diagnostic markers for HAP in the elderly. The combination of traditional inflammatory markers PCT and CRP with novel inflammatory marker sTREM-1 or HBP further improves the diagnostic performance.
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Feng DY, Zhou JX, Li X, Wu WB, Zhou YQ, Zhang TT. Differentiation Between Acinetobacter Baumannii Colonization and Infection and the Clinical Outcome Prediction by Infection in Lower Respiratory Tract. Infect Drug Resist 2022; 15:5401-5409. [PMID: 36119640 PMCID: PMC9480586 DOI: 10.2147/idr.s377480] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Acinetobacter baumannii is the most common microorganism in sputum cultures from long-term hospitalized patients and is often the cause of hospital-acquired pneumonia (HAP), which is usually associated with poor prognosis and high mortality. It is sometimes difficult to distinguish between A. baumannii infection and colonization. This study aimed to evaluate factors that differentiate infection from colonization and predict mortality in patients with nosocomial pneumonia caused by A. baumannii. Patients and Methods The data used in this study were collected in our hospital between January 2018 and December 2020 from patients whose sputum cultures were positive for A. baumannii. Results A total of 714 patients were included, with 571 in the infection group and 143 in the colonization group. The in-hospital mortality rate in the infection group was 20.5%. Univariate and multivariate logistic regression analyses showed that age, total number of inpatient departments, absolute neutrophil count, and C-reactive protein (CRP) level helped distinguish between infection and colonization. The area under the receiver operating characteristic curve (ROC) of the identification model was 0.694. In the infection group, age, Charlson comorbidity score, neutrophil-to-lymphocyte ratio, blood urea nitrogen/albumin ratio, CRP level, presence of multidrug resistance, and clinical pulmonary infection score (≥6) ratio were associated with in-hospital mortality. The area under the ROC curve for the prediction model was 0.828. The top three drug resistance rates in the infection group were 100% (cefazolin), 98.77% (ceftriaxone), and 71.8% (cefuroxime). Conclusion The combination of common parameters helps identify A. baumannii respiratory tract infection or colonization. Several novel predictors can be used to predict the risk of death from A. baumannii pneumonia to reduce mortality. The drug resistance of A. baumannii remains high.
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Affiliation(s)
- Ding-Yun Feng
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jian-Xia Zhou
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xia Li
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Wen-Bin Wu
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yu-Qi Zhou
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Tian-Tuo Zhang
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
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27
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Hoşgün D, Aydemir S. Factors affecting 90-day mortality in community and hospital acquired pneumonia patients with or without acute kidney injury. Afr Health Sci 2022; 22:567-577. [PMID: 36910350 PMCID: PMC9993250 DOI: 10.4314/ahs.v22i3.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background AKI is a significant risk factor for mortality. Inflammatory markers are commonly used in the prediction of prognosis in pneumonia patients. The present study aimed to evaluate the prevalence of AKI in hospitalized CAP and HAP patients and to investigate the role of inexpensive, practical, routinely measured serum biomarkers in predicting 90-day mortality. Materials and Methods The retrospective study included 381 patients in CAP patients and HAP patients who were hospitalized in our Chest Diseases clinic or ICU. Results Ninety-day mortality occurred in 115 (30.2%) patients (CAP, 28.7%; HAP, 34.7%). AKI was detected in 25.5% of the patients. On multivariate logistic regression analysis, the 90-day mortality risk was 0.931, 1.05, 0.607, and 1.999 times greater in patients with an increased APACHE II score and increased WBC, 1-h creatinine, and 48-h creatinine levels, respectively. In CAP patients, the 90-day mortality risk was 0.296, 0.539, and 1.966 times greater in patients with an increased CURB-65 score and elevated 1-h and 48-h creatinine levels, respectively. In HAP patients, however, the 90-day mortality risk was 3.554 times greater in patients with an increased 48-h creatinine level. Conclusion Novel practical scoring systems based on serum creatinine levels are needed for the prediction of long-term prognosis in pneumonia patients.
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Affiliation(s)
- Derya Hoşgün
- Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Intensive Care Unit, Ankara, Turkey. (Chest Disease Specialist , İntensive Care Specialist)
| | - Semih Aydemir
- Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Intensive Care Unit, Ankara, Turkey. (Anaesthesiology and Reanimation Specialist)
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Sun T, Liu Y, Cai Y, Zhai T, Zhou Y, Yang B, Wu X, Zhan Q. A Paired Comparison of Plasma and Bronchoalveolar Lavage Fluid for Metagenomic Next-Generation Sequencing in Critically Ill Patients with Suspected Severe Pneumonia. Infect Drug Resist 2022; 15:4369-4379. [PMID: 35971554 PMCID: PMC9375561 DOI: 10.2147/idr.s374906] [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: 05/16/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Plasma metagenomic next-generation sequencing (mNGS) has emerged as an attractive and minimally invasive technique for pathogen detection. However, few studies have demonstrated the need for simultaneous plasma and bronchoalveolar lavage fluid (BALF) mNGS in patients with severe pneumonia. Patients and Methods This study retrospectively performed a paired comparison of BALF and plasma mNGS in critically ill patients with suspected severe pneumonia from April 2019 to December 2020. The diagnostic performance of BALF and plasma mNGS was compared using the clinical composite diagnosis as the reference standard. Results In total, 57 patients were included in this study. Patients with positive plasma mNGS had shorter hospital stay days at the time of specimen acquisition (4.5 vs 11, P = 0.028) and a higher positivity rate of BALF culture (50% vs 22.9%, P = 0.033) than patients with negative plasma mNGS. Fifty-three patients (93%) were finally diagnosed with severe pneumonia. Significant differences were observed in the sensitivity of BALF and plasma mNGS (100% vs 42%, P < 0.001), and the diagnostic accuracy was 96% and 46%, respectively. The proportion of virus in positive plasma mNGS results was higher than that in BALF mNGS (23% vs 11%, P = 0.173) without significant difference. Although plasma mNGS detected additional microorganisms in 11/53 patients, the beneficial effect was observed in only 5/53 (9%) patients. Conclusion In this study, the clinical effect of simultaneously conducting mNGS of BALF and plasma samples was found to be limited. For patients with the suspected virus infection, plasma mNGS may be a supplementary test. Further studies are needed to identify the optimal indications for plasma mNGS.
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Affiliation(s)
- Ting Sun
- Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, People's Republic of China
| | - Yijie Liu
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Ying Cai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Tianshu Zhai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Yun Zhou
- Laboratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Bin Yang
- Vision Medicals Center for Infection Diseases, Guangzhou, People's Republic of China
| | - Xiaojing Wu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Qingyuan Zhan
- Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, People's Republic of China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
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Huang Y, Wang W, Huang Q, Wang Z, Xu Z, Tu C, Wan D, He M, Yang X, Xu H, Wang H, Zhao Y, Tu M, Zhou Q. Clinical Efficacy and In Vitro Drug Sensitivity Test Results of Azithromycin Combined With Other Antimicrobial Therapies in the Treatment of MDR P. aeruginosa Ventilator-Associated Pneumonia. Front Pharmacol 2022; 13:944965. [PMID: 36034783 PMCID: PMC9399346 DOI: 10.3389/fphar.2022.944965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of the research was to study the effect of azithromycin (AZM) in the treatment of MDR P. aeruginosa VAP combined with other antimicrobial therapies. Methods: The clinical outcomes were retrospectively collected and analyzed to elucidate the efficacy of different combinations involving azithromycin in the treatment of MDR-PA VAP. The minimal inhibitory concentration (MIC) of five drugs was measured by the agar dilution method against 27 isolates of MDR-PA, alone or in combination. Results: The incidence of VAP has increased approximately to 10.4% (961/9245) in 5 years and 18.4% (177/961) caused by P. aeruginosa ranking fourth. A total of 151 cases of MDR P. aeruginosa were included in the clinical retrospective study. Clinical efficacy results are as follows: meropenem + azithromycin (MEM + AZM) was 69.2% (9/13), cefoperazone/sulbactam + azithromycin (SCF + AZM) was 60% (6/10), and the combination of three drugs containing AZM was 69.2% (9/13). The curative effect of meropenem + amikacin (MEM + AMK) was better than that of the meropenem + levofloxacin (MEM + LEV) group, p = 0.029 (p < 0.05). The curative effect of cefoperazone/sulbactam + amikacin (SCF + AMK) was better than that of the cefoperazone/sulbactam + levofloxacin (SCF + LEV) group, p = 0.025 (p < 0.05). There was no significant difference between combinations of two or three drugs containing AZM, p > 0.05 (p = 0.806). From the MIC results, the AMK single drug was already very sensitive to the selected strains. When MEM or SCF was combined with AZM, the sensitivity of them to strains can be significantly increased. When combined with MEM and AZM, the MIC50 and MIC90 of MEM decreased to 1 and 2 ug/mL from 8 to 32 ug/mL. When combined with SCF + AZM, the MIC50 of SCF decreased to 16 ug/mL, and the curve shifted obviously. However, for the combination of SCF + LEV + AZM, MIC50 and MIC90 could not achieve substantive changes. From the FIC index results, the main actions of MEM + AZM were additive effects, accounting for 72%; for the combination of SCF + AZM, the additive effect was 40%. The combination of AMK or LEV with AZM mainly showed unrelated effects, and the combination of three drugs could not improve the positive correlation between LEV and AZM. Conclusion: AZM may increase the effect of MEM or SCF against MDR P. aeruginosa VAP. Based on MEM or SCF combined with AMK or AZM, we can achieve a good effect in the treatment of MDR P. aeruginosa VAP.
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Affiliation(s)
- Yuqin Huang
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Wenguo Wang
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Qiang Huang
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Zhengyan Wang
- Department of Respiratory Medicine, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Zhuanzhuan Xu
- Department of Respiratory Medicine, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Chaochao Tu
- Department of Respiratory Medicine, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Dongli Wan
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Miaobo He
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Xiaoyi Yang
- Department of Medicine, First Clinical School, Guangzhou Medical University, Guangzhou, China
| | - Huaqiang Xu
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
- *Correspondence: Huaqiang Xu, ; Hanqin Wang, ; Ying Zhao, ; Mingli Tu, ; Quan Zhou,
| | - Hanqin Wang
- Center for Translational Medicine, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
- *Correspondence: Huaqiang Xu, ; Hanqin Wang, ; Ying Zhao, ; Mingli Tu, ; Quan Zhou,
| | - Ying Zhao
- Department of Clinical Laboratory, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- *Correspondence: Huaqiang Xu, ; Hanqin Wang, ; Ying Zhao, ; Mingli Tu, ; Quan Zhou,
| | - Mingli Tu
- Department of Respiratory Medicine, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
- *Correspondence: Huaqiang Xu, ; Hanqin Wang, ; Ying Zhao, ; Mingli Tu, ; Quan Zhou,
| | - Quan Zhou
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
- *Correspondence: Huaqiang Xu, ; Hanqin Wang, ; Ying Zhao, ; Mingli Tu, ; Quan Zhou,
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Liu W, Pu Y, Zhu C, Qin A. Establishment of a scoring model for early diagnosis of infection associated with liver failure. Ann Hepatol 2022; 27:100713. [PMID: 35500804 DOI: 10.1016/j.aohep.2022.100713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Infection is a common complication of liver failure. Serum inflammatory markers used to diagnose infection have sufficient diagnostic sensitivity but low specificity. This study aimed to improve the early diagnosis of infections in liver failure patients by developing a diagnostic model and evaluating its predictive ability. PATIENTS AND METHODS A retrospective analysis of clinical data from liver failure patients. Cases were divided into infected and non-infected groups according to their clinical diagnosis. Nine infection-related predictors (age, body temperature, neutrophil ratio (NE%), procalcitonin (PCT), C-reactive protein (CRP), lactic acid (Lac), serum albumin (Alb), model of end-stage liver disease (MELD) score, and sequential organ failure assessment (SOFA) score) were included in multivariate logistic regression analysis. The diagnostic model was validated, and the receiver operating characteristic (ROC) curve was used to analyze its predictive accuracy. RESULTS In the model group, multivariate logistic regression analysis showed that age, body temperature, PCT, CRP, Lac, and SOFA score were independent predictors of infection associated with liver failure (P < 0.05). The area under the ROC curve (AUC) of the model was 0.899 (95% confidence interval [CI] 0.846-0.939), and the sensitivity and specificity were 86.2% and 80.4%, respectively. The AUC for the validation group was 0.953 (95% CI 0.899-0.983), and the sensitivity and specificity were 91.7% and 84.2%, respectively. CONCLUSIONS This study reports a model for early diagnosis of infection in liver failure patients. The model had high overall accuracy and showed good reproducibility and reliability in patients from different centers in the same region.
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Affiliation(s)
- Wenhui Liu
- Department of Infectious Diseases, Taicang First People's Hospital, Taicang, 215400, Jiangsu Province, China
| | - Yonglan Pu
- Department of Infectious Diseases, Taicang First People's Hospital, Taicang, 215400, Jiangsu Province, China.
| | - Chuanwu Zhu
- Department of Infectious Diseases, Suzhou Fifth People's Hospital, Suzhou, 215100, Jiangsu Province, China
| | - Ailan Qin
- Department of Infectious Diseases, First Affiliated Hospital, Soochow University, Suzhou, 215006, Jiangsu Province, China.
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Liu L, Liu C, Cai J, Chen J, Chen J, Fu Y, Yi K, Wang H, Li X. Relationship Between Invasive Fungal Infection and Hypostatic Pneumonia: A Prospective Cohort Study. Front Microbiol 2022; 13:859359. [PMID: 35794923 PMCID: PMC9251507 DOI: 10.3389/fmicb.2022.859359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022] Open
Abstract
Background The short-term mortality of hypostatic pneumonia (HP) is very high, and the treatment outcome is poor. The clinical diagnosis and treatment are primarily focused on bacterial and viral infection, ignoring the role of fungal infection at present. This study aims to validate the relationship between Invasive Fungal Infections (IFI) and HP. Methods In the cross-sectional study, a total of 11,371 participants have been enrolled. In the prospective cohort study, 4,441 individuals have been included at baseline and followed up from 2015 to 2019 with a total person years of 8,484.65. The standard procedures were used to assess questionnaire investigations, laboratory testing, and anthropometric indicators. For data analysis, logistic regression, restricted cubic spline, log-rank regression, Cox regression, and linear mixed effects model were applied to assess the relationship between IFI and HP risk longitudinally. Results In the cross-sectional study, elevated β-D-Glucan (BDG) concentrations are associated with a higher risk of HP prevalence in the total population, men, and women (ORT3 vs.T1 [95% CIs]: 2.12 [1.55, 2.91]; 2.01 [1.35, 2.99]; 2.34 [1.39, 3.94]), which were verified by a dose–effect relationship in the restricted cubic spline model. In the cohort study, Cox and Log-rank regression showed that the elevated BDG concentrations are associated with a significantly higher risk of HP incidence than participants with lower BDG concentrations (HRT3 vs.T1 [95% CIs]: 2.72 [1.36, 5.43], pLog–rank = 0.0086). During 5 years, the globulin (GLB) and C-reactive protein (CRP) were always on the top in the highest category of BDG concentrations. Between low and high BDG concentration, the total trend of GLB concentration was falling and the total trend of CRP concentration was rising with the increase of years (all the p-values < 0.0001). Conclusion In this study, IFI is associated with a higher risk of HP, with time sequence and related mechanisms requiring further investigation in the future.
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Affiliation(s)
- Lin Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianrong Cai
- Department of Ultrasound, Chongming Branch, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayun Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanyuan Fu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kexin Yi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Hui Wang,
| | - Xue Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Xue Li,
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Han J, Lv Z, Shen M, Wan Q, Xiao L, Wang G. Risk factors for hospital-acquired pneumonia among inpatients with mental disorders in a large mental health center within a tertiary general hospital. Am J Infect Control 2022; 51:446-453. [PMID: 35728721 DOI: 10.1016/j.ajic.2022.06.014] [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: 03/15/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Few researchers have investigated the incidence of and risk factors for hospital-acquired pneumonia (HAP) among inpatients with mental disorders in a general hospital. METHODS This study included patients with mental disorders hospitalized in a large mental health center (situated in a general hospital) between January 1, 2017 and July 31, 2021 (excluding January 1, 2020 to May 31, 2020). Risk factors for HAP were identified by logistic regression analysis after propensity score matching (PSM, 1:4) for gender, age, duration of observation and hospital ward. RESULTS The study included 16,864 patients. HAP incidence rate was 1.15% overall, 2.11% on closed wards, 0.75% on open wards, 4.45% in patients with organic mental disorders, 1.80% in patients with schizophrenia spectrum disorder, and 0.84% in patients with mood disorders. Risk factors for HAP after PSM were hypoproteinemia, chronic liver disease, use of clozapine, hospitalization during the previous 180 days, body mass index (BMI) ≤18.5 kg/m2, cholinesterase inhibitor use and mood stabilizer use. CONCLUSION HAP was common among inpatients with mental disorders. Risk factors for HAP in patients with mental disorders include hypoproteinemia, chronic liver disease, hospitalization during the past 180 days, BMI ≤18.5 kg/m2, and use of clozapine, cholinesterase inhibitors or mood stabilizers.
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Affiliation(s)
- Jingjing Han
- Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Zhihua Lv
- Department of Clinical laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Meiyu Shen
- Department of Mental Health Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Qirong Wan
- Department of Clinical Psychology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Ling Xiao
- Insititute of Neuropsychiatry, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China.
| | - Gaohua Wang
- Insititute of Neuropsychiatry, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China; Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China.
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Zhuo X, Zhao J, Wang L, Sun B, Sun L, Wang C, Li B, Fan Y, Liu Y, Cao B. Development and evaluation of a multiplex quantitative polymerase chain reaction assay for detecting bacteria associated with lower respiratory tract infection. Int J Infect Dis 2022; 122:202-211. [PMID: 35644352 DOI: 10.1016/j.ijid.2022.05.052] [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: 02/22/2022] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES This study aimed to establish a multiplex quantitative polymerase chain reaction (MQ-PCR) assay for 12 bacterial pathogens found in lower respiratory tract infection (LRTI) and to evaluate its performance in a cohort of 211 patients with LRTI. METHODS The study was divided into two stages: a pilot study to establish the methodology and a clinical validation study to evaluate its performance. In the pilot study, we established the MQ-PCR and analyzed its performance regarding limits of detection, reproducibility, specificity, and efficiency. In the clinical validation study, we obtained 211 sputum and/or bronchoalveolar lavage fluid (BALF) samples and detected pathogens by MQ-PCR. The MQ-PCR time was 3 h from sample collection to complete pathogen detection. RESULTS The limit of detection was 1000 copies/ml, and the maximum efficiency was >95%. When cutoffs of ≥105 copies/ml in sputum and ≥104 copies/ml in BALF were applied, the sensitivity, specificity, and positive and negative predictive values of the MQ-PCR were 77% (95% confidence interval [CI] 67-88%), 94% (95% CI 93-95%), 25% (95% CI 19-31%), and 99% (95% CI 99-100%), respectively. CONCLUSIONS This study demonstrates that the new MQ-PCR assay is time-saving, more effective and sensitive, and brings us closer to mainstream adoption of quantitative molecular detection of bacteria.
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Affiliation(s)
- Xianxia Zhuo
- Department of Pulmonary and Critical Care Medicine, Capital Medical University, Beijing, China; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science; National Clinical Research Center of Respiratory Diseases, Beijing, China
| | - Jiankang Zhao
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science; National Clinical Research Center of Respiratory Diseases, Beijing, China
| | - Lei Wang
- Beijing Applied Biological Technologies Co., Ltd
| | - Bin Sun
- Beijing Applied Biological Technologies Co., Ltd
| | - Lanhua Sun
- Beijing Applied Biological Technologies Co., Ltd
| | - Chunlei Wang
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science; National Clinical Research Center of Respiratory Diseases, Beijing, China
| | - Binbin Li
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science; National Clinical Research Center of Respiratory Diseases, Beijing, China
| | - Yanyan Fan
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science; National Clinical Research Center of Respiratory Diseases, Beijing, China
| | - Yingmei Liu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science; National Clinical Research Center of Respiratory Diseases, Beijing, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Capital Medical University, Beijing, China; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science; National Clinical Research Center of Respiratory Diseases, Beijing, China; Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China.
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Chen Z, Xu Z, Wu H, Gao S, Wang H, Jiang J, Li X, Chen L. Derivation and validation of a nomogram for predicting nonventilator hospital-acquired pneumonia among older hospitalized patients. BMC Pulm Med 2022; 22:144. [PMID: 35428276 PMCID: PMC9011946 DOI: 10.1186/s12890-022-01941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Currently, there is no effective tool for predicting the risk of nonventilator hospital-acquired pneumonia (NV-HAP) in older hospitalized patients. The current study aimed to develop and validate a simple nomogram and a dynamic web-based calculator for predicting the risk of NV-HAP among older hospitalized patients. Methods A retrospective evaluation was conducted on 15,420 consecutive older hospitalized patients admitted to a tertiary hospital in China between September 2017 and June 2020. The patients were randomly divided into training (n = 10,796) and validation (n = 4624) cohorts at a ratio of 7:3. Predictors of NV-HAP were screened using the least absolute shrinkage and selection operator method and multivariate logistic regression. The identified predictors were integrated to construct a nomogram using R software. Furthermore, the optimum cut-off value for the clinical application of the model was calculated using the Youden index. The concordance index (C-index), GiViTI calibration belts, and decision curve were analysed to validate the discrimination, calibration, and clinical utility of the model, respectively. Finally, a dynamic web-based calculator was developed to facilitate utilization of the nomogram. Results Predictors included in the nomogram were the Charlson comorbidity index, NRS-2002, enteral tube feeding, Barthel Index, use of sedatives, use of NSAIDs, use of inhaled steroids, and "time at risk". The C-index of the nomogram for the training and validation cohorts was 0.813 and 0.821, respectively. The 95% CI region of the GiViTI calibration belt in the training (P = 0.694) and validation (P = 0.614) cohorts did not cross the diagonal bisector line, suggesting that the prediction model had good discrimination and calibration. Furthermore, the optimal cut-off values for the training and validation cohorts were 1.58 and 1.74%, respectively. Analysis of the decision curve showed that the nomogram had good clinical value when the threshold likelihood was between 0 and 49%. Conclusion The developed nomogram can be used to predict the risk of NV-HAP among older hospitalized patients. It can, therefore, help healthcare providers initiate targeted medical interventions in a timely manner for high-risk groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01941-z.
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Wu M, Lan X, Lin S, Lai T, Lin W, Wu H. Synovial tuberculosis in wrist diagnosed based on metagenomic next-generation sequencing: A case report. EUR J INFLAMM 2022. [DOI: 10.1177/20587392221075507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Synovial tuberculosis in the wrist is a rare disease that is usually misdiagnosed at the early stage. In this case, we presented a 67-year-old male with wrist joint tuberculosis who presented repeated left wrist joint edema for more than 2 years. The patient received surgery twice. During the second surgery, the combination of metagenomic next-generation sequencing (mNGS) and pathological analysis contributed to the detection of Mycobacterium tuberculosis in lesion tissues. Conventional anti-tubercular therapy confirmed the diagnosis of synovial tuberculosis in the wrist joint. In conclusion, mNGS contributed to the rapid and accurate detection of tubercle bacillus.
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Affiliation(s)
- Meimei Wu
- Department of Digestive System, Fuzhou Second Hospital, Fuzhou, China
| | - Xianfeng Lan
- Department of Hand Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Shibei Lin
- Department of Hand Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Tian Lai
- Department of Hand Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Weiguo Lin
- Department of Digestive System, Fuzhou Second Hospital, Fuzhou, China
| | - Hao Wu
- Department of Hand Surgery, Fuzhou Second Hospital, Fuzhou, China
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Sun K, Li W, Li Y, Li G, Pan L, Jin F. Derivation and Validation of a Predictive Scoring Model of Infections Due to Acinetobacter baumannii in Patients with Hospital Acquired Pneumonia by Gram-Negative Bacilli. Infect Drug Resist 2022; 15:1055-1066. [PMID: 35321082 PMCID: PMC8935085 DOI: 10.2147/idr.s356764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background The prognosis of ABA-HAP patients is very poor. This study aimed to develop a scoring model to predict ABA-HAP in patients with GNB-HAP. Methods A single center retrospective cohort study was performed among patients with HAP caused by GNB in our hospital during January 2019 to June 2019 (the derivation cohort, DC). The variables were assessed on the day when qualified respiratory specimens were obtained. A prediction score was formulated by using independent risk factors obtained from logistic regression analysis. It was prospectively validated with a subsequent cohort of GNB-HAP patients admitted to our hospital during July 2019 to Dec 2019 (the validation cohort, VC). Results The final logistic regression model of DC included the following variables: transferred from other hospitals (3 points); blood purification (3 points); risk for aspiration (4 points); immunocompromised (3 points); pulmonary interstitial fibrosis (3 points); pleural effusion (1 points); heart failure (3 points); encephalitis (5 points); increased monocyte count (2 points); and increased neutrophils count (2 points). The AUROC of the scoring model was 0.845 (95% CI, 0.796 ~ 0.895) in DC and 0.807 (95% CI, 0.759 ~ 0.856) in VC. The scoring model clearly differentiated the low-risk patients (the score < 8 points), moderate-risk patients (8 ≤ the score < 12 points) and high-risk patients (the score ≥ 12 points), both in DC (P < 0.001) and in VC (P < 0.001). Conclusion This simple scoring model could predict ABA-HAP with high predictive value and help clinicians to choose appropriate empirical antibiotic therapy.
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Affiliation(s)
- Kang Sun
- Department of Respiratory and Critical Care Medicine, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaanxi Province, 710038, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, The 989th Hospital of Joint Support Force of Chinese People’s Liberation Army, Luoyang, Henan Province, 471003, People’s Republic of China
| | - Wangping Li
- Department of Respiratory and Critical Care Medicine, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaanxi Province, 710038, People’s Republic of China
| | - Yu Li
- Department of Infectious Diseases, Shaanxi Provincial People’s Hospital and The Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi Province, 710068, People’s Republic of China
- Shaanxi Center for Models of Clinical Medicine in International Cooperation of Science and Technology, Xi’an, Shaanxi Province, 710068, People’s Republic of China
| | - Guangyu Li
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Lei Pan
- Department of Respiratory and Critical Care Medicine, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaanxi Province, 710038, People’s Republic of China
- Correspondence: Lei Pan; Wangping Li, Department of Respiratory and Critical Care Medicine, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaanxi Province, 710038, People’s Republic of China, Email ;
| | - Faguang Jin
- Department of Respiratory and Critical Care Medicine, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaanxi Province, 710038, People’s Republic of China
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Zheng Q, Li S, Wen F, Lin Z, Feng K, Sun Y, Bao J, Weng H, Shen P, Lin H, Chen W. The Association Between Sleep Disorders and Incidence of Dry Eye Disease in Ningbo: Data From an Integrated Health Care Network. Front Med (Lausanne) 2022; 9:832851. [PMID: 35187009 PMCID: PMC8854755 DOI: 10.3389/fmed.2022.832851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the association between sleep disorders and dry eye disease (DED) in Ningbo, China. METHODS Our data came from the Yinzhou Health Information System (HIS), including 257932 patients and was based on a 1:1 matching method (sleep disorder patients vs. patients without sleep disorders) during 2013-2020. Sleep disorders and DED were identified using ICD-10 codes. Cox proportional hazards regression was used to identify the association between sleep disorders and DED. RESULTS The eight-year incidence of DED was significantly higher in participants with diagnosis of sleep disorders (sleep disorders: 50.66%, no sleep disorders: 16.48%, P < 0.01). Sleep disorders were positively associated with the diagnosis of DED (HR: 3.06, 95% CI: 2.99-3.13, P < 0.01), when sex, age, hypertension, diabetes and other systemic diseases were adjusted. In the sleep disorders patients, advancing age, female sex, and presence of coexisting disease (hypertension, diabetes, hyperlipidemia, thyroid disease, depression, heart disease, and arthritis) were significantly associated with the development of DED by the multivariate cox regression analysis (all P < 0.05).In addition, there was a significantly positive association between estazolam and the incidence of DED in both sleep disorder and non-sleep disorder groups (all P < 0.05). CONCLUSIONS Sleep disrder was associated with a three-time increased risk of DED. This association can be helpful in effective management of both sleep disorders and DED.
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Affiliation(s)
- Qinxiang Zheng
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Saiqing Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Feng Wen
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
| | - Zhong Lin
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Kemi Feng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Yexiang Sun
- Department of Chronic Diseases and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Jie Bao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Hongfei Weng
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
| | - Peng Shen
- Department of Chronic Diseases and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Hongbo Lin
- Department of Chronic Diseases and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Wei Chen
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
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Wu N, Ranjan P, Tao C, Liu C, Yang E, He B, Erb-Downward JR, Bo S, Zheng J, Guo C, Liu B, Sun L, Yan W, Wang M, Wang W, Wen J, Yang P, Yang L, Tian Q, Dickson RP, Shen N. Rapid identification of pathogens associated with ventilator-associated pneumonia by Nanopore sequencing. Respir Res 2021; 22:310. [PMID: 34893078 PMCID: PMC8665642 DOI: 10.1186/s12931-021-01909-3] [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: 06/08/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aetiology detection is crucial in the diagnosis and treatment of ventilator-associated pneumonia (VAP). However, the detection method needs improvement. In this study, we used Nanopore sequencing to build a quick detection protocol and compared the efficiency of different methods for detecting 7 VAP pathogens. METHODS The endotracheal aspirate (ETA) of 83 patients with suspected VAP from Peking University Third Hospital (PUTH) was collected, saponins were used to deplete host genomes, and PCR- or non-PCR-amplified library construction methods were used and compared. Sequence was performed with MinION equipment and local data analysis methods were used for sequencing and data analysis. RESULTS Saponin depletion effectively removed 11 of 12 human genomes, while most pathogenic bacterial genome results showed no significant difference except for S. pneumoniae. Moreover, the average sequence time decreased from 19.6 h to 3.62 h. The non-PCR amplification method and PCR amplification method for library build has a similar average sensitivity (85.8% vs. 86.35%), but the non-PCR amplification method has a better average specificity (100% VS 91.15%), and required less time. The whole method takes 5-6 h from ETA extraction to pathogen classification. After analysing the 7 pathogens enrolled in our study, the average sensitivity of metagenomic sequencing was approximately 2.4 times higher than that of clinical culture (89.15% vs. 37.77%), and the average specificity was 98.8%. CONCLUSIONS Using saponins to remove the human genome and a non-PCR amplification method to build libraries can be used for the identification of pathogens in the ETA of VAP patients within 6 h by MinION, which provides a new approach for the rapid identification of pathogens in clinical departments.
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Affiliation(s)
- Nan Wu
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Piyush Ranjan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Changyu Tao
- Department of Human Anatomy and Histology and Embryology, Peking University, Beijing, 100191, People's Republic of China
| | - Chao Liu
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Ence Yang
- Department of Medical Bioinformatics, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, People's Republic of China
| | - Bei He
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - John R Erb-Downward
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Shining Bo
- Intensive Care Unit, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Jiajia Zheng
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Chenxia Guo
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Beibei Liu
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Lina Sun
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Wei Yan
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Meng Wang
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Wenting Wang
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Jianing Wen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Ping Yang
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Lin Yang
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Qiaoshan Tian
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Robert P Dickson
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Ning Shen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China.
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Zhan Y, Xu T, He F, Guan WJ, Li Z, Li S, Xie M, Li X, Chen R, Cheng L, Zhong N, Ye F. Clinical Evaluation of a Metagenomics-Based Assay for Pneumonia Management. Front Microbiol 2021; 12:751073. [PMID: 34603275 PMCID: PMC8481773 DOI: 10.3389/fmicb.2021.751073] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
Clinical value of metagenomic next-generation sequencing (mNGS) in pneumonia management is still controversial. A prospective study was conducted to evaluate the clinical impact of PneumoSeq in 57 immunocompetent (ICO) and 75 immunocompromised (ICH) pneumonia patients. The value of PneumoSeq for both etiological and clinical impact investigation in pneumonia was assessed. Among the 276 potential pathogens detected with PneumoSeq in our cohort, 251 (90.9%) were cross-validated. Clinical diagnoses of the causative pathogens were obtained for 97 patients, 90.7% of which were supported by PneumoSeq. Compared to conventional testing, PneumoSeq suggested potentially missed diagnoses in 16.7% of cases (22/132), involving 48 additional pathogenic microorganisms. In 58 (43.9%) cases, PneumoSeq data led to antimicrobial treatment de-escalation (n = 12 in ICO, n = 18 in ICH) and targeted treatment initiation (n = 7 in ICO, n = 21 in ICH). The PneumoSeq assay benefited the diagnosis and clinical management of both ICH and ICO pneumonia patients in real-world settings.
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Affiliation(s)
- Yangqing Zhan
- State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Teng Xu
- Vision Medicals Co., Ltd., Guangzhou, China.,Key Laboratory of Animal Gene Editing and Animal Cloning in Yunnan Province and College of Veterinary Medicine, Yunnan Agricultural University, Kunming, China
| | - Fusheng He
- Vision Medicals Co., Ltd., Guangzhou, China
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Thoracic Surgery, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhengtu Li
- State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Shaoqiang Li
- State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | | | - Xiaolei Li
- Vision Medicals Co., Ltd., Guangzhou, China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, China
| | - Linling Cheng
- State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, Guangzhou, China
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Isac C, Samson HR, John A. Prevention of VAP: Endless evolving evidences-systematic literature review. Nurs Forum 2021; 56:905-915. [PMID: 34091899 DOI: 10.1111/nuf.12621] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/30/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Prevention of ventilator associated pneumonia (VAP) is the focus in critical care units. Immunocompromised patients, older adults, and postoperative patients are at greater risk for VAP. With the dynamic changes in the empirical world, updated evidence must be used to guide the standard of practice. This literature review assimilates the recent evidence for VAP prevention. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-analysis framework guided the selection of the included research articles. Medline, EBSCO host, CINAHL, UpToDate and Google Scholar databases explored, for relevant publications between 2010 and 2020. The quality of evidence for the 14 studies selected were rated using the hierarchy of quantitative research designs. RESULTS Evidence-based VAP preventive strategies are prevention of aspiration, minimizing ventilator days, reducing the pathogen load, safe endotracheal suction practices, and pharmaceutical preventive measures. The mandates for VAP preventive measures among coronavirus disease 2019 (COVID-19) patients is included. CONCLUSION Though some of these themes identify with the past, the nuances in their implementation are highlights of this review. The review reiterates the need to revisit ambiguous practices implemented for VAP prevention. Adherence to evidence-based practices, by education, training, and reduction of workload is the key to VAP prevention.
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Affiliation(s)
- Chandrani Isac
- Adult Health & Critical Care, College of Nursing, Sultan Qaboos University, Al Khod, Muscat, Sultanate of Oman
| | - Hema Roslin Samson
- Adult Health & Critical Care, College of Nursing, Sultan Qaboos University, Al Khod, Muscat, Sultanate of Oman
| | - Anitha John
- Adult Health & Critical Care, College of Nursing, Sultan Qaboos University, Al Khod, Muscat, Sultanate of Oman
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Li S, Zhang QL, Guo RJ, Lv XZ, Yang X. Quantitative evaluation and significance of ultrasound in bronchoalveolar lavage for lung consolidation in children with severe mycoplasma pneumonia. Transl Pediatr 2021; 10:2325-2334. [PMID: 34733673 PMCID: PMC8506056 DOI: 10.21037/tp-21-381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/07/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effect of lung ultrasound on bronchoalveolar lavage in the treatment of mycoplasma pneumonia in children. METHODS Thirty children with mycoplasma pneumonia who were treated with medication and bronchial lavage were selected. We collected the results of laboratory and imaging examinations after admission, and the changes in lung consolidation area were examined by ultrasound before, immediately upon completion, and at 1, 3, and 7 days after bronchoalveolar lavage. The effective factors affecting bronchial lavage were analyzed through logistic regression. RESULTS Univariate regression analysis showed significant differences in the lung consolidation area at admission, before, immediately upon completion, and at 1 and 7 days after lavage, as well as in the disease course and atelectasis (or not). Multivariate analysis showed that there were statistical differences in the lung consolidation area at admission, atelectasis (or not), and disease course: lung consolidation area at admission [odds ratio (OR): 2.31512, 95% confidence interval (CI): (0.00182, 0.031775), P=0.029474], atelectasis [OR: 2.695742, 95% CI: (0.079281, 0.597218), P=0.012629], and disease course [OR: -2.43347, 95% CI: (-0.02568, -0.00211), P=0.022773]. CONCLUSIONS Lung ultrasound can evaluate the effect of bronchial lavage through lung consolidation and atelectasis, which can provide a reference for clinical treatment.
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Affiliation(s)
- Shuo Li
- Department of Ultrasound Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qi-Li Zhang
- Department of Ultrasound Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Rui-Jun Guo
- Department of Ultrasound Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiu-Zhang Lv
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xue Yang
- Department of Pediatrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Lorente L. To reduce the current rates of ventilator-associated pneumonia after implementation of the Pneumonia Zero program: This is the challenge. Med Intensiva 2021; 45:501-505. [PMID: 34452858 DOI: 10.1016/j.medine.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/22/2019] [Indexed: 10/20/2022]
Affiliation(s)
- L Lorente
- Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
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Meng N, Ye Z, Liu Y, Qin C, Su Y. Impact of the 'weekend effect' on hospital-acquired pneumonia after aneurysmal subarachnoid hemorrhage. Postgrad Med 2021; 133:974-978. [PMID: 34323649 DOI: 10.1080/00325481.2021.1959936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Weekend admission has been reported to be associated with poor clinical outcomes of various diseases. This study aimed to determine whether weekend admission increases the incidence of hospital-acquired pneumonia (HAP) in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS We retrospectively analyzed aSAH patients admitted to our hospital between 2014 and 2020. These patients were divided into weekend and weekday groups. We compared the incidence of HAP and other clinical outcomes between the two groups. Risk factors for HAP were identified by logistic regression analysis. RESULTS Of 653 included aSAH patients, 145 (22%) were admitted on weekends and 508 (78%) were admitted on weekdays. The incidence of HAP in the weekend group was significantly higher than that in the weekday group (25% vs 16%, P = 0.01). The weekend group showed worse clinical outcomes, including worse neurological outcome (74% vs 65%, P = 0.03), higher risk of intensive care unit (ICU) admission (21% vs 13%, P = 0.01) and longer length of stay (21.3 vs 16.4 days, P < 0.01). Age ≥ 60 years (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.3-3.0, P < 0.01), modified Fisher score (MFS) ≥ 3 (OR = 1.7, 95% CI = 1.1-2.6, P = 0.02), weekend admission (OR = 1.8, 95% CI = 1.1-2.8, P = 0.02) and operative treatment (OR = 2.3, 95% CI = 1.2-4.5, P = 0.02) were risk factors for HAP following aSAH. CONCLUSION Weekend admission was associated with a higher incidence of HAP in aSAH patients. This study suggested that medical administrators may need to optimize healthcare services on weekends.
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Affiliation(s)
- Ningqin Meng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ziming Ye
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ying Liu
- Department of Rehabilitation, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chao Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ying Su
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Du L, Zhao Y, Yin C, Liu S, Cui Z, Zhang M. The applied research on the intra-abdominal pressure monitoring in early enteral nutrition in patients with severe pneumonia. Am J Transl Res 2021; 13:6987-6993. [PMID: 34306453 PMCID: PMC8290670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the applied value of intra-abdominal pressure (IAP) monitoring in early enteral nutrition (EEN) in patients with severe pneumonia. METHODS 96 patients with severe pneumonia who underwent EEN treatment in our hospital from June 2017 to June 2019 were selected. According to the random number table method, they were divided into a control group (48 patients) and an observation group (48 patients). The control group was treated using the conventional EN method, and the observation group was treated using the intra-abdominal pressure monitoring besides the conventional EN method. The incidence of EN intolerance, the acute physiology and chronic health evaluation (APECHEll) scores, the positive end expiratory pressure (PEEP) value, mechanical ventilation time, EN implementation days, length of stay in ICU, the incidence of ventilator-associated pneumonia, mortality, and the incidence of multiple organ dysfunction syndrome were compared between the two groups. RESULTS Compared with the control group, the incidence of EEN intolerance in the observation group was significantly reduced. The results of univariate analysis showed that, in the EN intolerance group, the IAP, the PEEP value and APACHEII scores after 3 days of EEN implementation were higher than the EEN tolerance group, indicating a influencing factor of EEN intolerance (P<0.05). The results of multivariate analysis showed that IAP value was a risk factor for EEN intolerance (P<0.05). The ROC curve analysis result for IAP to predict EEN tolerance showed that the area under the curve for IAP value to predict EN tolerance was 0.856, the optimal cut-off value was 10.73 mmHg, the sensitivity was 95.10%, and the specificity was 89.60%. CONCLUSION The intra-abdominal pressure monitoring during the EEN in patients with severe pneumonia is a preferred method to guide the patients' EEN.
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Affiliation(s)
- Liqiang Du
- Department of Gastrointestinal Surgery, The People’s Hospital of HengshuiHengshui, Hebei, China
| | - Yuanyuan Zhao
- Department of Intensive Care Unit, The People’s Hospital of HengshuiHengshui, Hebei, China
| | - Changheng Yin
- Department of Gastrointestinal Surgery, The People’s Hospital of HengshuiHengshui, Hebei, China
| | - Shuhong Liu
- Department II of Geriatrics, The People’s Hospital of HengshuiHengshui, Hebei, China
| | - Zhaobo Cui
- Department of Intensive Care Unit, The People’s Hospital of HengshuiHengshui, Hebei, China
| | - Min Zhang
- Department of Orthopaedics, The Second People’s Hospital of HengshuiHengshui, Hebei, China
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Li WZ, Wu HL, Chen YC, Guo BN, Liu XF, Wang Y, Wu JF, Zhang J. Pharmacokinetics, pharmacodynamics, and safety of single- and multiple-dose intravenous ceftobiprole in healthy Chinese participants. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:936. [PMID: 34350251 PMCID: PMC8263851 DOI: 10.21037/atm-21-588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/30/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ceftobiprole is a novel β-lactam cephalosporin with activity against Gram-positive and -negative bacteria. The aim of the present study was to investigate the pharmacokinetics (PK), pharmacokinetics/pharmacodynamics (PK/PD), safety and tolerance of ceftobiprole in Chinese participants, to evaluate this dosage regimen for the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) in China. METHODS The use of ceftobiprole was investigated in a single-center, open-label, single- and multiple-dose study using 12 healthy Chinese participants (6 males and 6 females). Ceftobiprole plasma and urine concentrations were analyzed using a validated liquid chromatography-tandem mass spectrometry assay. The PK/PD characteristics of 500 mg ceftobiprole every 8 h at 1.5-, 2-, 3-, or 4-h infusion time were analyzed by Monte Carlo simulations (MCS). RESULTS The maximum plasma concentration of ceftobiprole was observed 2 h after dosage; its terminal half-life was about 3 h. Ceftobiprole was predominantly eliminated in urine, and the cumulative excretion in 24 h was >90%. There was no accumulation after multiple dosing. Both single and multiple doses were well tolerated, with no severe or serious adverse events (AEs). PK/PD analysis indicated that Staphylococcus pneumoniae (S. pneumoniae) and Staphylococcus aureus (S. aureus) were sensitive to ceftobiprole. About half of extended-spectrum β-lactamase (ESBL) non-producing Enterobacteriaceae are sensitive to ceftobiprole, according to PK/PD results of ceftobiprole. For Pseudomonas aeruginosa (P. aeruginosa), no regimen was found to be effective against strains. CONCLUSIONS The PK/PD results indicated that 500 mg ceftobiprole every 8 h at 2-h infusion time is expected to achieve good microbiological efficacy in the treatment of CAP and HAP in China.
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Affiliation(s)
- Wan-Zhen Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China
- National Health Commission and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hai-Lan Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China
- National Health Commission and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuan-Cheng Chen
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China
- National Health Commission and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| | - Bei-Ning Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China
- National Health Commission and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Fen Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China
- National Health Commission and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China
- National Health Commission and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ju-Fang Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China
- National Health Commission and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China
- National Health Commission and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China
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46
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Li Y, Li X, Wen Z, Zhang X, Liu Y, Wei L. Effect of open versus closed endotracheal suctioning on intracranial pressure in severe brain-injured children: Study protocol for a randomized controlled trial. Nurs Open 2021; 8:2886-2891. [PMID: 34037323 PMCID: PMC8363411 DOI: 10.1002/nop2.656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/14/2022] Open
Abstract
AIM To compare the effects and safety of open and closed endotracheal suction in children with severe brain injury. DESIGN A single-blinding, single-centre randomized controlled trial (RCT). METHODS The children with severe brain injury admitted to the intensive care unit (ICU) from 1 September 2020-31 August 2022 will be included. And a total of 172 children with severe brain injury are expected to be included. The intracranial pressure, SpO2 and heart rate before suctioning, at the end of suction, and at 5 and 10 min after suction, the estimated sputum volume for each suction, the incidence of ventilator-associated pneumonia, the duration of mechanical ventilation and the length of ICU stay will be analysed. RESULTS This present RCT has been prospectively registered in China Clinical Trial Registry (http://www.chictr.org.cn, ChiCTR2000030963). This present study is expected to provide reliable evidence to the airway management in children with severe brain injury.
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Affiliation(s)
- Yan Li
- SICU, Children's Hospital of Nanjing Medical University, Nanjing City, China
| | - Xiaoyan Li
- SICU, Children's Hospital of Nanjing Medical University, Nanjing City, China
| | - Zunjia Wen
- SICU, Children's Hospital of Nanjing Medical University, Nanjing City, China
| | - Xin Zhang
- SICU, Children's Hospital of Nanjing Medical University, Nanjing City, China
| | - Yingfei Liu
- SICU, Children's Hospital of Nanjing Medical University, Nanjing City, China
| | - Li Wei
- SICU, Children's Hospital of Nanjing Medical University, Nanjing City, China
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Chen Z, Wu H, Jiang J, Xu K, Gao S, Chen L, Wang H, Li X. Nutritional risk screening score as an independent predictor of nonventilator hospital-acquired pneumonia: a cohort study of 67,280 patients. BMC Infect Dis 2021; 21:313. [PMID: 33794788 PMCID: PMC8013169 DOI: 10.1186/s12879-021-06014-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/23/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Currently, the association of nutritional risk screening score with the development of nonventilator hospital-acquired pneumonia (NV-HAP) is unknown. This study investigated whether nutritional risk screening score is an independent predictor of NV-HAP. METHODS This retrospective cohort study was conducted between September 2017 and June 2020 in a tertiary hospital in China. The tool of Nutritional Risk Screening 2002 (NRS-2002) was used for nutritional risk screening. A total score of ≥3 indicated a patient was "at nutritional risk." Logistic regression was applied to explore the association between the NRS score and NV-HAP. RESULTS A total of 67,280 unique patients were included in the study. The incidence of NV-HAP in the cohort for the NRS < 3 and ≥ 3 NRS group was 0.4% (232/62702) and 2.6% (121/4578), respectively. In a multivariable logistic regression model adjusted for all of the covariates, per 1-point increase in the NRS score was associated with a 30% higher risk of NV-HAP (OR = 1.30; 95%CI:1.19-1.43). Similarly, patients with NRS score ≥ 3 had a higher risk of NV-HAP with an odds ratio (OR) of 2.06 (confidence interval (CI): 1.58-2.70) than those with NRS score < 3. Subgroup analyses indicated that the association between the NRS score and the risk of NV-HAP was similar for most strata. Furthermore, the interaction analyses revealed no interactive role in the association between NRS score and NV-HAP. CONCLUSION NRS score is an independent predictor of NV-HAP, irrespective of the patient's characteristics. NRS-2002 has the potential as a convenient tool for risk stratification of adult hospitalized patients with different NV-HAP risks.
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Affiliation(s)
- Zhihui Chen
- Department of Epidemiology and Biostatistics, and Centre for Clinical Big Data Statistics, Second Affiliated Hospital, Zhejiang University College of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, China.,Department of Infection Control, Wenzhou people's Hospital, Wenzhou, China
| | - Hongmei Wu
- Department of Infection Control, Wenzhou people's Hospital, Wenzhou, China
| | - Jiehong Jiang
- XingLin Information Technology Company, Hangzhou, China
| | - Kun Xu
- XingLin Information Technology Company, Hangzhou, China
| | - Shengchun Gao
- Department of Infection Control, Wenzhou people's Hospital, Wenzhou, China
| | - Le Chen
- Department of Infection Control, Wenzhou people's Hospital, Wenzhou, China
| | - Haihong Wang
- Department of Infection Control, Wenzhou people's Hospital, Wenzhou, China
| | - Xiuyang Li
- Department of Epidemiology and Biostatistics, and Centre for Clinical Big Data Statistics, Second Affiliated Hospital, Zhejiang University College of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, China.
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48
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Jiao J, Li Z, Wu X, Cao J, Liu G, Liu Y, Li F, Zhu C, Song B, Jin J, Liu Y, Wen X, Cheng S, Wan X. Risk factors for 3-month mortality in bedridden patients with hospital-acquired pneumonia: A multicentre prospective study. PLoS One 2021; 16:e0249198. [PMID: 33784317 PMCID: PMC8009424 DOI: 10.1371/journal.pone.0249198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mortality among patients with hospital-acquired pneumonia (HAP) is quite high; however, information on risk factors for short-term mortality in this population remains limited. The aim of the current study was to identify the risk factors for mortality in bedridden patients with HAP during a 3-month observation period. METHODS A secondary data analysis was conducted. In total, 1141 HAP cases from 25 hospitals were included in the analysis. Univariate and multilevel regression analyses were performed to identify the risk factors for mortality. RESULTS During the 3-month observation period, there were 189 deaths among bedridden patients with HAP. The mortality rate in this study was 16.56%. Multilevel regression analysis showed that ventilator-associated pneumonia (OR = 2.034, 95%CI: 1.256, 3.296, p = 0.004), pressure injuries (OR = 2.202, 95%CI: 1.258, 3.852, p = 0.006), number of comorbidities (OR = 1.076, 95%CI: 1.016,1.140, p = 0.013) and adjusted Charlson Comorbidity Index score (OR = 1.210, 95%CI: 1.090, 1.343, p<0.001) were associated with an increased risk of mortality, while undergoing surgery with general anaesthesia (OR = 0.582, 95%CI: 0.368, 0.920, p = 0.021) was associated with a decreased risk of mortality. CONCLUSIONS The identification of risk factors associated with mortality is an important step towards individualizing care plans. Our findings may help healthcare workers select high-risk patients for specific interventions. Further study is needed to explore whether appropriate interventions against modifiable risk factors, such as reduced immobility complications or ventilator-associated pneumonia, could improve the prognoses.
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Affiliation(s)
- Jing Jiao
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Zhen Li
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Jing Cao
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Ge Liu
- Department of Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Ying Liu
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Fangfang Li
- Department of Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People’s Hospital, Zhengzhou, Henan Province, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, Hubei Province, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People’s Hospital, Chengdu, Sichuan Province, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
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McEnery T, Martin-Loeches I. Predicting ventilator-associated pneumonia. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:670. [PMID: 32617290 PMCID: PMC7327331 DOI: 10.21037/atm.2020.03.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Tom McEnery
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity College, Wellcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland.,Department of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity College, Wellcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland.,Department of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland.,Hospital de Barcelona, IDIBAPS, CIBERes, Barcelona, Spain
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50
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Dou H, Hu F, Wang W, Ling L, Wang D, Liu F. Assessment of the sedative effects of dexmedetomidine and propofol treatment in patients undergoing mechanical ventilation in the ICU and relationship between treatment and occurrence of ventilator-associated pneumonia and detection of pathogenic bacteria. Exp Ther Med 2020; 20:599-606. [PMID: 32537018 PMCID: PMC7282099 DOI: 10.3892/etm.2020.8699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/13/2020] [Indexed: 12/15/2022] Open
Abstract
The present study aimed to investigate the sedative effects of dexmedetomidine combined with propofol in patients undergoing mechanical ventilation in the intensive care unit (ICU), and to reveal the risk factors of ventilator-associated pneumonia (VAP). A retrospective analysis of 322 patients who had been subject to mechanical ventilation in the ICU ward was performed. Subjects were divided into two groups: A group treated with dexmedetomidine and propofol (combined group) and a group treated with dexmedetomidine alone (monotherapy group). Clinical data, sedative effects, the number of VAP patients and the distribution of VAP pathogens were assessed. Multivariate analysis and receiver operating characteristic (ROC) curves were used to predict VAP. Significant differences in the sedative effects between the two groups were observed (P<0.001). The incidence of VAP was significantly higher in the monotherapy group compared with the combined group (P<0.05). Multivariate logistic regression analysis demonstrated that age, acute physiology chronic health evaluation score, consciousness, invasive operations, recovery time, extubation time and sedation regimen were independent risk factors for VAP in the ICU during mechanical ventilation. ROC curves indicated that the areas under the curve for age, acute physiology chronic health score, consciousness, invasive operations, recovery time, extubation time and sedation regimen were 0.934, 0.870, 0.632, 0.677, 0.865, 0.950 and 0.603, respectively. In summary, dexmedetomidine combined with propofol can shorten the recovery and extubation times of mechanical ventilation patients in the ICU. Different sedation schemes are also independent risk factors for VAP during mechanical ventilation in the ICU.
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Affiliation(s)
- Hongjie Dou
- Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China
| | - Fangbao Hu
- Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China
| | - Wen Wang
- Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China
| | - Lin Ling
- Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China
| | - Deqiang Wang
- Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China
| | - Fenlian Liu
- Intensive Care Unit, Shanghai Fengxian District Central Hospital, Fengxian, Shanghai 201499, P.R. China
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