Factors influencing pulmonary infection in elderly neurocritical patients and their predictive values: a data analysis for consecutive four-year / 中华危重病急救医学

Objective:To analyze the factors influencing pulmonary infections in elderly neurocritical patients in the intensive care unit (ICU) and to explore the predictive value of risk factors for pulmonary infections.Methods:The clinical data of 713 elderly neurocritical patients [age ≥ 65 years, Glasgow coma score (GCS) ≤ 12 points] admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from 1 January 2016 to 31 December 2019 were retrospectively analyzed. According to whether or not they had HAP, the elderly neurocritical patients were divided into hospital-acquired pneumonia (HAP) group and non-HAP group. The differences in baseline data, medication and treatment, and outcome indicators between the two groups were compared. Logistic regression analysis was used to analyze the factors influencing the occurrence of pulmonary infection.The receiver operator characteristic curve (ROC curve) was plotted for risk factors and a predictive model was constructed to evaluate the predictive value for pulmonary infection.Results:A total of 341 patients were enrolled in the analysis, including 164 non-HAP patients and 177 HAP patients. The incidence of HAP was 51.91%. According to univariate analysis, compared with the non-HAP group, mechanical ventilation time, the length of ICU stay and total hospitalization in the HAP group were significantly longer [mechanical ventilation time (hours): 171.00 (95.00, 273.00) vs. 60.17 (24.50, 120.75), the length of ICU stay (hours): 263.50 (160.00, 409.00) vs. 114.00 (77.05, 187.50), total hospitalization (days): 29.00 (13.50, 39.50) vs. 27.00 (11.00, 29.50), all P < 0.01], the proportion of open airway, diabetes, proton pump inhibitor (PPI), sedative, blood transfusion, glucocorticoids, and GCS ≤ 8 points were significantly increased than those in HAP group [open airway: 95.5% vs. 71.3%, diabetes: 42.9% vs. 21.3%, PPI: 76.3% vs. 63.4%, sedative: 93.8% vs. 78.7%, blood transfusion: 57.1% vs. 29.9%, glucocorticoids: 19.2% vs. 4.3%, GCS ≤ 8 points: 83.6% vs. 57.9%, all P < 0.05], prealbumin (PA) and lymphocyte count (LYM) decreased significantly [PA (g/L): 125.28±47.46 vs. 158.57±54.12, LYM (×10 9/L): 0.79 (0.52, 1.23) vs. 1.05 (0.66, 1.57), both P < 0.01]. Logistic regression analysis showed that open airway, diabetes, blood transfusion, glucocorticoids and GCS ≤ 8 points were independent risk factors for pulmonary infection in elderly neurocritical patients [open airway: odds ratio ( OR) = 6.522, 95% confidence interval (95% CI) was 2.369-17.961; diabetes: OR = 3.917, 95% CI was 2.099-7.309; blood transfusion: OR = 2.730, 95% CI was 1.526-4.883; glucocorticoids: OR = 6.609, 95% CI was 2.273-19.215; GCS ≤ 8 points: OR = 4.191, 95% CI was 2.198-7.991, all P < 0.01], and LYM, PA were the protective factors for pulmonary infection in elderly neurocritical patients (LYM: OR = 0.508, 95% CI was 0.345-0.748; PA: OR = 0.988, 95% CI was 0.982-0.994, both P < 0.01). ROC curve analysis showed that the area under the ROC curve (AUC) for predicting HAP using the above risk factors was 0.812 (95% CI was 0.767-0.857, P < 0.001), with a sensitivity of 72.3% and a specificity of 78.7%. Conclusions:Open airway, diabetes, glucocorticoids, blood transfusion, GCS ≤ 8 points are independent risk factors for pulmonary infection in elderly neurocritical patients. The prediction model constructed by the above mentioned risk factors has certain predictive value for the occurrence of pulmonary infection in elderly neurocritical patients.

Research progress on the epidemiology of pneumonia / 预防医学

@#Pneumonia is a common lower respiratory tract infection, which causes a large disease and economic burden worldwide, and is an important public health problem to be solved urgently. Based on review of publications pertaining to the epidemiology of pneumonia from 2013 to 2023, this article summaries the epidemiological characteristics and main influencing factors of pneumonia. It is found that the epidemiological characteristics of pneumonia vary in different areas; men, the elderly and children are the high-risk groups of pneumonia incidence and mortality; and age, smoking, alcohol consumption, air pollution, comorbidity and vaccination are the main factors affecting the incidence and mortality of pneumonia. Strengthening health education, reducing exposure to risk factors and promoting vaccination are recommended to lower the morbidity and mortality of pneumonia in susceptible populations.

Etiological profile, prescribing pattern of antibiotics and clinical outcomes of pneumonia patients in a tertiary care hospital in South India during 5-year period

Background: Pneumonia is one of the most important and serious lower respiratory tract infections, which requires implacable attention. This work aimed to document the causative organisms, antibiotics used, and outcome of pneumonia patients hospitalized in a tertiary care hospital. Materials and Methods: A retrospective study was conducted in the medical departments of a tertiary care teaching hospital for 5 years. Demographic details and clinical details including pertinent laboratory values of patients diagnosed with pneumonia were documented and analyzed using a specifically designed data collection form. Results: The study was conducted on 190 patients. The average age of the study population was 56.7 ± 22.6 years and there was a male preponderance of 111(58.4%) patients. Klebsiella pneumonia was found to be the most frequently isolated pathogen in 12.5% of the sputum culture, followed by Acinetobacter baumannii in 10.22% and Pseudomonas aeruginosa in 9.09%. The most commonly prescribed empirical antibiotics were beta-lactam antibiotics mostly in combination with macrolides for synergy irrespective of Pneumonia Severity Index (PSI) classes. Definitive therapy was classified based on World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classification of antibiotics, watch category antibiotics were prescribed according to culture report and reserve antibiotics were prescribed only in those cases where watch category antibiotics were resistant. On analyzing PSI of community-acquired pneumonia (176 patients), most of the patients in the study belong to class 4: 61 patients (34.7%) and class 5: 44 patients (25%). For the high-risk patients (PSI class 4 and 5), mortality was approximately 3.8% (4 of 105) and for low-risk patients, there was zero mortality reported within 30 days. Conclusion: Gram-negative bacteria were the major pathogens causing Pneumonia in the study site contradictory to the data from developed countries. Identifications of pathogens and appropriate antibiotic therapy based on PSI score can bring down the duration of hospital stay and mortality of patients with pneumonia.

Risk factors for acquisition of ESBL-producing Escherichia coli and Klebsiella pneumoniae on non-ventilator-associated hospital-acquired pneumonia in a tertiary care hospital in Indonesia

Aims@#This study was aimed to identify the risk factors for the acquisition of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae on non-ventilator hospital-acquired pneumonia (NV-HAP) patients in a tertiary care hospital in Indonesia.@*Methodology and results@#A case-control study was performed between March 31, 2018, and August 31, 2019. Twenty-eight ESBL-producing E. coli and K. pneumoniae isolates and 28 susceptible strains of E. coli and K. pneumoniae obtained from NV-HAP patients were included in this study. Phenotypic screening for ESBL production was performed by the Vitek2 system and subsequently confirmed by double-disk synergy tests. The use of 3rd generation cephalosporin as initial antibiotic therapy for more than three days was the significant risk factor for the acquisition of ESBL-producing E. coli and K. pneumoniae among NV-HAP patients (odds ratio [OR] 41.827; p=0.001). The length of stay of patients with NV-HAP acquiring the ESBL strains was longer than 10 days (OR 17.334; p=0.001).@*Conclusion, significance and impact of study@#The use of 3rd generation cephalosporin as the initial antibiotic for NV-HAP should be restricted to prevent the emergence of ESBL-producing strains. Infection prevention measures are required to control the acquisition of ESBL-producing E. coli and K. pneumoniae in NV-HAP patients.

Differential gene expression and bioinformatics analysis in sepsis secondary to pneumonia / 中华危重病急救医学

Objective:To analyze and screen the key genes of sepsis secondary to pulmonary infection by bioinformatics, and to provide theoretical basis for the basic research of the disease and find an ideal animal model program.Methods:Experiment 1 (bioinformatics analysis): gene expression data sets of pulmonary infection secondary sepsis patients and multiple sepsis animal models were screened by Gene Expression Omnibus (GEO) Database, and gene differences were analyzed by R software. Differential genes were analyzed by gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Correlation analysis was conducted between differential genes and clinical symptoms in the data set of pulmonary infection secondary sepsis, and the correlation heat map between differential genes and clinical symptoms was drawn. Key genes were screened by weighted gene co-expression network analysis (WGCNA) and protein-protein interaction network analysis (PPIN) clustering. Experiment 2 (sepsis animal model preparation): male mice weighing 21-25 g were randomly divided into the key genes group and the control (Sham) group. And cecal ligation and puncture (CLP) was used to establish mouse sepsis model, while the mice in sham group were performed by exposure of cecum. And all the mice were scarified 24 hours after surgery to extract the total RNA from lung tissue, real time fluorescent quantitative polymerase chain reaction (RT-qPCR) was used to detect mRNA expression of key genes.Results:Experiment 1 (bioinformatics analysis): 319 differential genes were showed by GSE 134364 and GSE 65682 data set analysis of pulmonary infection secondary sepsis. And there was no genetic difference between community acquired pneumonia (CAP) and hospital acquired pneumonia (HAP) in patients with pulmonary infection secondary to sepsis. Obvious differences existed between differential genes in animal models, and there was no common differential gene. Differential genes in patients and animal models were similarly enriched in GO function, mainly in cell differentiation, regulation of cell process, and regulation of cellular response to stimuli, there were significant differences in pathway enrichment, among which, CLP animal models showed higher consistency with patients. The key genes obtained by WGCNA and PPIN analysis were MAPK14, NLRC4 and LCN2. Experiment 2 (sepsis animal model preparation): animal experiment results showed that the mRNA expressions of MAPK14, NLRC4 and LCN2 in lung tissue of CLP model mice were significantly up-regulated compared with the sham group.Conclusions:MAPK14, NLRC4 and LCN2 are key genes involved in the regulation of biological processes of pulmonary sepsis secondary to infection, and are potential research directions of this disease. What's more, CLP animal model can better reflect the biological characteristics of patients with pulmonary infection secondary sepsis, and is one of the ideal animal model schemes for pulmonary infection secondary sepsis.

Analysis of risk factors of hospital-acquired pneumonia after craniocerebral trauma / 中国医师进修杂志

Objective:To analyze the risk factors of hospital-acquired pneumonia (HAP) after craniocerebral trauma.Methods:A total of 329 patients undergoing craniocerebral trauma surgery from December 2014 to December 2019 in Yicheng People′s Hospital of Zaozhuang City were enrolled. The data were reviewed and divided into HAP group (42 patients) and non-HAP group (287 patients) according to whether HAP occurred after surgery. The age, onset to operation time, surgery duration, and hospital stay between the two groups were compared. The differences of preoperative factors, intraoperative factors and postoperative factors between the two groups were compared. The risk factors of HAP after craniocerebral trauma were analyzed by Logistic multi-factor regression analysis.Results:The age, onset to operation time, surgery duration, hospital stay in HAP group were longer than those in the non-HAP group: (55.09 ± 8.14) years vs. (45.98 ± 8.06) years, (9.65 ± 0.54) h vs. (7.43 ± 0.72) h, (332.54 ± 72.65 )min vs. (281.09 ± 78.54) min, (17.13 ± 2.56) d vs. (5.02 ± 3.09), the differences were statistically significant ( P<0.05). The differences in the types of brain diseases between the two groups were statistically significant ( P<0.05). The results of single factor analysis showed that the history of pulmonary disease, scores of Glasgow Coma Scale (GCS) < 8 points and ≥8 points, whether or not emergency operation, preoperatie antibiotics, reintubated, endotracheal intubation, indwelling gastric tube, and raise the head of a bed 30° to 45°, proton pump inhibitors, craniocerebral trauma and non traumatic diseases, mechanical ventilation, floor nutrition start time, giving glucocorticoid between the HAP group and non-HAP group had significant difference ( P<0.05). The Logistic multi-factor regression analysis showed that the age >50 years old, surgery duration >4 h, preoperative GCS<8 points, emergency surgery, tracheotomy and indwelling gastric tube were independent risk factors of HAP after surgery ( P<0.05). Conclusions:For patients undergoing surgical treatment of craniocerebral trauma, it is necessary to estimate the risk of postoperative HAP based on age, preoperative GCS score, elective surgery after emergency, operation time, and control risk factors.

Value Addition on Trend of Pneumonia Disease in India- The Current Update

Pneumonia continues to be the leading infectious cause of death among children under the age of five worldwide. Diagnosis of this disease is primarily dependent on physical examination, clinical history,and radiographic studies. Microbiological studies of the lower respiratory tract secretions have proven to be futile, however, sputum gram staining and culturing methods often aid in the diagnosis and management of these infections. Aspiration pneumonia often occurs in a community setting and primarily involves anaerobes like Staphylococcus aureus or gram-negative rods such as Klebsiella pneumonia, and other Enterobacteriaceae and Pseudomonas species. The total number of cases taken in the study of acute pneumonia was22 (15 male subjects and 7 female subjects). Biochemical tests were conducted for identifying different organisms present in the samples collected from patients suffering from acute pneumonia.Distribution of bacteria in the case of acute pneumonia was as follows: Staphylococcus aureus was recorded to be the highest (36.36%) followed by Streptococcus pneumonia (18.18%) and Klebsiella pneumonia (18.18%), Pseudomonas pneumonia (13.63%), Haemophilus influenza(9.09%) and lastly Chlamydia pneumonia(4.45%). A maximum number of laboratories proven acute pneumonia cases (36.36%) belonged to 61-70 years. The distribution of cases was marginally more in urban areas (63.63%). By occupation largest group (36.36%) was of others in case of acute pneumonia were as farmers, housewivesand others were the largest groups (22.73%) each. The microbial etiology derived from the present study found that Klebsiella pneumoniawas an independent risk factor for mortality in severe community-acquired pneumonia. Moreover, two important findings were drawn from this study. K. pneumoniawas identified as the causative pathogen in 22% of cases, second to S. pneumonia

Hypoalbuminemia and Central Venous Catheter as Risk Factors for Multidrug-resistant Healthcare-associated Pneumonia in an Intensive Care Setting

The rapid emergence of antibiotic­resistant bacteria is a threat to global health particularly in the area of healthcare­associate pneumonia (HCAP) where there is high rate of mortality. In general, guidelines should serve as a framework that needs to be complemented by local antibiogram data due to multiple factors influencing the development of multidrug­resistant (MDR) HCAP. Failure to administer prompt and appropriate empirical therapy would often result in a high mortality rate. Based on these concerns, the aim of the study was to evaluate the appropriate empirical use of antibiotic and risk factors of MDR HCAP based on local pathogen resistant pattern. This was a retrospective analysis on HCAP in critical care of a tertiary­care hospital with data fromJanuary 2016 to December 2018. Patients diagnosed with HCAP: hospital­associated pneumonia (HAP) and ventilator­associated pneumonia (VAP), with positive bacterial cultures were included into the study. Of the 269 patients and isolates included, 160 (59.5%) had MDR strains. The top causative pathogens isolated were Acinetobacter baumannii(n=104, 38.7%), Pseudomonas aeruginosa(n=66, 24.5%), Klebsiella spp(n==55, 20.4%), and Staphylococcus aureus(n=16, 5.9%). The incidence of inappropriate empirical antibiotic was significantly higher in patients with MDR HCAP (n=135, 84.4%) compared to those with non­MDR HCAP (n=34, 31.2%) (p < 0.001). Mortality was significantly higher in patients receiving inappropriate empirical therapy (n = 118, 72.4%) compared to those receiving appropriate empirical antibiotic (n = 36, 54.5%) (P = 0.009). The independent risk factors for MDR HCAP identified in this study were hypoalbuminemia (odds ratio [OR] 3.43, 95% confidence interval [CI] 1.08 –10.87, p = 0.036) and indwelling central venous catheter (OR 5.65, 95% CI 1.13 –28.18, p = 0.035). This work serves as a basis for a center­specific guideline to improve antibiotic use among HCAP patients in intensive care setting.

Spectrum of microbial infection in an Intensive Care Unit: a single centre tertiary care experience in Southern Indian state of Karnataka

Background: There is an increased incidence of hospital acquired infection, especially in ICU setting, the most common being ICU acquired pneumonia which increases the morbidity, mortality, prolongs hospital stay and consuming more resources. Microbial etiology of intensive care unit (ICU)-acquired pneumonia (ICUAP) determines antibiotic treatment and outcomes which vary from centre to centre. Hence, a study of risk factors, clinical profile of patient, microorganisms and their resistance patterns to antibiotics are important for the diagnosis, prognosis of patient with ICU acquired pneumonia and also in the prevention of the same.Methods: Patients with ICUAP confirmed microbiologically were prospectively compared according to identification of 1 (monomicrobial) or more (polymicrobial) potentially pathogenic microorganism. Patients without microbiological confirmation were excluded from the study. We assessed clinical characteristics, microbiology and outcome variables.Results: In the present study 60 patients with ICU Pneumonia were included out of which 50 (83%) had mono-microbial infection. Most common organism isolated in mono microbial infection was Klebsiella species (26%), followed by Acinetobacter species (25%), out of which 20 percent was multidrug resistant. Multi-drug resistance was similarly frequent in both groups. Outcome variables like initial response to the empiric treatment, length of stay and mortality were similar in both monomicrobial and polymicrobial pneumonia. Mortality rates were higher with higher pneumonia scores (p value <0.002) and with multi organ dysfunction (p <0.008) irrespective of mono microbial or poly microbial infection.Conclusions: In this study mono microbial infection was more than polymicrobial, the most common organism being Kliebsiella species followed by Acinetobacter species. When empiric treatment is frequently appropriate, mortality rates were higher with higher pneumonia scores and MODS. In our study polymicrobial aetiology did not influence the outcome of ICUAP.

Environmental surveillance of Legionella pneumophila in distal water supplies of a hospital for early identification & prevention of hospital-acquired legionellosis

Background & objectives: Legionella pneumophila, a ubiquitous aquatic organism is found to be associated with the development of the community as well as hospital-acquired pneumonia. Diagnosing Legionella infection is difficult unless supplemented with, diagnostic laboratory testing and established evidence for its presence in the hospital environment. Hence, the present study was undertaken to screen the hospital water supplies for the presence of L. pneumophila to show its presence in the hospital environment further facilitating early diagnosis and prevention of hospital-acquired legionellosis. Methods: Water samples and swabs from the inner side of the same water taps were collected from 30 distal water outlets present in patient care areas of a tertiary care hospital. The filtrate obtained from water samples as well as swabs were inoculated directly and after acid buffer treatment on plain and selective (with polymyxin B, cycloheximide and vancomycin) buffered charcoal yeast extract medium. The colonies grown were identified using standard methods and confirmed for L. pneumophila by latex agglutination test. Results: About 6.66 per cent (2/30) distal water outlets sampled were found to be contaminated with L. pneumophila serotype 2-15. Isolation was better with swabs compared to water samples. Interpretation & conclusions: The study showed the presence of L. pneumophila colonization of hospital water outlets at low levels. Periodic water sampling and active clinical surveillance in positive areas may be done to substantiate the evidence, to confirm or reject its role as a potential nosocomial pathogen in hospital environment.

Effect of post pyloric feeding on hospital-acquired pneumonia and mortality in patients with critical respiratory disease / 肠外与肠内营养

Objective:To investigate the effect of post pyloric feeding on hospital-acquired pneumonia and mortality in patients with critical respiratory disease.Methods:A retrospective survey of 41 cases of post pylorus feeding (post pylorus feeding group,n =41) in respiratory intensive care unit (RICU) was carried out,and 41 patients who received nasogastric feeding (nasogastric feeding group,n =41) were investigated in the same RICU.The incidence of ventilator-associated pneumonia (VAP),the incidence of hospital-acquired pneumonia (HAP,excluding VAP) and the in-hospital mortality of RICU were observed and compared between the two groups.Vomiting,aspiration,gastric retention,diarrhea,and the times of stopping enteral feeding were observed and compared as well.Results:The incidence of HAP in the post pylorus feeding group was 2.4％,which was significantly lower than that in the nasogastric feeding group (22％,P ＜ 0.05).The incidences of VAP in the post pylorus feeding group and nasogastric tube feeding group were 16.7％ and 8.7％ individually,which was no significant difference between the two groups (P ＞ 0.05).The mortality in RICU in the post pyloric feeding group was 36.6％,which was similar to that in the nasogastric feeding group (41.5％) (P ＞ 0.05).There was no difference in terms of vomiting,aspiration,gastric retention,diarrhea,and the times of stopping enteral nutrition.Conclusion:Compared with nasogastric feeding,post pyloric feeding reduces the incidence of HAP in critical respiratory patients.Nevertheless,post pyloric feeding fails to affect the incidence of VAP and in-hospital mortality in RICU.

The effect of early enteral nutrition on ventilator associated pneumonia in patients with Guillain Barre syndrome / 肠外与肠内营养

Objective:To investigate the effect of early enteral nutrition on ventilator-associated pneumonia in patients with Guillain Barre syndrome.Methods:This study was a prospective study.The study subjects were 36 patients diagnosed with Guillain Barre syndrome in the neuro-intensive care unit of our hospital from May 2011 to May 2017.Among them,18 patients received enteral nutrition support treatment within 24 hours after mechanical ventilation (early group),and 18 patients received enteral nutrition support treatment more than 24 hours after mechanical ventilation (control group).The two groups were compared with nutritional indicators,complications of enteral nutrition,ventilatorassociated pneumonia incidence,mechanical ventilation time,NICU residence time,APACHE Ⅱ score and mortality after treatment.Results:In the early group,the incidence of ventilator-associated pneumonia,mechanical ventilation time,NICU residence time and APACHE Ⅱ score after treatment were lower than the control group and the nutritional status index were better than the control group.Meanwhile,the incidence of complications of enteral nutrition such as diarrhea,gastrointestinal bleeding and stress hyperglycemia was relatively low.Moreover,the fatality rate was lower than the control group,but there was no statistical significance.Conclusions:Early application of enteral nutrition support therapy can improve the nutritional status of patients,reduce the incidence of ventilator-associated pneumonia,shorten the time of mechanical ventilation,reduce mortality and improve the prognosis of patients.

Clinical characteristics and outcomes of severe community- and hospitalacquired pneumonia / 中国感染与化疗杂志

Objective To explore the clinical characteristics and prognostic factors of severe community-acquired pneumonia (SCAP) and severe hospital-acquired pneumonia (SHAP). Methods Clinical data of patients with severe pneumonia were reviewed and analyzed retrospectively. Multivariate logistic regression analysis was conducted to investigate the potential prognostic factors. Results A total of 70 SCAP cases and 110 SHAP cases were identified. SHAP patients showed higher proportion of surgical operation (P＜0.001), radiotherapy and/or chemotherapy (P=0.006) within 1 month, higher Charlson comorbidity index (P=0.001), and more malignancies (P＜0.001) than SCAP patients, but fewer failed organs (P=0.048), lower proportion of heart failure (P=0.003), and lower level of BNPmax (P=0.037) than SCAP. SHAP patients showed more total days of hospital stay than SCAP patients [33.0 (25.0, 43.3) days versus 14.0 (5.8, 28.3) days, P＜0.001 ], and higher 180-day mortality than SCAP patients (44.6％ versus 27.5％, P=0.047). The 180-day survival rate was significantly different between SCAP and SHAP patients (χ2=4.009, P=0.045). Multivariate analysis indicated that APACHE-II score (OR=20.449, P=0.002), cancer (OR=6.183, P=0.039), maximum D-dimer level (OR=13.841, P=0.008), and renal replacement therapy (RRT) (OR=19.456, P=0.003) were associated with the outcomes of SCAP patients. Two or more organ failure (OR=6.308, P=0.028), ventilator-associated pneumonia (OR=4.491, P=0.005), and RRT (OR=11.456, P=0.002) were associated with the outcomes of SHAP patients. Conclusions SCAP doesn't show significant difference from SHAP in in-hospital mortality or 30-day mortality. SHAP is associated with higher 180-day mortality than SCAP.

Risk factors of pulmonary embolism in patients initially diagnosed as neurointensive care unit hospital-acquired pneumonia / 第二军医大学学报

Objective To explore the risk factors of pulmonary embolism (PE) in the patients initially diagnosed as neurointensive care unit hospital-acquired pneumonia (NICUHAP) with increased D-dimer level. Methods A case-control study was taken to observe the clinical data from the patients with NICUHAP who were initially diagnosed in the Tenth People’s Hospital of Tongji University between Jan. 2007 and Jan.2018. According to the results of computed tomography pulmonary angiography (CTPA) examination, the patients were divided into PE group and non-PE group. The pulmonary artery occlusion index (PAOI) was calculated in the patients of the PE group. Univariate and multivariate logistic regression analyses were performed to explore the risk factors for PE. Results A total of 129 patients initially diagnosed as NICUHAP were included in this study and received CTPA examination. The median D-dimer levels of PE patients (n=75) and non-PE patients (n=54) were 3.97 mg/L and 0.88 mg/L, respectively, and the difference was significant (P38.5 °C), and elevated cardiac troponin I level were possible independent risk factors for PE. Conclusion The patients initially diagnosed as NICUHAP with PE have elevated D-dimer level compared with the patients without PE. There is no significant correlation between D-dimer level and PAOI. The patients initially diagnosed as NICUHAP, who are older than 60 years, or accompanied with coronary heart disease, chronic obstructive pulmonary disease, varicose veins of lower limbs, thoracodynia, shortness of breath, hemoptysis, elevated cardiac troponin I level or with a body temperature below 38.5 °C, need CTPA examination to exclude PE.

Risk factors of hospital-acquired pneumonia due to Carbapenem-resistant Klebsiella pneumonia in the ICU / 国际检验医学杂志

Objective To understand the risk factors of hospital-acquired pneumonia(HAP) due to Carbapenem-resistant Kleb-siella pneumonia (CRKP) ,and propose prevention and control measures to reduce the incidence of hospital infection rate .Methods A total of Klebsiella pneumonia infection 73 patients with HAP ,who were treated in the ICU of a tertiary hospital in Chongqing from January 2014 to March 2016 were included .The 27 cases with CRKP were assigned as case group ,46 cases with Carbapenem-susceptible Klebsiella pneumonia(CSKP) were included as control group .Univariate and the multivariate Logistic regression analy-sis was performed for the risk factors .Results Univariate analysis showed that ,before infection ,the use of antimicrobial agents≥7 days ,Carbopenems ,mechanical ventilation ≥7 days ,APACHE Ⅱ score ,and at least 11 factors were the risk factors for CRKP HAP .Multivariate Logistic regression analysis showed that ,Carbapenems ,and mechanical ventilation≥7 days before infection and APACHE Ⅱ score was an independent risk factor of CRKP HAP .Conclusion Carbapenems ,and mechanical ventilation≥7 days before infection and APACHE Ⅱ score are the independent risk factors for CRKP HAP .Rational use of antibiotics ,reducing me-chanical ventilation and doing good hand hygiene are effective measures to reduce the incidence of CRKP HAP .

Risk factors of hospital-acquired pneumonia due to Carbapenem-resistant Klebsiella pneumonia in the ICU / 国际检验医学杂志

Objective To understand the risk factors of hospital-acquired pneumonia(HAP) due to Carbapenem-resistant Kleb-siella pneumonia (CRKP) ,and propose prevention and control measures to reduce the incidence of hospital infection rate .Methods A total of Klebsiella pneumonia infection 73 patients with HAP ,who were treated in the ICU of a tertiary hospital in Chongqing from January 2014 to March 2016 were included .The 27 cases with CRKP were assigned as case group ,46 cases with Carbapenem-susceptible Klebsiella pneumonia(CSKP) were included as control group .Univariate and the multivariate Logistic regression analy-sis was performed for the risk factors .Results Univariate analysis showed that ,before infection ,the use of antimicrobial agents≥7 days ,Carbopenems ,mechanical ventilation ≥7 days ,APACHE Ⅱ score ,and at least 11 factors were the risk factors for CRKP HAP .Multivariate Logistic regression analysis showed that ,Carbapenems ,and mechanical ventilation≥7 days before infection and APACHE Ⅱ score was an independent risk factor of CRKP HAP .Conclusion Carbapenems ,and mechanical ventilation≥7 days before infection and APACHE Ⅱ score are the independent risk factors for CRKP HAP .Rational use of antibiotics ,reducing me-chanical ventilation and doing good hand hygiene are effective measures to reduce the incidence of CRKP HAP .

Clinical evaluation of prolonged infusion versus standard infusion of meropenem in the treatment of hospital-acquired pneumonia in elderly patients / 中国感染与化疗杂志

Objective To compare the clinical efficacy and safety of meropenem administered by standard 30-minute infusion or prolonged 3-hour infusion regimen in treatment of hospital acquired pneumonia (HAP) in elderly patients,and evaluate the effect of augmented renal clearance on clinical efficacy.Methods An open-label randomized controlled clinical trial was conducted.A total of 40 elderly patients (≥65 years of age) with HAP requiring meropenem therapy were enrolled from September 1,2015 to August 31,2016.The patients were randomly assigned to receive meropenem 1.0 g in 100 mL ot 0.9％ NaCl solution by constant-rate continuous intravenous infusion over 3 hours (study group,n=20) or by constant-rate intravenous infusion over 30 minutes (control group,n=20),every 8 hours,for at least 7 days.Clinical efficacy and safety were compared between groups.According to the level of creatinine clearance (Ccr),the 40 patients were further divided into group A1 [Ccr ≥ 130 (mL/min)/1.73 m2] and A2 [Ccr＜ 130 (mL/min)/1.73 m2].The patients with Ccr≥ 130 (mL/min)/1.73 m2 in control group belonged to group B1,and those in study group belonged to group B2.Clinical efficacy was compared between group A1 and A2,and between group B1 and B2.Results The clinical cure rate was 70.00％ (14/20) in study group and 50.00％ (10/20) in control group (P＜0.05).The 28-day survival rate was 85.00％ (17/20) in study group and 65.00％ (13/20) in control group (P＜0.05).The clinical pulmonary infection score (CPIS) was improved significantly in study group (reduction of 2.88±2.51) than in control group (reduction of 1.25 ± 1.67) (P＜ 0.05).Procalcitonin (PCT) level was more improved in study group [reduction of (2.43± 0.68) μg/L] than in control group [reduction of (1.05±0.27) μg/L] (P＜0.05).The duration of meropenem treatment and days of hospital stay did not show significant difference between study group and control group (P＞0.05).The common adverse reactions were transient elevation of serum transaminases and diarrhea in both groups.The incidence of adverse reactions did not show significant difference between groups (P＞0.05).Further analysis indicated that the clinical cure rate was 44.44％ (4/9) in group A1 and 64.52％ (20/31) in group A2 (P＜0.05).The 28-day survival rate was 66.67％ (6/9) in group A1 and 77.42％ (24/31) in group A2 (P＜0.05).CPIS reduction was 1.62±1.61 in group A1 and 2.19±2.2 in group A2 (P＜0.05).The reduction of PCT level was (1.41 ±0.39) μg/L in group A1 and (1.84±0.5) μg/L in group A2 (P＜0.05).The duration of meropenem treatment and days of hospital stay did not show significant difference between group A1 and group A2.The clinical cure rate was 1/4 in group B1 and 3/5 in group B2 (P＜0.05).The 28-day survival rate was 2/4 in group B1 and 4/5 in group B2 (P＜0.05).CPIS reduction was 0.68±0.93 in group B1 and 2.56±2.29 in group B2 (P＜ 0.05).The reduction of PCT level was (0.61 ±0.15) μg/L in group B 1 and (2.21 ± 0.63) μg/L in group B2 (P＜0.05).The duration of meropenem treatment and days of hospital stay did not show significant difference between group B1 and group B2 (P＞0.05).Conclusions Prolonged intravenous infusion of meropenem over 3 hours provides better clinical efficacy than the standard 30-minute infusion of meropenem in the treatment of HAP in elderly patients without increase of adverse reactions.Augmented renal clearance may reduce the clinical efficacy of meropenem,which can be improved by 3-hour prolonged infusion ofmeropenem.

Case analysis of linezolid in treatment of hospital-acquired MRSA pneumonia after ineffective glycopeptide antibiotics treatment / 重庆医学

Objective To analyze the case of inezolid in effectively treating hospital-acquired methicillin-resistant staphylo-coccus aureus (MRSA) pneumonia after ineffective glycopeptide antibiotics treatment in order to provide opinions for the clinical use .Methods The antibacterial drugs analysis was performed on 1 case of hospital-acquired MRSA pneumonia after acute subdural hematoma removal operation in this hospital ,and the curative effects and economic indicators of glycopeptide antibacterial drugs and inezolid were conducted the evidence-based evaluation .Results Using glycopeptide antibacterial drugs in this patient had poor cura-tive effect ,and then changing to inezolid anti-infection treatment obtained the success .This patient used vancomycin 2 g ,generic teicoplanin 400 mg and inezolid 1200 mg per day ;the average daily costs were 497 ,341 ,788 Yuan respectively .Conclusion Lin-ezolid can be selected for treating hospital-acquired MRSA pneumonia patient after ineffective glycopeptide antibacterial drugs treat-ment .

Pathogenic features and risk factors of hospital-acquired pneumonia in patients with acute spontaneous intracerebral hemorrhage in intensive care unit / 中华临床感染病杂志

Objective To analyze the pathogenic features and risk factors of hospital-acquired pneumonia in patients with acute spontaneous intracerebral hemorrhage (sICH) in intensive care unit (ICU).Methods The clinical data of 110 patients with sICH admitted in ICU during January 2015 and February 2017 were collected.Patients were divided into hospital-acquired pneumonia group (HAP group,n =66) and non-HAP group (n =44).Multivariate Logistic regression was used to study the risk factors of HAP,and pathogen distribution and drug susceptibility were analyzed.Results Multivariate Logistic regression demonstrated that long-term mechanical ventilation (OR =1.028,95％ CI 1.012-1.044,P ＜ 0.01),lower score of glasgow coma scale (GCS) (OR =1.550,95％ CI 1.148-2.093,P ＜ 0.01),prolonged hospital stay (OR =1.131,95％ CI 1.046-1.224,P ＜0.01) and underlying diseases more than two forms (OR =9.793,95％ CI 1.012-1.044,P ＜ 0.01) were the independent risk factors of HAP,while high plasma albumin level was protective factor for HAP (OR =0.897,95％ CI O.811-0.992,P ＜ 0.05).One hundred and eighty-three bacterial strains were isolated from 66 patients,the top 4 pathogens were Acinetobacter baumannii (28.96％,53/183),Klebsiella pneumonia (15.85％,29/183),Pseudomonas aeruginosa (13.11％,24/183) and Staphylococcus aureus (12.02％,22/183).Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa were highly resistant to the majority of antibiotics,some of which even reached 100％.Staphylococcus aureus showed high resistance to macrolides,fluoroquinolones and β-lactam antibiotics.Conclusions There is high incidence of HAP in patients with sICH,and the pathogenic bacteria are mainly gram-negative bacteria.Effective prevention and treatment measures should be taken to reduce the incidence of HAP for patients with sICH in ICU.

The correlation between early enteral nutrition and ventilator associated pneumonia in patients with severe cerebrovascular disease / 肠外与肠内营养

Objective:To investigate the effect of early enteral nutrition on ventilator-associated pneumonia in patients with severe cerebrovascular disease,and to evaluate nutritional status,intestinal nutrition tolerance,pH value of gastric juice and incidence of gastrointestinal bleeding.Methods:This study was a prospective study.The subjects were 72 patients with severe cerebrovascular disease in the intensive care unit of Neurology Department of our hospital from March 2014 to May 2017.All patients were treated with nasal feeding and mechanical ventilation.Among them,36 patients received enteral nutrition support treatment within 24 hours (early group),and 36 patients received enteral nutrition support treatment after 24 hours (control group).The two groups were compared with the incidence of ventilator-associated pneumonia,weaning success rate,complications of enteral nutrition rate,and gastrointestinal bleeding within 7 days,serum albumin and serum prealbumin level after 7 days,survival rate after 28 days.We also analyzed the changes in pH of the gastric juice at admission,1 day,3 days,7 days,and 14 days after treatments.Results:In the early group,the incidence of ventilator-associated pneumonia,gastrointestinal bleeding,complications of enteral nutrition,were lower than the control group.The serum level of albumin and prealbumin,the rate of successful weaning and 28 day survival rate were higher than the control group.After the early enteral nutrition,the pH value of gastric juice increased significantly.Conclusion:Early application of enteral nutrition support therapy can improve the nutritional status of patients,reduce the incidence of ventilatorassociated pneumonia,improve the success rate of weaning,reduce the fatality rate and improve the prognosis of patients.Early enteral nutrition support treatment can also increase pH value of gastric juice and reduce the incidence of gastrointestinal complication and gastrointestinal bleeding.