Sputum bacterial culture and drug resistance of 475 patients with pneumonia / 公共卫生与预防医学

Objective To understand the distribution and drug resistance of pathogenic bacteria in sputum culture of pneumonia, and to provide evidence for the rational application of clinical antibacterial drugs . Methods The clinical data of 475 patients with positive sputum bacterial culture admitted to department of respiratory medicine of Neijiang Hospital of Traditional Chinese Medicine from May 2020 to May 2023 were collected. The types and drug resistance of pathogenic bacteria isolated from sputum culture were statistically analyzed . Results A total of 539 strains of pathogenic bacteria were isolated from the sputum culture of 475 patients with pneumonia, including 344 strains (63.82%) of Gram-negative bacteria [mainly Klebsiella pneumoniae (79 strains, 14.66%)] and 195 strains (36.18%) of Gram-positive bacteria [mainly Streptococcus pneumoniae (70 strains, 12.99%)]. Klebsiella pneumoniae was highly sensitive to aztreonam, levofloxacin, amikacin, imipenem, and ertapenem, with the sensitivity rates of 94.67%, 92.41%, 94.87%, 96.00% and 98.67% respectively. Streptococcus pneumoniae was absolutely sensitive to teicoplanin, vancomycin and linezolid, and was highly sensitive to cefpirome, levofloxacin, imipenem and ertapenem, with the sensitivity rates of 94.29%, 91.43%, 97.14% and 98.48%. Conclusions The common pathogenic bacteria of patients with pneumonia in Neijiang Hospital of Traditional Chinese Medicine include Klebsiella pneumoniae and Streptococcus pneumoniae. Various pathogenic bacteria have different degrees of resistance to common antibacterial drugs. It is necessary to combine with the types and drug susceptibility results of pathogenic bacteria for the rational application of antibacterial drugs.

Analysis on the technical results of tuberculosis laboratory testing in Liaoning Province from 2016 to 2022 / 中国热带医学

@#Abstract: Objective To evaluate the application of TB laboratory detection technology in Liaoning Province from 2016 to 2022, and to provide scientific basis for further improving the detection rate of Mycobacterium tuberculosis in the province. Methods The medical records of registered tuberculosis patients in Liaoning Province from 2016 to 2022 were collected from the "Tuberculosis Information Management System" in the "China Disease Prevention and Control Information System" subsystem. Statistical analysis was performed for sputum coating, sputum culture, and molecular biology testing. Results From 2016 to 2022, a total of 152 778 patients with pulmonary tuberculosis were registered in Liaoning Province. The detection rate of sputum smear microscopy was 98.03% (149 775/152 778), the detection rate of sputum culture was 20.72% (31 661/152 778), and the detection rate of molecular biology testing was 20.21% (30 737/152 778). From 2018 to 2022, the rate of molecular biological detection showed an increasing trend (χ2trend=7 104.466, P<0.01), while from 2016 to 2021, the detection rate of sputum culture showed an increasing trend, with statistical significance (χ2trend=3,068.701, P<0.01). The sputum smear detection rate showed a downward trend（χ2trend=689.913, P<0.01). . There were significant differences in the results of sputum smear microscopy, sputum culture, and molecular biology testing, as confirmed by the McNemar test (P<0.01). The positive rate of pathogenic academics increased from 26.27% in 2016 to 51.55% in 2022, showing a yearly upward trend (χ2trend=5 262.863, P<0.01), with significant differences between each year (χ2=5 686.935, P<0.01). Among pulmonary tuberculosis patients with positive pathogenic microorganisms, the proportion of sputum smear-positive cases decreased from 94.32% to 52.36%, showing a downward trend (χ2trend=5 010.104, P<0.01). The proportion of culture-positive cases increased from 5.68% in 2016 to 12.83% in 2022, showing an upward trend (χ2trend=122.501, P<0.01). In Liaoning Province, molecular biology testing has been carried out since 2018, and the proportion of molecular biology-positive cases increased from 11.51% to 34.81%, showing an increasing trend (χ2trend=1 969.326, P<0.01). The number of positive patients in molecular biological tests in municipal hospitals accounted for 18.69% (8 386/44 778) of etiological positive patients, while the number of positive patients in county-level hospitals accounted for 13.61% (2 439/17 924) of etiological positive patients, with significant differences (χ2=231.594, P<0.01). Conclusions The implementation of molecular biology testing for tuberculosis in Liaoning Province is one of the main measures to improve the positive rate of etiology, and it helps to diagnose tuberculosis patients timely and accurately

Study on distribution and drug resistance of sputum culture pathogens in child infectious pneumonia / 国际检验医学杂志

Objective To analyze the composition ,distribution and drug resistance change of sputum cul-ture pathogenic bacteria .Methods The clinical data in 4502 children patients with infectious pneumonia trea-ted in the branch hospital of the Urumqi Municipal First People′s Hospital from January 2013 to December 2016 were retrospectively and statistically analyzed on the distribution ,composition and drug resistance of dif-ferent bacterial species in sputum culture pathogenic bacteria ,pathogenic bacterial composition and drug re-sistance of major pathogens in different years ,and selection of empirical antibacterial medication treatment scheme .Results Among 4502 cases of infectious pneumonia ,1801 strains of pathogenic bacteria were isola-ted from the sputum culture ,including 1026 strains of Gram-positive bacteria and 775 strains of gram negative bacteria .There was no statistically significant difference in the pathogens composition among different years (P>0 .05) .Conclusion The pathogens composition change from sputum culture in child infectious pneumonia is unconspicuous ,but the drug resistance of pathogenic bacteria is gradually enhanced ,it is necessary to pay close attention to the pathogenic bacterial spectrum of child infectious pneumonia and its drug resistance trend for guiding the medication and treatment .

G-test and GM-test combined with sputum fungal culture for the early diagnosis of invasive fungal infection in intensive care unit patients / 中国感染控制杂志

Objective To evaluate the detection value of serum (1,3)-β-D glucan (G-test) and galactomannan (GM-test) combined with sputum fungal culture in the early diagnosis of invasive fungal infection(IFI) in intensive care unit(ICU) patients.Methods Inpatients with high risk factors for IFI in the ICU of the Affiliated Hospital of Xuzhou Medical University between January 2015 and December 2016 were chosen,they were divided into 3 groups according to the diagnostic criteria of IFI:IFI group(including confirmed and clinically diagnosed cases),suspected IFI group,and non-IFI group.The results of serum G-test,GM-test,and sputum fungal culture in three groups of patients were analyzed,early diagnostic value in IFI with combined three tests was evaluated.Results A total of 264 ICU patients were investigated,IFI group,suspected IFI group,and non-IFI group were 56,43,and 165 cases respectively.Among 56 cases of confirmed IFI,46,39,and 34 were positive for G-test,GM-test,and fungal culture respectively.The sensitivity,specificity,positive predictive value,and negative predictive value of combined three detection were 98.2％,82.4％,65.5％,and 99.3％ respectively,positive likelihood ratio,negative likelihood ratio,and Youden index were 5.58,0.02,and 0.98 respectively.The sensitivity and negative predictive values of combined three detection were both higher than those of single G-test,GM-test,and sputum fungal culture (all P＜0.05);but specificity and positive predictive value of combined three detection were not significantly different from single G-test,GM-test,and sputum fungal culture(all P＞0.05).Conclusion The combination of G-test,GM-tests,and sputum fungal culture can improve the sensitivity of early diagnosis of IFI in ICU patients,and guide the clinicians in the early treatment of IFI.

Clinical, radiological and bacteriological profile of patients with community acquired pneumonia (CAP)

Background: Community acquired pneumonia (CAP) has been recognized as a common and potentially lethal condition nearly two centuries ago. CAP is a spectrum of diseases ranging from a simple febrile respiratory infection to a severe and fulminating illness leading to death. Aim: To obtain comprehensive insight into the mode of presentation, clinical, bacteriological and radiological profile of patients with community acquired pneumonia for the early detection of the disease. Materials and methods: A total 50 patients diagnosed as community acquired pneumonia as defined by MNR Medical College and Hospital were considered and analyzed individual clinical, radiological and microbial status for predetermination of disease. Results: Dyspnoea was significantly dominant in aged CAP patients (p< 0.001) and chest pain was frequent in younger CAP patients (p=0.090). Gram-positive cocci were observed in (70%) and gramnegative bacilli in 26% whereas, mixed cocci were found in 4%. In radiological examination, CAP associated with COPD was constituted 22%. Conclusion: Identification and determining the etiological and clinical patterns of Community Acquired Pneumonia helps in adoption of regionally optimized diagnostic and therapeutic approach.

Distribution and Drug Resistance of Pathogens by Sputum Culture in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Our Hospital / 中国药房

OBJECTIVE:To understand the distribution and drug resistance of the pathogens by sputum culture in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in our hospital so as to provide reference for rational use of antibiotics. METHODS:From Dec. 2010 to Dec. 2014,the sputum specimens were collected from the AECOPD patients,then the identification of 307 strains of pathogens and drug susceptibility test were carried out,and the data were analyzed statistically by using SPSS 17.0 software. RESULTS:A total of 307 strains of pathogens were collected,of which 17 cases of gram-positive ba-cillus accounted (5.54%),247 cases of gram negative cocci (80.46%),43 cases of fungi accounted (14.00%). The most com-mon isolates from sputum specimens were Pseudomonas aeruginosa (33.22%),Acinetobacter baumannii (19.54%),Stenotroph-omonas maltophilia(9.77%),Klebsiella pneumoniae(7.82%),Candida albicans(6.84%),etc. P. aeruginosa and A. baumannii were highly multidrug-resistant. There were 10 strains of ESBLs-producing K. pneumonia isolated, with the isolation rate of 41.67%. No Staphylococcus aureus strain was found resistant to vancomycin,teicoplanin or linezolid. Methicillin resistant strains in S. aureus(MRSA)accounted for 50.00%. CONCLUSIONS:Gram-negative bacilli are the most common pathogens in the AE-COPD patients. The common species of pathogens are highly resistant. More attention should be paid to the drug resistance monitor-ing of pathogens and rational use of antibiotics according to the results of susceptibility test.

Early diagnosis values of C-reactive protein and procalcitonin for children with bacterial infectious pneumonia / 国际检验医学杂志

Objective To explore the early diagnosis value of C‐reactive protein (CRP) and procalcitonin (PCT ) for bacterial in‐fectious pneumonia of children .Methods A total of 101 children with bacterial infectious pneumonia ,64 children with non‐bacterial infectious pneumonia and 73 children with non‐infectious disease were selected in bacterial infectious pneumonia group ,non‐bacterial infectious pneumonia group and non‐infectious disease group respectively .Serum PCT and CRP levels were measured before treat‐ment in the three groups .With sputum culture results as gold standard for the diagnosis of bacterial infectious pneumonia ,the sensi‐tivity ,specificity ,positive predictive value ,negative predictive value ,Youden index and diagnostic accuracy of PCT ,CRP ,PCT /CRP series test and parallel test were calculated for bacterial infectious pneumonia diagnosis .Results The levels of PCT and CRP of children in bacterial infectious pneumonia group were significant higher than those of children in non‐bacterial infectious pneumonia group and non‐infectious disease group(P < 0 .05) .The sensitivity ,specificity ,positive predictive value ,negative predictive value , Youden index and diagnostic accuracy of PCT ( ≥ 0 .5 ng/mL as the best intercept point) for bacterial infectious pneumonia diagno‐sis were 0 .743 ,0 .719 ,0 .806 ,0 .639 ,0 .461 and 0 .733 .And the same values for PCT /CRP series test were 0 .604 ,0 .875 ,0 .884 , 0 .583 ,0 .479 and 0 .709 respectively .All the values were higher than those of children in non‐bacterial infectious pneumonia group and non‐infectious disease group except sensitivity .Conclusion The combination of PCT and PCT /CRP series test is ideal method for early diagnosis of bacterial infectious pneumonia with high sensitivity and specificity .

Observation of high-sensitivity C-reactive protein and white blood cell levels in patients with positive sputum culture results / 国际检验医学杂志

Objective To investigate the change of high‐sensitivity C‐reactive protein(hs‐CRP) and white blood cell(WBC) in patients with positive sputum culture results .Methods hs‐CRP and WBC were determined in 116 patients with positive sputum culture results ,which were divided into 5 groups according to strains ,and control group of patients with negative sputum culture re‐sults .Levels and abnormal rates of various parameters were compared between each group .Results hs‐CRP levels significantly in‐creased in the 5 sputum culture positive groups ,compared with control group(P<0 .05) ,and that of Candida albicans group was the most high .WBC and neutrophile granulocyte(NEU) levels of 4 positive groups were obviously raised(P<0 .05) besides Haemophi‐lus influenzae group ,and the elevation tendency was the most obvious in Streptococcus pneumoniae group .The 5 positive groups were all with high detectable rates of hs‐CRP elevation .The detectable rate of WBC elevation in Streptococcus pneumoniae group was 64 .7% ,higher than Haemophilus influenzae group(P<0 .05) .Conclusion The majority of patients with positive sputum cul‐ture results could be with inflammatory response because of bacterial infection or colonization .

Factors Affecting Discordance between Sputum Smear and Culture Conversion Rates In Newly Diagnosed Pulmonary Tuberculosis: A Retrospective Study in Developing Country.

Aims: To assess the performance of sputum AFB smear for monitoring treatment response and outcome of anti-tuberculous drugs among newly diagnosed smear positive pulmonary TB patients. Study Design: This study was conducted prospectively among newly diagnosed smear positive pulmonary TB patients. Place and Duration of Study: Queen Savang Vadhana Memorial Hospital and Chonburi Regional Hospital, Chonburi province, Thailand during April 2010 and July 2012. Methodology: Sputum AFB smear, culture and drug susceptibility test were performed at the time of diagnosis, the second and the fifth month of treatment. Baseline characteristic, clinical and laboratory parameters, treatment regimens and adverse events were recorded. Descriptive statistics and multiple logistic regression analysis were applied as appropriate. The performance of sputum AFB smear for monitoring treatment response and outcome of anti-tuberculous drugs was done using culture as the gold standard. Results: Of 297 eligible pulmonary TB cases, majorities were male (72.4%) with median age of 39 years, illiterate to low educated (52.6%) and earning low income (77.5%). Cough was the most common symptom (91.2%) and cavity was present in 31.1%. At the second month, 17.0% of patients had discordance between sputum AFB smear and culture. High bacilli load (adjusted OR=2.38, CI=1.09-5.18), and hearing alteration (adjusted OR=10.98, CI=1.79-67.28) were significant predictors. Hypoalbuminemia was significantly more severe in patients with false positive AFB smear (P=.04). Sensitivity and specificity for AFB smear were 44.7% and 89.6% at the second month and 57.1% and 97.5% at the fifth month, respectively. MDR-TB was diagnosed in 1.0% and success rate was 77.1%. Conclusions: Baseline AFB smear ≥ 2+ and hypoalbuminemia as well as adverse events during intensive phase are strongly recommended as the criteria to prioritize culture and DST for new smear positive pulmonary TB patients with positive AFB smear at the second and the third month of treatment in developing countries.

Causes of unqualified culturing of sputum specimens and corresponding countermeasures / 现代临床护理

Objective To investigate the causes of unqualified sputum specimens culturing and put forward the countermeasures.Methods One thousand five hundred and twenty-four sputum specimens from January to December in 2012 were collected as control group and another 768 cultured sputum specimens from January to June in 2013 as the experimental group.The sputum specimens in the control group were analyzed by a designated nurse to find out causes for the unqualified specimens and work out countermeasures.Then the strategies to avoid unqualified specimens were used in the experimental group.Finally, the unqualified rate was compared between the two groups.Result The experimental group was significantly better than the control group before taking the measures for culturing in terms of time for specimen collection, inadequacy in specimens, unprepared oral tract, quality in specimens, sputum collected from deep into lungs(P<0.05).Conclusion The main causes of unqualified specimens included improper choice of time for specimen collection, inadequacy in specimens and unprepared oral tract.Enhanced training to medical staff, health education to patients and standardized flowchart for specimens collection are critical for the improvement of qualified sputum culturing.

Comparative analysis of various clinical laboratory diagnosis methods of pulmonary tuberculosis / 国际检验医学杂志

Objective To discuss the value of combination of various clinical laboratory methods in the diagnosis of Mycobacteri-um tuberculosis(MTB) .Methods T-SPOT .TB ,sputum smear ,sputum culture ,and MTB-DNA detection were used to detect MTB .The sensitivity ,specificity ,rate of missed diagnosis ,coincidence rate and correct diagnosis index for tuberculosis diagnosis of the four methods and their pairwise combinations were analyzed and compared .Results Comparing with other methods ,T-SPOT . TB combined with MTB-DNA detection had the highest sensitivity ,coincidence rate and correct diagnosis index ,and the lowest rate of missed diagnosis ,with significant difference(P<0 .05) .Conclusion T-SPOT .TB combined with MTB-DNA detection could be used as an adjuvant method for the early diagnosis of tuberculosis .

Guidance significance of sputum smear on sputum culture / 国际检验医学杂志

Objective To understand the guidance significance of sputum smear on the sputum culture by comparing the micro-scopic detection results of sputum smear with the sputum culture results in 227 cases.Methods 227 cases of sputum specimen were collected for observing the character and smear staining by microscopy.These specimens were divided into the class A,B,C and D according to the standards and simultaneously conducted the culture.The relationship between smear and culture was analyzed.Reˉ sults Among 227 cases of sputum specimen,158 cases were qualified and accounted for 69.60%,and 69 cases were unqualified and accounted for 30.40%.Potential pathogens were detected in 128 cases,the positive detection rate was 56.39%,the positive detec-tion rate of qualified sputum specimens was 70.39% and which of unqualified sputum specimens was 28.00%.The coincidence rate of qualified sputum specimen smear results and the culture results was 72.78%.The positive rate of cytophagic bacteria in the qual-ified sputum specimens was 11.72%,in which 14 cases of cytophagic bacteria were the qualified class A sputum specimens with the positive rate of 16.67% and 5 cases of cytophagic bacteria were the class B sputum specimens with the positive rate of 6.76 %. Conclusion The sputum smear microscopic detection can provide the important information for the diagnosis and treatment of re-spiratory infections and the sputum smear has the important guiding significance for sputum culture.

Isolation of Mycobacterium fortuitum in sputum specimens of a patient with chronic cough: Is it clinically significant?

Managing chronic cough is diagnostically challenging especially in primary care. This case report highlights the difficulties experienced in approaching a case of chronic cough from a primary care perspective. The discussion also involves the clinical significance and treatment dilemma of M. fortuitum chelonae complex that was isolated from the sputum cultures of an elderly woman who presented with chronic cough for more than a year.

Correlation analysis of lower respiratory tract bacterial colonization and airway inflammation in stable COPD patients / 中国基层医药

Objective To detect sputum quantitative bacterial culture and sputum cell counts in stable chro -nic obstructive pulmonary disease (SCOPD) patients, and explore the correlation between lower airway bacterial colo-nization(LABC) and airway inflammation.Methods 47 patients with SCOPD were chosen ,all patients induced spu-tum specimens to sputum quantitative bacterial culture and sputum cell counts ,sputum and serum IL-8 levels were al-so detected.Results There were 13 patients whose bacterial colonization of the lower respiratory tract in patients was higher than 107CFU/mL.Serum IL-8 levels of 13 patients was ( 70.65 ±19.89 ) pg/mL, sputum IL-8 levels was (364.65 ±74.19)pg/mL,all significantly higher than those whose bacterial colonization of the lower respiratory tract lower than 107CFU/mL,(15.87 ±3.01)pg/mL and (146.65 ±28.11)pg/mL,there were statistically significant difference(t=13.43,9.76,all P<0.05).After 1-year follow-up,FEV1 decline(0.071 ±0.016)L in patients whose bacterial colonization of the lower respiratory tract≥107CFU/mL,it was significantly higher than those whose bacterial colonization of the lower respiratory tract <107CFU/mL;the frequency of acute exacerbation was (2.93 ±1.07) times,significantly more than those whose bacterial colonization of the lower respiratory tract <107CFU/mL,the differ-ences were statistically significant (t=5.43,6.54,all P<0.05).Conclusion Lower respiratory tract bacterial colo-nization in patients with SCOPD can aggravate the inflammatory response and increase degree of airflow limitation .

Comparison of pathogenic bacteria and drug sensitivity in neonates with pneumonia hospitalized in intensive care unit and common in-patient ward / 中华实用儿科临床杂志

Objective The differences in pathogenic bacteria and their drug sensitivity in neonates with pneumonia were compared between:(1) neonates treated in NICU and stayed in common in-patient ward ; (2) neonates treated with ventilator or without ventilator; (3)neonates supported by different mechanical ventilation mode.Methods The data of 222 neonates with pneumonia hospitalized in the Children's Hospital of Chongqing Medical University between Jul.2012 to Jan.2013 were analyzed retrospectively.Patients were divided into NICU group(n =152) and common in-patient ward group (n =70).Meanwhile,in NICU group,the neonates were divided into inspiration support group (n =90) and without inspiration support group(n =62).Moreover,in inspiration support group,the patients were further divided into invasive ventilation group who were treated by mechanical ventilation support(n =74),and noninvasive ventilation group who were only treated by CPAP(n =16).The differences in pathogenic bacteria and their drug sensitivity were compared among different groups.Results 1.The findings of pathogenic bacteria of sputum culture:the pathogens were mainly Gram-negative bacilli both in NICU group and common in-patient ward group,but the ratio of Gram-negative bacilli in NICU group was significantly higher than that of common in-patient ward group[92.6％ (150/162 cases) vs 68.7％ (44/64 cases),x2 =28.846,P =0.000] ; the ratio of multidrug-resistant bacteria in NICU group was significantly higher than that in common in-patient ward group,[18.5％ (30/162 cases) vs 0,x2 =13.666,P =0.000].No difference in the ratio of Gram-negative bacilli was found between inspiration support group and without inspiration support group[91.6％ (108/118 cases) vs 95.5％ (42/44 cases),x2 =6.805,P =0.224].There was no significant difference in the ratio of multidrug-resistant bacteria between groups with or without inspiration support[20.4％(24/118 cases) vs 19.0％ (8/44 cases),x2 =0.095,P =0.826].No significant difference in the ratio of Gram-negative bacilli was found between the invasive ventilation group and the noninvasive ventilation group [90.2％ (92/102 cases) vs 100.0％ (16/16 cases),x2 =3.552,P =0.169].Escherichia coli,pseudomonas aeruginosa,acinetobacter bauman were the majority of multidrug resistant bacteria(drug-resistant rate was 66.0％-100.0％) in NICU group.2.Drug sensitivity results of sputum culture:the pseudomonas aeruginosa in the invasive ventilation group were resistant to conventional antibiotics,but sensitive to multiple stuck ring (drug-sensitive rate was 100.0％).Klebsiella pneumoniae subspecies,enterobacter cloacae had certain sensibility to imipenem and cilastatin sodium for injection use,meropenem,amikacin(drug-sensitive rate was 60.0％-100.0％).Because of these Gram-negative bacilli derived from different groups,even the same bacillus to the same antibiotics their drug-sensitive rate still had certain differences:the drug-sensitive rate of Gram-negative bacilli in NICU group was generally lower than that of common in-patient ward group;meanwhile,that in the inspiration support group was generally lower than that without inspiration support group ; moreover,that in the invasive ventilation group was generally lower than that of noninvasive ventilation group.The major Gram-negative bacilli in the common in-patient ward group had almost resistance to cefazolin sodium and ampicillin mostly(drug-resistant rate were 100.0％),but had sensibility to some extent to piperacillin/tazobactam and ceftazidime (drug-sensitive rate were 50.0％-70.0％) ;which also had higher sensibility to amikacin,levofloxacin,meropenem,imipenem and cilastatin sodium for injection use (drug-sensitive rate was ＞ 70.0％).Conclusions The pathogens were mainly Gram-negative bacilli in neonates treated in NICU with pneumonia.The top five bacilli were klebsiella pneumoniae subspecies,bauman acinetobacter,pseudomonas,enterobacter and escherichia coli.The neonates with pneumonia who were managed in NICU or treated with ventilator or supported by invasive ventilation might more easily infected by multidrug-resistant bacteria.Carbon penicillins,aminoglycoside antibiotics might be more effective during treating the neonates with pneumonia who are treated in NICU.The antibiotic containing enzyme inhibitor,or carbon penicillins,aminoglycosides and quinolones might be effective during treating the neonate with pneumonia who are managed in common in-patient ward.

The value of procalcitonin in predicting the severity of critically ill children / 中华急诊医学杂志

Objective To study the value of Procalcitonin (PCT) in predicting the severity of the critically ill children by analyzing the clinical data of increased PCT level.Methods A total of 392 patients with increased PCT admitted to the PICU of Hunan Children's Hospital from August 2011 to April 2012 were enrolled.The data of clinical manifestations,medical condition,sputum culture,organ function and prognosis were summarized and analyzed statistically.The continuous variables were analyzed with t-test,the categorical variables were analyzed with Chi-squared test,and the correlation analysis was calculated using Pearson coefficients.Results Serum PCT had a positive correlation with inflammatory markers such as C-reactive protein (CRP),white blood cell (WBC) count and the percentage of neutrophils (NEU％) (P ＜ 0.01).PCT was significantly higher when sputum culture was positive (P ＜0.05) but there were no obvious changes in CRP,WBC and NEUT％ (P ＞ 0.05).Serum PCT increased obviously in the presence of organ dysfunction.The higher serum PCT,the more likely multiple organ failure would happen.The PCT level upon admission in death group (63 cases) was (62.43 ± 70.19) ng/ml,which was higher than that in survival group (P ＜ 0.01).Conclusions PCT level is helpful in assessment of severity and prognosis of bacterial infection in critically ill children,and can reflect the organ dysfunction objectively.It can improve the survival rate and the life quality in critically ill children.

Cambios del esquema antibiótico en neumonía adquirida en la comunidad. Valor del cultivo de esputo en pacientes ingresados al Hospital de San José, Bogotá D.C. / Changes in antimicrobial regimes to treat community-acquired pneumonia: value of sputum culture in patiens admitted to the San José Hospital, Bogotá D. C.

Introducción: la utilidad del Gram y cultivo de esputo para el manejo y seguimiento de los pacientes con neumonía adquirida en la comunidad (NAC) es aun controversial. Objetivo: describir la frecuencia de cambio del manejo antibiótico de acuerdo con el resultado del cultivo de esputo en enfermos hospitalizados con NAC. Tipo de estudio: descriptivo de corte transversal. Métodos: pacientes ingresados al servicio de medicina interna del Hospitalde San José con diagnóstico clínico y radiológico de NAC que no requirieran manejo en UCI. Se incluyeron 86 casos en un período de cuatro meses a quienes se les aplicó al ingreso la escala de pronóstico CURB 65, la presencia o no de comorbilidades, la positividad del Gram y cultivo de esputo, la estancia hospitalaria y el cambio de antibiótico de acuerdo con el resultado del cultivo de esputo si la muestra era significativa. Resultados: el promedio de edad de la población fue 58.8 años (DS 21.7). El 45% tenía comorbilidades al ingreso y el 37% algún tipo de complicación asociada con la NAC. En la escala de CURB-65 el 52% tenía un punto, dos puntos el 27%, tres el 3.5 % y con cuatro el 2%. La respuesta a la terapia antibiótica se observó en el 85% y la frecuencia del cambio antibiótico según el reporte de cultivo ocurrió en el 10% (6/62). La mediana de días de estancia hospitalaria fue de cinco. El 95% egresó del hospital y el 5% restante fue trasladado a otro servicio. Conclusiones: el Gram y cultivo de esputo son ayudas diagnósticas de bajo costo y útiles en pacientes con NAC clasificados segúnlas escalas de severidad de alto riesgo o neumonías severas, en donde el aislamiento del germen es crucial paradirigir la terapia antibiótica; en neumonías no severas no han demostrado mayor utilidad ya que pocas veces hay aislamiento del germen y no generan cambios en el manejo del paciente. Se debe asegurar la adecuada toma y procesamiento para aumentar la probabilidad de aislamiento.

Introduction: the applicability of sputum Gram stain and culture to define management and follow-up of patients with community-acquired pneumonia (CAP) remains controversial. Objective: to describe the frequency of changes in antimicrobial therapy based on results of sputum culture in hospitalized patients with CAP. Type of study: this is a descriptive cross sectional study. Methods: patients admitted to the Internal Medicine Department at the San José Hospital with radiologic and clinic diagnosis of CAP who did not require ICU care were selected. Eighty-six (86) cases in a four-month period were included. They were graded with the CURB-65 prediction scale upon admission considering comorbid factors, positive sputum Gram stain and culture, hospital stay and change of antimicrobial therapy based on the result of the sputum culture when sample was substantial. Results: the mean age of the study population was 58,8 years (SD 21,7). Forty-five percent (45%) had comorbidities upon admission and 37% had some type of complication associated to CAP. In the CURB-65 scale 52% rated one point, 27% rated two points, 3,5 % three points and 2% four points. Response toantimicrobial therapy was observed in 85% and a change of antimicrobial regime based on culture results occured in 10% (6/62). The median number of days in hospital was five. Ninety-five percent (95%) were discharged from the hospital and the remaining 5% were transferred to another department. Conclusions: sputum Gram stain and culture are low-cost diagnostic tools and are useful in patients with CAP classified acording to the high-risk severity scales or severe pneumonias, in which isolation of the pathogen is crucial to tailor antimocrobial therapy; in non-severe pneumonias they have not shown mayor applicability for in a very small number of cases the etiologic organism is isolated and no changes in patient management are generated...

Nursing research in the sputum culture specimen monitoring of patients with pulmonary infection / 中国实用护理杂志

Objective We discussed the nursing management measures to improve the qualified rate of sputum culture specimen of patients with pulmonary infection. Methods We monitored the qualified rate of sputum culture specimen, positive rate, pathogen distribution and drug resistance for patients with pulmonary infection in our hospital. Data collected from January 2007 to February 2008 were set as the test group. Data collected from January 2005 to December 2006 were set as the control group. The monitoring effect was compared in the two groups. Results The qualified rate of sputum culture specimen and the distribution of bacteria and fungus in the test group were different from those of the control group (P<0.01). Conclusions To strengthen the quality control of sputum culture specimen, comprehensively improve the cognition of nurses to the significance of qualified rate of sputum culture specimen and the techique of collecting sputum culture specimen could ensure the qualified rate of sputum culture specimen.