Objective To explore whether hospitalized elderly patients with severe communityacquired pneumonia ( SCAP) have better outcomes if they are treated with dual-therapy consisting of a β-lactam/macrolide or fluoroquinolone.Methods A prospective study was conducted in patients with SCAP aged 65 years or older between January 2007 and January 2012. These patients were assigned to a combination therapy group or a β-lactam monotherapy group by the attending physicians. Time to clinical stability( TCS) and total mortality were calculated. Prognostic factors for death were analyzed. Results Among the 232 patients, 153 patients were given β-lactam/macrolide or β-lactam/ fluoroquinolone ( macrolide in 67 patients and fluoroquinolone in 86) , while 79 were treated with β-lactam monotherapy. Compared with the monotherapy group, the combination therapy group was associated with significant decreased TCS ( median TCS, 10 days vs. 13 days) , and lower overall in-hospital mortality( 24.2% vs. 43.0%, P lt;0. 01) . Compared with fluoroquinolone, macrolide use was associated with lower ICU mortality ( 14.9% vs. 31.4% , P lt;0. 01) . Simplified acute physiology score Ⅱ, pneumonia severity index, mutilobar infiltration, and β-lactam monotherapy were confirmed as independent predictors of death. Conclusion β-lactam/macrolide or β-lactam/ fluoroquinolone combination therapy, especially with macrolide, has superiority over β-lactam monotherapy in elderly patients with SCAP, and should be recommended.
Based on review and practice of literature search of clinical economic evaluation, We have discussed the source and search strategy of literatures of clinical economic evaluation. A sample on antibiotics in the treatment of community-acquired pneumonia was shown concurrently.
Objective By comparing the clinical characteristics, etiological characteristics, laboratory examination and prognosis of community acquired pneumonia (CAP) patients with and without pleural effusion (PE), the risk factors affecting the 30-day mortality of CAP patients with PE were analyzed. Methods The clinical data of inpatients with CAP in 13 hospitals in different regions of China from January 1, 2014 to December 31, 2014 were analyzed retrospectively. According to the imaging examination, the patients were divided into two groups: PE group (with pleural effusion) and non-PE group (without pleural effusion). The clinical data, treatment, prognosis and outcome of the two groups were compared. Finally, multivariate analysis was used to analyze the risk factors of 30-day mortality in patients with PE. Results Of the 4781 patients with CAP, 1169 (24.5%) were PE patients, with a median age of 70 years, and more males than females, having smoking, alcoholism, inhalation factors, long-term bed rest, complicated with underlying diseases and complications, such as respiratory failure, acute respiratory distress syndrome (ARDS), cardiac insufficiency, septic shock, acute renal failure and so on. The hospitalization time was prolonged; the intensive care unit (ICU) occupancy rate, mechanical ventilation rate, mortality within 14 days and mortality within 30 days in the PE group were higher than those in the non-PE group. Multivariate analysis showed that the risk factors affecting 30-day mortality in the patients with PE were urea nitrogen >7 mmol/L (OR=2.908, 95%CI 1.095 - 7.724), long-term bed rest (OR=4.308, 95%CI 1.128 - 16.460), hematocrit <30% (OR=4.704, 95%CI 1.372 - 16.135), acute renal failure (OR=5.043, 95%CI 1.167 - 21.787) and respiratory failure (OR=6.575, 95%CI 2.632 - 16.427), ARDS (OR=8.003, 95%CI 1.852 - 34.580). ConclusionsThe hospitalization time and ICU stay of PE patients are prolonged, the risk of complications increases, and the hospital mortality increases significantly with the increase of age, complication and disease severity. The independent risk factors affecting 30-day mortality in PE patients are urea nitrogen >7 mmol/L, long-term bed rest, hematocrit <30%, acute renal failure, respiratory failure, and ARDS.
ObjectiveTo explore the efficacy of community-acquired pneumonia (CAP) by tracheoscopy intervention altimeter and analyze and compare its financial burden.MethodsRetrospective analysis of 419 hospitalized patients with CAP was carried in respiratory medicine department of four hospitals from July 1, 2017 to August 31, 2018 (Changhai Hospital, Shanghai First People’s Hospital, Baoshan Branch of Shanghai First People’s Hospital, and Baoshan Integrated Traditional Chinese and Western Medicine Hospital). According to the time of tracheoscopy intervention treatment, they were divided into 3 groups: 127 patients treated with tracheoscopy intervention during the initial treatment period (within 72 h after obtaining imaging diagnosis) were included in an early intervention group, 158 patients treated with tracheoscopy intervention 72 h after obtaining imaging diagnosis were included in a medium-term intervention group, and 134 patients treated without tracheoscopy intervention were included in a non-intervention group. The total efficiency of treatment, improvement of clinical symptoms, imaging absorption, serum inflammation index level, sputum culture positive rate, change rate, efficiency after drug change, hospital stay and hospitalization cost were compared among three groups.ResultsThe total efficiency of treatment in the early intervention group was higher than that of the medium-term intervention group and the non-intervention group, with statistically significant difference (P<0.05), and the time of normality of body temperature, the time of disappearance of strong sputum and cough in the early intervention group, the absorption time of chest X-rays were shorter than that of the medium-term intervention group and the non-intervention group, and the difference was statistically significant (P<0.05); peripheral blood hemoglobin, serum calcitonin and hypersensitive C reactive protein levels were lower than those in the medium-term intervention group and the non-intervention group, with statistically significant differences (P<0.05), and the sputum-positive and drug-change rates in the early intervention group and the medium-term intervention group were higher than those in the non-intervention group, and the difference was statistically significant (P<0.05); the duration of hospital stay in the early intervention group was shorter than that of the medium-term intervention group and the non-intervention group, and the cost of hospitalization was less than that of the medium-term intervention group and the non-intervention group, and the difference was statistically significant (P<0.05).ConclusionTracheoscopy intervention treatment in the initial period of CAP not only significantly improves the efficacy, but also significantly reduces treatment costs and length of hospitalization, hence it is worth clinical promotion.
Objective To overview the systematic reviews about the efficacy and safety of respiratory fluoroquinolones for community-acquired pneumonia (CAP). Methods We electronically searched databases including China National Knowledge Internet, WanFang Data, VIP, PubMed, Embase and The Cochrane Library to collect systematic reviews or Meta-analyses about respiratory fluoroquinolones for CAP from inception to November 2, 2017. Two reviewers independently screened literatures, extracted data, and then AMSTAR tool was used to assess the methodological quality of included studies. Results A total of 18 systematic reviews/Meta-analyses were included. The results of quality assessment indicated the scores ranged from 5 to 10. Among the 11 items, the item 1 of " Was an ‘a priori’ design provided” and item 4 " Was the status of publication (i.e. grey literature) used as an inclusion criterion” appeared to be the most problematic. The results of overview suggested that: the efficacy of respiratory fluoroquinolones might be similar to β-lactams plus macrolides combination treatment for CAP. However, respiratory fluoroquinolones might be more safety. In addition, the efficacy of respiratory fluoroquinolones sequential therapy for CAP was similar to that of continuous intravenous therapy, but the adverse reactions of the former were fewer. Conclusions Respiratory fluoroquinolones might be similar in efficacy for CAP to other antibiotics recommended by the guidelines with less adverse reactions. However, it can increase multi-drug resistance and potential tuberculosis drug resistance, we should strictly follow the principle of rational use of antibiotics to avoid abuse.
ObjectiveTo compare the value of CURB-65 score and expanded CURB-65 score in evaluating prognosis of pneumonia in non-HIV infected patient and HIV infected patient.MethodsThe study included 206 hospitalized pneumonia patients without HIV infection and 299 pneumonia patients with HIV infection. According to their clinical prognosis within 4 weeks of treatment, they were divided into a deterioration group and an improvement group. The basic situation and the differences of clinical indicators between the two groups were compared. The predictive value of CURB-65 score and expanded CURB-65 score for clinical prognosis of pneumonia in non-HIV infected patients and HIV infected patients was compared by using receiver operator characteristic (ROC) curve.ResultsFor the pneumonia patients without HIV infection, the area under ROC curve (AUC) of CURB-65 score and expanded CURB-65 score were 0.862 and 0.848, respectively. There was no significant difference in AUC between CURB-65 score and expanded CURB-65 score (Z=0.661, P=0.5084). The Youden indexes of CURB-65 score and expanded CURB-65 score were 60.11% and 54.92%, respectively. For the pneumonia patients with HIV infection, the AUC of CURB-65 score and expanded CURB-65 score were 0.588 and 0.634, respectively. There was no significant difference between them (Z=1.416, P=0.1567). The Youden index of the two scores was 19.53% and 20.52%, respectively.ConclusionsThe CURB-65 score and expanded CURB-65 score can effectively evaluate the clinical prognosis of pneumonia in non-HIV infected patients, but their predicted values are limited in evaluating the prognosis of pneumonia in HIV infected patients.
ObjectiveTo explore procalcitonin (PCT) dynamically in severe community-acquired pneumonia (SCAP) patients to evaluate the effects of different kinds of medical treatments and assess the clinical significance of the change of PCT. MethodsAll of the selected 60 SCAP patients treated from January 2009 to April 2011 met the standards of IDSA/ATS Guidelines for CAP. There were 38 males and 22 females, with an average age of 66.3 years. The sterile venous blood specimen samples were collected from the patients at day 0 to day 5. PCT and C-reactive protein (CRP) were measured by enzyme linked immunosorbent assay throughout the research. At day six, based on oxygenation index (PaO2/FiO2) ratio higher than 250, inflammation absorption on chest X ray after vasoactive agents were stopped, Glasgow scores higher than 10 and urine volume equal to or higher than 0.5 mL/(kg·d), we divided the patients into recovery group and deterioration group. Data were analyzed by SAS 9.0 software, and P<0.05 was considered to be statistically significant. ResultsThe analysis results showed that PCT and CRP bore a significantly positive relationship on day 0 (r=0.38, P=0.00). The research also indicated that PCT had a faster declining rate than CRP and white blood cells count throughout the clinical treatment. The average of PCT declined 29% in 48 hours. Following the criterion of PCT decrease by 30%, the research showed that PCT had a higher sensibility and specificity (66.87% and 85.50%, respectively) in 48 hours than 72 hours (70.05% and 100.00%), 96 hours (79.88% and 75.23%), and 120 hours (83.10% and 100.00%). ConclusionFollowing the criterion of PCT decrease by 30% after using antibiotics can be an clinical objective index to guide the use of antibiotics and provide the basis for clinical application and prognosis.
Objective To measure the expression level of Myc-interacting zinc finger protein-1 (MIZ1) in peripheral blood mononuclear cells (PBMC) of patients with severe and non-severe community-acquired pneumonia (CAP) and its relationship with inflammatory factors. Methods Thirty-six CAP patients from Beijing Chaoyang Hospital from April 2018 to June 2019 were enrolled in this study. MIZ1 mRNA level in PBMC were measured by reverse transcriptase-quantitative polymerase chain reaction. The levels of interleukin (IL)-6, IL-8, IL-10, and interferon-α in the serum of patients were measured by enzyme-linked immunosorbent assay. The levels of MIZ1 mRNA and inflammatory factors were compared between the severe CAP patients and the non-severe CAP patients. Results Compared with non-severe CAP patients, the MIZ1 mRNA level in the PBMC of severe CAP patients was lower (P<0.05) than non-severe group. Receiver operating characteristic (ROC) curve of the expression level of MIZ1 in PBMC was calculated according to whether CAP was severe or non-severe, and the area under ROC curve was 0.731 (P=0.018). Spearman correlation analysis showed that MIZ1 mRNA was negatively correlated with IL-10 level in the severe CAP patients (Spearman correlation co-efficient was –0.620, P<0.05). Conclusions MIZ1 may indicate the severity of CAP. MIZ1 may affect IL-10 so as to play a role in inflammation regulation.