Application of metagenomic next-generation sequencing in prevention and control of infection in solid organ transplantation / 器官移植

Organ transplantation has become an effective treatment for multiple end-stage diseases. However, the recipients of organ transplantation need to take immunosuppressive drugs for a long time after operation, which leads to low immune function and relatively high incidence of bacterial, viral and fungal infections. Traditional microbial detection methods, such as pathogen culture, immunological detection and polymerase chain reaction, have been widely applied in infection detection, whereas these methods may cause problems, such as long detection time and presumed pathogens. Metagenomic next-generation sequencing has been widely adopted in infection prevention and control in organ transplantation in recent years due to high detection rate and comprehensive detection of pathogen spectrum. In this article, the application of metagenomic next-generation sequencing in the prevention and control of infection in solid organ transplantation was reviewed, aiming to provide reference for the diagnosis and treatment of transplantation-related infection.

Risk factors for postoperative pulmonary infection in lung cancer patients: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To systematically evaluate the risk factors for postoperative pulmonary infection in patients with lung cancer (PPILC), and to provide a theoretical reference for clinicians to prevent the occurrence of PPILC. Methods     The databases of CNKI, Wanfang data, VIP, CBM, PubMed, EMbase and The Cochrane Library were searched by computer to collect researches on the risk factors for PPILC. The search period was from 2012 to 2021. Two clinicians independently screened literature and extracted data and assessed studies for risk of bias, cross-checked and agreed. Meta-analysis was performed using RevMan 5.3 software. Results     A total of 25 studies were included, including 20 case-control studies, 1 cohort study, and 4 cross-sectional studies, covering 15 129 patients. Twenty case-control studies and 1 cohort study had Newcastle-Ottawa Scale (NOS) scores≥6 points, and 4 cross-sectional studies had the Agency for Health Care Quality and Research (AHRQ) scale scores≥6 points. The results of meta-analysis showed that the risk factors for PPILC included: (1) 4 patient's own factors: age≥60 years, male, smoking history, smoking index≥400; (2) 7 preoperative factors: suffering from diabetes, chronic heart failure and chronic obstructive pulmonary disease, the ratio of forced expiratory volume in 1 second to forced expiratory volume<70%, the ratio of forced expiratory volume in 1 second to the predicted value, preoperative airway colonization, non-standard use of prophylactic antibiotics before surgery; (3) 3 intraoperative factors: operation time≥3 h, thoracotomy, the number of resected lobe≥2; (4) 3 postoperative factors: postoperative pain, postoperative mechanical ventilation≥12 h, postoperative invasive operation. Large number of preoperative lymphocyte, intraoperative systematic lymph node dissection, TNM stage Ⅰ and Ⅱ, and enhanced recovery after surgery were protective factors for PPILC. Conclusion     The current research evidence shows that multiple factors are associated with the risk of PPILC. However, considering the influence of the quality and quantity of the included literature, the results of this study urgently need to be further verified by more high-quality clinical studies.

Connotation of Xiao Chaihu Decoction combined with Maxing Shigan Decoction based on severe cases and modern pathophysiological mechanism and application for severe pulmonary infection and acute exacerbation of chronic obstructive pulmonary disease in critical care medicine / 中国中药杂志

Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic herbal formula. All of them are derived from Treatise on Cold Damage(Shang Han Lun) by ZHANG Zhong-jing. This combination has the effects of harmonizing lesser yang, relieving exterior syndrome, clearing lung heat, and relieving panting. It is mainly used for treating the disease involving the triple-Yang combination of diseases and accumulation of pathogenic heat in the lung. Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic combination for the treatment of exogenous diseases involving the triple-Yang combination. They are commonly used in exogenous diseases, especially in the north of China. This combination is also the main treatment strategy for coronavirus disease 2019(COVID-19) accompanied by fever and cough. Maxing Shigan Decoction is a classical herbal formula for treating the syndrome of phlegm-heat obstructing the lung. "Dyspnea after sweating" suggests the accumulation of pathogenic heat in the lung. Patients with mild symptoms may develop cough and asthma along with forehead sweating, and those in critical severe may develop whole-body sweating, especially the front chest. Modern medicine believes that the above situation is related to lung infection. "Mild fever" refers to syndromes rather than pathogenesis. It does not mean that the heat syndrome is not heavy, instead, it suggests that severe heat and inflammation have occurred. The indications of Xiao Chaihu Decoction combined with Maxing Shigan Decoction are as follows.(1) In terms of diseases, it is suitable for the treatment of viral pneumonia, bronchopneumonia, lobar pneumonia, mycoplasma pneumonia, COVID-19 infection, measles with pneumonia, severe acute respiratory syndrome(SARS), avian influenza, H1N1 influenza, chronic obstructive pulmonary disease with acute exacerbation, pertussis, and other influenza and pneumonia.(2) In terms of syndromes, it can be used for the syndromes of bitter mouth, dry pharynx, vertigo, loss of appetite, vexation, vomiting, and fullness and discomfort in the chest and hypochondrium. It can also be used to treat alternate attacks of chill and fever and different degrees of fever, as well as chest tightness, cough, asthma, expectoration, dry mouth, wanting cold drinks, feeling agitated, sweating, yellow urine, dry stool, red tongue, yellow or white fur, and floating, smooth, and powerful pulse, especially the right wrist pulse.

Etiological distribution and influencing factors of COPD patients with pulmonary infection / 公共卫生与预防医学

Objective To discuss the Etiological Distribution of COPD patients and explore the potential influencing factors of COPD infection. Methods From January 2018 to January 2021, 134 patients with concurrent pulmonary infection and 131 patients without any infection were selected from all 295 patients with COPD treated in our hospital. A total of 265 patients (30 patients with accidental pulmonary infection and other organ system infection, which did not meet the inclusion and exclusion criteria of this study, were excluded). The study collected the basic information of subjects and the information of potential factors affecting pulmonary infection. SPSS statistical software package was used to analyze the research data. Firstly, the etiology of patients with COPD infection (134 cases) was further analyzed to explore the distribution characteristics of etiology. At the same time, the related conditions of COPD patients with infection (134 cases) and patients without any infection (131 cases) were compared and analyzed to explore the related factors affecting COPD patients with pulmonary infection. Results A total of 149 bacterial strains were detected in this study. Gram-negative bacteria accounted for a higher proportion of lung infection (97/149 , 65.10%), gram-positive bacteria 50 strains (50/149 , 33.56%), and other (fungi, etc.) 2 strains (2/149 , 1.34%). Gram-negative bacteria included acinetobacter baumannii (53/149 , 35.57%), Klebsiella pneumoniae (25/149 , 16.78%), Pseudomonas aeruginosa (16/149 , 10.74%) and Escherichia coli (3/149 , 2.01%). Gram-positive bacteria included staphylococcus aureus (24/149,16.11%), Staphylococcus superficial (13/149 , 8.72%), Staphylococcus haemolyticus (9/149 , 6.04%), and streptococcus pneumoniae (4/149,2.68%). Compared with chronic obstructive pulmonary disease (134 cases) and without any infection (131 cases), it was suggested that the proportion of patients aged >60 years, smoking history, type 2 diabetes mellitus, mechanical ventilation and antibiotics use time was >15 days (P60 years, smoking history, type 2 diabetes mellitus, and >15 OR duration of antimicrobial use were all risk factors, and all of them had P<0.05. Conclusion Gram negative bacteria are the main pathogens of lung infection in COPD patients. The risk of lung infection is higher in patients with high age, smoking history, type 2 diabetes and long time use of antibiotics, which is worthy of clinical attention.

Epidemiological characteristics and risk prediction of pulmonary infection in elderly patients with chronic obstructive pulmonary disease / 公共卫生与预防医学

Objective To explore the epidemiological characteristics of pulmonary infection in elderly patients with chronic obstructive pulmonary disease (COPD), and to construct a risk prediction model. Methods Among of 125 elderly patients with COPD from May 2020 to June 2022 were selected as the research subjects. The epidemiological characteristics of infected patients were counted, and the risk factors of pulmonary infection in patients were analyzed and a prediction model was constructed. Results A total of the 125 elderly patients with COPD, there were 46 cases of pulmonary infection, with the infection rate of 36.80%. The detection rate of Gram-negative bacteria was higher than that of Gram-positive bacteria or fungi (64.44% vs 33.33% or 2.22%, P2=0.812 and P=0.295. ROC curve analysis revealed that the AUC value of the prediction model on predicting the pulmonary infection in elderly patients with COPD was 0.802. Conclusion The pathogenic bacteria of elderly patients with COPD complicated with pulmonary infection are mainly Gram-negative bacteria. The prediction model constructed according to the risk factors of pulmonary infection in patients has predictive value on pulmonary infection in patients.

Risk factors for postoperative pulmonary infection in patients with esophageal cancer: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To systematically evaluate the risk factors for postoperative pulmonary infection in patients with esophageal cancer. Methods    CNKI, Wangfang Data, VIP, CBM, PubMed, EMbase, The Cochrane Library were searched from inception to January 2021 to collect case-control studies, cohort studies and cross-sectional studies about risk factors for postoperative pulmonary infection in patients with esophageal cancer. Two researchers independently conducted literature screening, data extraction and quality assessment. RevMan 5.3 software and Stata 15.0 software were used for meta-analysis. Results    A total of 20 articles were included, covering 5 409 patients of esophageal cancer. The quality score of included studies was 6-8 points. Meta-analysis results showed that age (MD=1.99, 95%CI 0.10 to 3.88, P=0.04), age≥60 years (OR=2.68, 95%CI 1.46 to 4.91, P=0.001), smoking history (OR=2.41, 95%CI 1.77 to 3.28, P<0.001), diabetes (OR=2.30, 95%CI 1.90 to 2.77, P<0.001), chronic obstructive pulmonary disease (OR=3.69, 95%CI 2.09 to 6.52, P<0.001), pulmonary disease (OR=2.22, 95%CI 1.16 to 4.26, P=0.02), thoracotomy (OR=1.77, 95%CI 1.32 to 2.37, P<0.001), operation time (MD=14.08, 95%CI 9.64 to 18.52, P<0.001), operation time>4 h (OR=3.09, 95%CI 1.46 to 6.55, P=0.003), single lung ventilation (OR=3.46, 95%CI 1.61 to 7.44, P=0.001), recurrent laryngeal nerve injury (OR=5.66, 95%CI 1.63 to 19.71, P=0.006), and no use of patient-controlled epidural analgesia (PCEA) (OR=2.81, 95%CI 1.71 to 4.61, P<0.001) were risk factors for postoperative pulmonary infection in patients with esophageal cancer. Conclusion    The existing evidence shows that age, age≥60 years, smoking history, diabetes, chronic obstructive pulmonary disease, pulmonary disease, thoracotomy, operation time, operation time>4 h, single lung ventilation, recurrent laryngeal nerve injury, and no use of PCEA are risk factors for postoperative pulmonary infection in patients with esophageal cancer. Due to the limitation of the quantity and quality of included literature, the conclusion of this study still needs to be confirmed by more high-quality studies.

Comparison of adverse events after on-pump and off-pump coronary artery bypass grafting in patients with COPD / 中华胸心血管外科杂志

Objective:To investigate the difference of adverse events in patients with chronic obstructive pulmonary disease (COPD) who underwent on-pump coronary artery bypass grafting (ONCABG) and off-pump coronary artery bypass grafting (OPCABG).Methods:The clinical data of COPD patients undergoing CABG surgery admitted to Beijing Anzhen Hospital affiliated to Capital Medical University from January 2021 to December 2021 were retrospectively analyzed. According to whether they received cardiopulmonary bypass or not, they were divided into ONCABG group (64 cases) and OPCABG group (154 cases). The preoperative and postoperative clinical data were analyzed. The whole group was divided into 4 subgroups (ON1、ON2、OP1、OP2) according to whether receiving cardiopulmonary bypass or not and FEV160% as the cut-off point, to investigate the difference of postoperative adverse events.Results:A total of 218 patients were included, ranging in age from 45 to 76 years old, with a mean age of (63.81±7.72) years, including 149 males (68.35%). There was no significant difference in the incidence of postoperative adverse events between the ONCABG and OPCABG groups ( P>0.05). In subgroup analysis, the incidence of postoperative pulmonary infection (72.73% vs. 45.65%, P<0.05) and postoperative atrial fibrillation (59.09% vs. 32.61%, P<0.05) was higher in ON1 (FEV1≤60% ONCABG, 22 cases) group than in OP1 (FEV1≤60% OPCABG, 46 cases) group. Conclusion:The incidence of postoperative pulmonary infection and atrial fibrillation in COPD patients with FEV1≤60% was higher in ONCABG than in OPCABG.

Comparison of omadacycline and meropenem plus linezolid in treatment of pulmonary infection: A real-world cohort study / 中华临床感染病杂志

Objective:To compare the efficacy and safety of omacycline with meropenem plus linezolid in the treatment of patients with pulmonary infection.Methods:The clinical data of 58 patients with pulmonary infection admitted to the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital and Jiande First People’s Hospital from December 2021 to May 2022 were retrospectively analyzed. The patients were divided into the omacycline group ( n=29) and the meropenem combined with linezolid group (combined group, n=29). The omacycline group was given intravenous omacycline 200 mg or 100 mg, q. d, and the combined group was given intravenous meropenem (1 000 mg, t.i.d) and linezolid (600 mg, b. i.d). The clinical efficacy and drug-related adverse events of two groups were observed. SPSS 22.0 statistical software was used for data analysis. Results:In the omacycline group, 8 cases (27.6%, 8/29) were cured, 19 cases (65.5%, 19/29) were improved, and 2 cases (6.9%, 2/29) were worsened. In the combined group, 1 case (3.4%, 1/29) was cured, 26 cases (89.7%, 26/29) were improved, and 2 cases (6.9%, 2/29) died. There was a statistically significant difference between the two groups ( χ2=6.533, P=0.038). The respiratory failure occurred in 3 cases (10.3%, 3/29) of the omacycline group and 5 cases (17.2%, 5/29) of the combined group ( χ2=0.580, P=0.446). In those patients who were cured or improved, the median time from treatment initiation to disease remission was 3.0 (2.0, 5.5) d in the omacycline group and 5.0 (4.0, 6.0) d in the combined group ( Z=-2.122, P=0.034). There was no significant difference in the incidence of adverse reactions between the two groups [6.9% (2/29) vs. 13.8% (4/29), χ2=0.744, P=0.389]. Conclusion:Omacycline exhibits a good efficacy and safety in the treatment of patients with pulmonary infection, which may be prioritized for the treatment of pulmonary infections.

Analysis of influencing factors and therapeutic effects of hemodialysis combined with pulmonary infection in patients with diabetes nephropathy / 中国医师杂志

Objective:To investigate and analyze the risk factors of pulmonary infection in hemodialysis patients with diabetes nephropathy (DN), and explore the effect of different antibiotic application methods on the efficacy of DN patients with pulmonary infection.Methods:337 inpatients with DN who were admitted to Lishui Central Hospital from August 2021 to April 2022 were selected as the study subjects, and the proportion of pathogenic bacteria in patients with pulmonary infection caused by hemodialysis was analyzed, and the influencing factors of pulmonary infection were analyzed by single factor and multiple factor logistic regression models. DN patients with pulmonary infection were treated with single or multiple antibiotics, and their curative effects were analyzed and compared.Results:Among 337 hospitalized patients with DN in this study, the rate of pulmonary infection caused by hemodialysis was 24.04%(81/337). 87 strains of pathogenic bacteria were cultivated, and the main pathogens of the infected individuals were Klebsiella pneumoniae (36.78%, 32/87), Staphylococcus aureus (17.24%, 15/87), and Acinetobacter baumannii (16.09%, 14/87). The results of univariate analysis showed that patient age, dialysis time, hospital stay, hemoglobin, postprandial blood glucose, malnutrition (blood albumin level<35 g/L), renal function, and volume load were the influencing factors for pulmonary infection in DN patients undergoing hemodialysis (all P<0.05). Multivariate logistic regression model analysis showed that dialysis time, hemoglobin, postprandial, blood glucose malnutrition, renal function, and volume load were risk factors for pulmonary infection caused by hemodialysis (all P<0.05). After treatment, the levels of white blood cells, neutrophils, and hypersensitive reactive protein in patients with pulmonary infection were significantly reduced compared to before treatment (all P<0.05). The effective rate of multi antibiotic therapy (97.44%, 38/39) was higher than that of single antibiotic therapy (80.95%, 34/42) (χ 2=5.563, P=0.018). Conclusions:There are many independent risk factors for pulmonary infection during hemodialysis in DN patients. The infection rate should be reduced through adequate dialysis, blood glucose control, nutrition supplementation, anemia correction and other measures, and the infected can be treated timely with antibiotics according to the situation.

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.

Analysis of pathogenic bacteria and influencing factors of death in patients with severe neurological pulmonary infection / 中国医师杂志

Objective:To investigate the distribution of respiratory pathogens and risk factors of death in patients with pulmonary infection in neurosurgical intensive care unit (NICU).Methods:A total of 87 patients with pulmonary infection in the NICU of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2018 to December 2019 were collected, and the pathogens of their respiratory tract were analyzed to understand the types and distribution of bacteria in the lung infection. Univariate statistical analysis was used to analyze the relationship between the patient′s clinical outcome with age, diabetes, hypertension, renal insufficiency, hypoproteinemia, anemia, chronic respiratory disease, surgery, tracheotomy, and bacterial multi-resistance. Binary logistic regression analysis was used to analyze the influencing factors of death in NICU patients with pulmonary infection.Results:A total of 112 pathogenic bacteria were isolated in this research group, including 83 Gram-negative bacteria (74.11%), 22 Gram-positive bacteria (19.64%), and 7 Fungi (5.25%). Imipenem was highly sensitive to Gram-negative bacteria, vancomycin was highly sensitive to Gram-positive bacteria, and other drugs were highly resistant. 41 patients died (47.13%). Age≥60 ( OR=3.501, 95% CI: 1.152-10.638), renal insufficiency ( OR=3.872, 95% CI: 1.336-11.224), tracheotomy ( OR=0.317, 95% CI: 0.114-0.882), bacteria multi-drug resistance ( OR=3.480, 95% CI: 1.162-10.422) were independent risk factors for death in NICU patients with pulmonary infection. Conclusions:Patients with severe neurological diseases are in critical condition, and there are many patients with pulmonary infection, with poor prognosis and high mortality. Gram-negative bacteria are the most common respiratory pathogens. Carbapenems account for the highest proportion of antibiotics in clinic. Advanced age, renal insufficiency and bacterial multidrug resistance increase the mortality of patients, while early tracheotomy can reduce the mortality of patients.

Distribution of pathogenic bacteria and levels of inflammatory factors in hospitalized patients with pulmonary infection / 公共卫生与预防医学

Objective To analyze the distribution of pathogenic bacteria and the level of inflammatory factors in hospitalized patients with pulmonary infection. Methods A total of 516 inpatients with pulmonary infection in our hospital from January 2016 to April 2021 were randomly selected. According to the acute physiological and chronic health status score (APACHE II) within 24 hours after admission, they were divided into low-risk group (APACHE II score 20 points, 95 cases). In addition, 200 inpatients without pulmonary infection in the same period were selected as the control group. The sputum specimens of the observation group were cultured and identified by automatic microbial analyzer. The levels of procalcitonin (PCT), tumor necrosis factor -α(TNF-α) and hypersensitive C-reactive protein (hs-CRP) in the two groups were detected by ELISA. Results A total of 643 strains of pathogenic bacteria were detected in patients with pulmonary infection, among which 169 strains (26.28%) were gram-positive bacteria, mainly 93 strains (14.46%) of Staphylococcus aureus, 57 strains (8.86%) of streptococcus pneumoniae. There were 429 strains (66.72%) of gram-negative bacteria, mainly 187 strains (29.08%) of Acinetobacter baumannii and 163 strains (25.35) of Klebsiella pneumoniae. There were 45 strains of fungi (7.00%). Serum PCT, TNF-α and hs-CRP levels in experimental group were significantly higher than those in control group (t1=27.167, t2=6.419, t3=34.591, P<0.05). The serum levels of PCT, TNF-α and hs-CRP in high-risk group were significantly higher than those in medium-risk and low-risk groups (P<0.05); Serum PCT, TNF-α and hs-CRP levels in medium-risk group were significantly higher than those in low-risk group (P<0.05); Pearson correlation analysis showed that PCT, TNF-α and hs-CRP were significantly positively correlated with the severity of pulmonary infection in hospitalized patients (r=0.725, 0.617, 0.679, P<0.05). Conclusion Acinetobacter baumannii, Klebsiella pneumoniae and Staphylococcus aureus were the main pathogenic bacteria in hospitalized patients with pulmonary infection. The levels of inflammatory factors in patients with pulmonary infection were significantly increased, which could be used to assess the severity of the patient's disease..

Predictive value of EIT-based global inhomogeneity index for postoperative pulmonary infection in patients with craniocerebral trauma / 中华急诊医学杂志

Objective:To investigate the predictive efficacy of global inhomogeneity (GI) index based on pulmonary electrical impedance tomography (EIT) in postoperative pulmonary infection of patients with craniocerebral trauma.Methods:A total of 90 patients with emergency craniocerebral trauma underwent surgery under general anesthesia in Suzhou Science & Technology Town Hospital. According to the complication of pulmonary infection at the 3rd day after operation, they were divided into the pulmonary infection group (P3 group) and non-pulmonary infection group (NP3 group), and according to the complication of pulmonary infection at the 7th day after operation, they were divided into the P7 group and NP7 group. The average GI index within 5 min before anesthesia induction (T 0) and 5 min after endotracheal intubation (T 1) and other clinical data in the perioperative period were collected. The prevalence of pulmonary infection at the 3rd and 7th days after operation was recorded. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of preoperative GI index for pulmonary infection at the 3rd and 7th days after operation. Results:A total of 88 patients were included. Among them, 26 patients developed pulmonary infection within 3 days after operation, and the prevalence rate was 29.5%. Pulmonary infection occurred in 38 patients within 7 days after operation, and the prevalence rate was 43.2%. Within 3 days after operation, the preoperative Glasgow Coma Scale score in the P3 group was significantly lower than that in the NP3 group ( P < 0.05). Within 3 days after operation, GI index in the P3 group increased significantly at T 1 when compared with the NP3 group ( P< 0.001). Within 7 days after operation, GI index in the P7 group increased significantly at T 1 when compared with the NP7 group ( P < 0.05). GI index at T1 accurately predicted pulmonary infection within 3 days after operation (AUC = 0.857, P < 0.001), and the best intercept value was ≥0.4225 (sensitivity: 0.846, specificity: 0.823). GI index at T 1 predicted pulmonary infection within 7 days after operation (AUC = 0.667, P < 0.005), and the best intercept value was ≥0.4225 (sensitivity: 0.579, specificity: 0.780), but the prediction efficiency was poor. Conclusions:The average GI index within 5 min after endotracheal intubation can be used as an effective predictor of pulmonary infection within 3 days after operation.

Multi-disciplinary team on acute heart failure complicated with respiratory failure after allograft nephrectomy / 器官移植

Objective To evaluate the effect of multi-disciplinary team (MDT) on acute heart failure (AHF) complicated with respiratory failure after allograft nephrectomy. Methods MDT discussion was performed on a patient with hemorrhagic shock caused by sudden renal graft hemorrhage, who developed acute myocardial infarction (AMI) with AHF, acute pulmonary congestion, pulmonary infection and acute respiratory failure 2 weeks after allograft nephrectomy. And treatment plan was formulated and effect evaluation was conducted. Results Based on the opinions of MDT discussion, the patient was given nasal high-flow oxygen therapy, continuous veno-venous hemodiafiltration (CVVHDF) to reduce cardiac load, anticoagulant, dilating blood vessels, reducing myocardial oxygen consumption, improving myocardial remodeling, lipid regulation, anti-infection, nutritional support, and other comprehensive treatment. The clinical outcome of the patient was good and regular hemodialysis treatment was resumed. Conclusions Application of MDT pattern helps to formulate a comprehensive and effective individualized treatment plan for patients with AHF and respiratory failure after allograft nephrectomy, which can enhance clinical treatment effects and improve prognosis of patient.

Diagnostic value of detection of pathogens in bronchoalveolar lavage fluid by metagenomics next-generation sequencing in organ transplant patients with pulmonary infection / 中华危重病急救医学

Objective:To evaluate the diagnostic value of metagenomics next-generation sequencing (mNGS) in detecting pathogens in bronchoalveolar lavage fluid (BALF) for pulmonary infection in solid organ transplant patients in intensive care unit (ICU).Methods:A retrospective study was conducted, the BALF samples from 46 patients with post organ transplant pneumonia/suspected pneumonia admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of University of Science and Technology of China from August 2018 to August 2021 were collected, all tested by simultaneous mNGS and conventional comprehensive microbial test (CMT), and the results of CMT were used as the reference standard to compare the differences in the diagnostic value of mNGS and CMT for pulmonary infections in solid organ transplant patients, and to analyze the diagnostic value of mNGS for mixed infections.Results:① Pneumonia pathogens: a total of 31 pathogens were detected in 35 patients, including bacteria (16 species), fungi (9 species) and viruses (6 species). Among them, 25 pathogens were detected by mNGS and CMT, and only 19 pathogens were detected by mNGS. Among the microorganisms isolated by mNGS method, the detection rates of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae were higher [51.4%(18/35), 42.9% (15/35), 31.4% (11/35), respectively]; Candida albicans, Aspergillus and Pneumocystis carinii were the most commonly detected fungi [31.4% (11/35), 22.9% (8/35), 22.9% (8/35), respectively]; 20 patients were positive for the virus, and the most commonly detected viruses were cytomegalovirus, herpesvirus and EB virus [28.6% (10/35), 20.0% (7/35), 17.1% (6/35), respectively]. In addition, one case of Brucella was detected by mNGS.② Diagnostic efficiency: as far as bacterial detection is concerned, 20 cases of negative results were obtained by CMT detection of 35 samples included in the study, and a total of 10 cases of positive results were obtained by mNGS detection of negative samples; the percentage of mNGS positive samples was significantly higher than that of CMT positive samples [odds ratio ( OR) = 5.5, 95% confidence interval (95% CI) = 1.2-24.8, P = 0.02]. When compared with CMT, the sensitivity and specificity of mNGS were 93.3% and 50.0%, and the positive predictive value (PPV) and negative predictive value (NPV) were 58.3%, 91.1%. As far as fungal detection was concerned, there was no significant difference in the percentage of positive samples between the two methods ( OR = 1.5, 95% CI = 0.5-4.2, P = 0.60); the sensitivity and specificity of mNGS were 72.2% and 64.7%, and the PPV and NPV were 68.4%, 68.8%; CMT test of the 35 included samples produced 17 negative results, and mNGS test of the negative samples produced 6 positive results. A total of 20 patients tested positive for the virus by mNGS. In addition, 23 patients (65.7%) were diagnosed with pulmonary mixed infection. Conclusion:The use of mNGS to detect pathogens in BALF can improve the sensitivity and specificity of bacterial identification of pulmonary infection in critically ill organ transplant patients, and mNGS has obvious advantages in detecting virus and identifying mixed infections.

Effect of permissive hypercapnia on perioperative pulmonary inflammatory response in patients undergoing thoracoscopic combined with laparoscopic esophagectomy / 中华内分泌外科杂志

Objective:To study the effect of permissive hypercapnia on pulmonary infection in patients underwent thoracoscopic combined with laparoscopic radical esophagectomy.Methods:From 2018 to 2020, 90 who patients underwent thoracoscopic laparoscopy combined with radical esophagectomy were divided into 3 groups by random who number table method, including 30 patients in experimental group 1, 30 patients in experimental group 2, and 30 patients in control group.PaCO 2 was maintained in the range of 56 mmHg-65 mmHg in experimental group 1, 46 mmHg-55 mmHg in experimental group 2 and 35 mmHg-45 mmHg in control group. The peak airway pressure (Ppeak) , lung dynamic compliance (Cdyn) and oxygenation index (OI) were observed and compared among the three groups after endotracheal intubation (T1) , 30 min after right artificial pneumothorax (T2) and 30 min after right lung recruitment (T3) ;The clinical pulmonary infection score (CPIS) , serum procalcitonin (PCT) on the 1st, 4th and 7th day after operation were analyzed and compared. Results:At T2, observation group A had the highest dynamic lung compliance (25.13 ± 5.70 vs 22.28 ± 4.26 vs 19.99 ± 4.36), the fastest heart rate (102.04 ± 10.91 vs 96.46 ± 9.91 vs 92.28 ± 8.08) and the lowest airway pressure (17.62 ± 1.79 vs 18.96 ± 1.90 vs 20.39 ± 1.71) ( P < 0.05). Observation group A had the lowest CPIS on the 1st, 4th and 7th day after operation compared with observation group B and control group (1.12±0.77 vs 1.71±0.90 vs 2.64±1.07) (6.08±1.20 vs 7.43±1.10 vs 8.31±1.55) (1.69±1.12 vs 2.32±0.98 vs 3.44±1.25) ( P<0.05) . Conclusion:Permissive hypercapnia can reduce airway resistance, improve lung compliance and reduce the risk of postoperative pulmonary infection.

Risk factors of postoperative pulmonary infection of gastric cancer and perioperative intervention measures / 中华胃肠外科杂志

Gastric cancer is a common digestive system malignancy. Surgical operation is the main treatment of radical treatment for gastric cancer. Pulmonary infection is a common postoperative complication of gastric cancer. Because there is no clear and unified definition of pulmonary complications, the current researches show that the incidence of postoperative pulmonary infection of gastric cancer is about 1.8%-18.1%. The incidence of postoperative pulmonary infection will prolong the hospital stay, increase the cost of hospitalization, and even develop into respiratory failure leading to early postoperative death. There are many factors affecting postoperative pulmonary infection of gastric cancer, including age, smoking history, pulmonary function, pulmonary disease history, operation method, operation time, intraoperative bleeding volume, gastric tube retention time, postoperative lying time and so on. There are also many perioperative interventions. This article reviews the risk factors and perioperative interventions of postoperative pulmonary infection of gastric cancer.

Value of serum YKL-40 in the diagnosis of anti-MDA5-positive patients with dermatomyositis complicated with severe pulmonary injury / 北京大学学报(医学版)

OBJECTIVE@#To investigate the value of serum and bronchoalveolar lavage fluid (BALF) chitinase-3-like-1 protein (YKL-40) in the diagnosis of anti-melanoma differentiation-associated gene 5 (MDA5)-positive dermatomyositis (DM) patients complicated with serious pulmonary injury, including rapidly progressive interstitial lung disease (RP-ILD) and pulmonary infection.@*METHODS@#Anti-MDA5 antibodies positive patients with DM who were hospitalized in the Department of Rheumatology of China-Japan Friendship Hospital from 2013 to 2018 were involved in this study. Demographic information, clinical, laboratory and imaging data were retrospectively collected. ELISA was used to detect the serum and BALF levels of YKL-40. The receiver operating characteristic (ROC) curve was drawn, and the area under ROC curve (AUC) was used to evaluate the diagnostic value of serum YKL-40 for pulmonary injury.Interstitial lung disease (ILD) was confirmed by chest high-resolution CT (HRCT). RP-ILD was defined as progressive respiratory symptoms such as dyspnea and hypoxemia within 3 months, and/or deterioration of interstitial changes or appearace of new pulmonary interstitial lesions on chest HRCT. Pulmonary infection was considered as positive pathogens detected in qualified sputum, blood, bronchoalveolar lavage fluid or lung biopsy specimens.@*RESULTS@#A total of 168 anti-MDA5-positive DM patients including 108 females and 60 males were enrolled in the study. Of these patients, 154 had ILD, and 66(39.3%) of them presented RP-ILD. Seventy patients with pulmonary infection were confirmed by etiology. In the patients with RP-ILD, 39 (59.1%) of them were complicated with pulmonary infection. While only 31 cases(30.4%) had pulmonary infection in the non-RP-ILD patients. The incidence of pulmonary infection in the patients with RP-ILD was significantly higher than that of those with non-RP-ILD (P < 0.001). The serum YKL-40 levels in the RP-ILD patients with pulmonary infection were the highest compared with RP-ILD without pulmonary infection, non-RP-ILD with pulmonary infection and non-RP-ILD without pulmonary infection groups among all the patients [83 (42-142) vs. 42 (21-91) vs. 43 (24-79) vs. 38 (22-69), P < 0.01].The sensitivity, specificity and AUC of serum YKL-40 in the diagnosis of RP-ILD complicated with pulmonary infection were 75%, 67%, and 0.72, respectively. The AUC of diagnosed of anti-MDA5 positive DM patients complicated with RP-ILD and pulmonary infection was higher than that of patients complicated with only RP-ILD and only pulmonary infection (0.72 vs. 0.54 and 0.55, Z=2.10 and 2.11, P < 0.05).@*CONCLUSION@#The prognosis of anti-MDA5-positive DM patients with RP-ILD and pulmonary infection were poor. Serum YKL-40 level can be used as a helpful tool for the diagnosis of coexistence of these conditions in the patients.

Retrospective analysis of the risk factors for secondary pulmonary infection after cervical spinal cord injury / 中华物理医学与康复杂志

Objective:To analyze retrospectively the risk factors for pulmonary infection after traumatic cervical spinal cord injury.Methods:The 154 patients with a cervical spinal cord injury studied included 120 with a pulmonary infection and 34 uninfected controls. Regressions were evaluated using data on their genders, ages, the cause of injury, affected segments, the neurological level of the injury (NLI), and the presence of a vertebral fracture or dislocation.Results:Age, complete injury, NLI at C 1 to C 4, and an injury-to-treatment time of more than 8 hours were found to be independent risk factors for secondary pulmonary infection. Conclusion:Elderly spinal cord injury patients, with a complete injury, an NLI between C 1 and C 4 or an injury-to-treatment time of more than 8 hours have a higher risk of pulmonary infection.

Clinical analysis ofnocardia infection in lung transplant recipient: a report of five cases / 中华器官移植杂志

Objective:To explore the clinical manifestations and imaging features of nocardia infection (NI) after lung transplantation and boost the diagnosis and treatment of NI.Methods:From January 2018 to December 2019, basic profiles, clinical manifestations, laboratory examinations, imaging features and treatment outcomes of 5 lung transplant recipients with a diagnosis of NF were retrospectively analyzed and summarized with the relevant literatures. There were 4 males and 1 female with a median age of 66(26-69) years. 3 patients were single-lung transplantation, 2 patients were bilateral-lung transplantation. The median time from an initial diagnosis of NI to lung transplant surgery was 6(5-19) months. Common symptoms included fever, cough with yellow phlegm and shortness of breath. Laboratory findings showed lymphopenia, significantly high C-reactive protein levels, a slight elevation of procalcitonin, hypoproteinemia and anemia. The major manifestations of high-resolution computed tomography (CT) included multiple nodules, consolidation, cavitation and pleural effusion.Results:Five strains of N. farcinica were identified from bloodstream infection ( n=2) and pulmonary infection ( n=3). After with a combined therapy of two sensitive agents, all patients improved and were discharged from hospital. During follow-ups, one patient died and the remainders were cured. Conclusions:Nocardia infection occurs in lung transplant recipients mostly within 1 year post-operation. There are non-specific symptoms and imaging features of multiple nodules and consolidation. Combination therapy of sensitive agents is indicated for lung transplant recipients with NI.