The solithromycin journey—It is all in the chemistry

The macrolide class of antibiotics, including the early generation macrolides erythromycin, clarithromycin and azithromycin, have been used broadly for treatment of respiratory tract infections. An increase of treatment failures of early generation macrolides is due to the upturn in bacterial macrolide resistance to 48% in the US and over 80% in Asian countries and has led to the use of alternate therapies, such as fluoroquinolones. The safety of the fluoroquinolones is now in question and alternate antibiotics for the outpatient treatment of community acquired bacterial pneumonia are needed. Telithromycin, approved in 2003, is no longer used owing to serious adverse events, collectively called the ‘Ketek effects’. Telithromycin has a side chain pyridine moiety that blocks nicotinic acetylcholine receptors. Blockade of these receptors is known experimentally to cause the side effects seen with telithromycin in patients use. Solithromycin is a new macrolide, the first fluoroketolide, which has been tested successfully in two Phase 3 trials and is undergoing regulatory review at the FDA. Solithromycin is differentiated from telithromycin chemically and biologically in that its side chain is chemically different and does not significantly block nicotinic acetylcholine receptors. Solithromycin was well tolerated and effective in clinical trials.     

缺血性脑卒中患者介入治疗后并发相关性肺炎的病原菌分布及药敏分析

目的:探讨缺血性脑卒中患者介入治疗后并发相关性肺炎的病原菌分布情况及其耐药性,为临床合理选择抗菌药物进行抗感染治疗提供参考。方法:选择2016年5月-2018年6月大连医科大学附属大连市中心医院神经内一科收治的182例缺血性脑卒中介入治疗后并发相关性肺炎患者,对患者痰标本进行细菌培养和鉴定,并对培养阳性的病原菌进行药物敏感性试验。结果:182例患者共送检痰标本并进行细菌培养276次,其中阳性检出199次,阳性检出率为72.10%,检出病原菌215株,革兰阴性杆菌153株,占71.16%,其中鲍氏不动杆菌是主要病原菌,占24.19%,其次为肺炎克雷伯菌,占20.93%;革兰阳性球菌62株,占28.84%,其中金黄色葡萄球菌为主要的病原菌,占11.16%,其次为溶血葡萄球菌,占7.91%。革兰阴性杆菌和革兰阳性球菌中的主要病原菌对抗菌药物的耐药性较严重,且存在多药耐药性的现象。结论:缺血性脑卒中患者介入治疗后并发相关性肺炎的病原菌以革兰阴性杆菌为主,且存在多药耐药率高的现象,临床应合理选取抗菌药物进行治疗。     

血钙对老年肺炎患者的严重程度及预后的影响

目的：研究血清钙离子浓度与老年肺炎患者的严重程度及预后的关系。方法：按照脓毒症的诊断标准将入住急诊ICU的老年肺炎患者206例,分为脓毒症组（155例）和非脓毒症组（51例）,脓毒症组又按照预后分为存活组（91例）和死亡组（64例）。分别测定血清钙离子浓度、血浆白蛋白、C-反应蛋白（CRP）、血白细胞计数等有关的实验室指标,比较2组指标的差别。结果：脓毒症组中血清钙离子浓度较非脓毒症组降低,CRP、血白细胞计数较非脓毒症组升高（P〈0．01）;亚组分析中,死亡组中血清钙离子浓度较存活组降低（P〈0．01）,CRP较存活组升高（P〈0．05）,血白细胞计数两组比较无明显差异（P〉0．05）;血清钙离子浓度与血浆白蛋白的浓度呈高度正相关。结论：血清钙离子浓度对判断老年肺炎患者的预后有一定的临床意义。     

支原体肺炎合并胸腔积液、肺不张27 例临床分析

目的:探讨肺炎支原体肺炎合并胸腔积液、肺不张的诊断和治疗问题。方法:回顾性分析27例MPP合并胸腔积液、肺不张患儿的临床特征、诊治过程的临床资料,并结合文献进行讨论。结果:在27例MPP患儿中,肺CT表现为胸腔积液17例,肺不张10例;24例治愈,1例胸膜肥厚粘连,2例遗留闭塞性细支气管炎。结论:对MPP合并胸腔积液、肺不张患儿应早诊断,早治疗,除应用大环内酯类药物外,应联合应用头孢菌素,激素及丙种球蛋白,疗效肯定。     

Arbidol/IFN-α2b therapy for patients with corona virus disease 2019: a retrospective multicenter cohort study

The spread of COVID-19 is accelerating. At present, there is no specific antiviral drugs for COVID-19 outbreak. This is a multicenter retrospective cohort study of patients with laboratory-confirmed COVID-19 infection pneumonia from 3 hospitals in Hubei and Guangdong province, 141 adults (aged ≥18 years) without ventilation were included. Combined group patients were given Arbidol and IFN-α2b, monotherapy group patients inhaled IFN-α2b for 10–14 days. Of 141 COVID-19 patients, baseline clinical and laboratory characteristics were similar between combined group and monotherapy group, that 30% of the patients leucocytes counts were below the normal range and 36.4% of the patients experienced lymphocytopenia. The duration of viral RNA of respiratory tract in the monotherapy group was not longer than that in the combined therapy group. There was no significant differences between two groups. The absorption of pneumonia in the combined group was faster than that in the monotherapy group. We inferred that Arbidol/IFN - 2 b therapy can be used as an effective method to improve the COVID-19 pneumonia of mild patients, although it helpless with accelerating the virus clearance. These results should be verified in a larger prospective randomized environment.     

The microbiota protects against Pseudomonas aeruginosa pneumonia via γδ T cell-neutrophil axis in mice

Exposure to antimicrobials leading to microbiota dysbiosis has been found to be an independent risk factor for extensively drug-resistant Pseudomonas aeruginosa acquisition. Microbiota dysbiosis may induce imbalanced immune responses and can affect disease susceptibility. However, the potential role of commensal microbiota in bacterial pneumonia is poorly defined. The aim of this study was to investigate the mechanistic basis for the defective host defenses against P. aeruginosa pneumonia induced by antibiotic pretreatment perturbing microbiota. We found that antibiotic pretreatment significantly perturbed the composition of intestinal microbiota. The microbiota dysbiosis impaired host defenses against P. aeruginosa pneumonia, as reflected by the increased bacterial burden and dissemination, compromised local inflammatory responses and shortened survival time in microbiota-depleted mice compared with controls. This impairment correlated with a defective γδ T17 cell and downstream neutrophil responses. Anti-TCRγδ-treated mice had changes similar to those in the microbiota-depleted mice. Overall, our results suggest the importance of microbiota in supporting the host defense against pneumonia, define a crucial role for the γδ T cell-neutrophil axis in the potential mechanism, and delineate the deleterious effects of antibiotic treatment on antibacterial defenses.     

老年肺癌非手术治疗医院内获得性肺炎的临床特点分析及对策

目的探讨老年肺癌非手术治疗患者医院内获得性肺炎的临床特点及对策。方法对2006年1月至2008年12月住院的275例非手术治疗老年肺癌的医院内获得性肺炎（Hospital-acquired pneumonia,HAP）情况进行回顾性分析。结果本组病例发生院内获得性肺炎165例。以中央型肺癌、鳞癌易发院内获得性肺炎;由革兰阴性菌导致的HAP明显高于革兰阳性菌与真菌;放疗加化疗HAP感染率高于单纯放疗或化疗;随着白细胞下降,感染率明显增高,特别是粒细胞〈1.0×10^9/L者感染率最高。结论根据老年肺癌非手术治疗院内获得性肺炎的临床特点把HAP的预防作为根本措施,一旦出现感染应及时治疗。     

Anti-inflammatory effect of chemically modified chitin

Anti-inflammatory effects of the three types of chitin derivatives namely phosphated chitin (P-chitin), phosphated–sulfated chitin (PS-chitin), and sulfated chitin (S-chitin) were investigated using a canine model of chitosan-induced pneumonia. After simultaneous administration of chitosan with or without each chitin derivative (chitosan alone: n=6, chitosan and P-chitin: n=6, chitosan and PS-chitin: n=1, and chitosan and S-chitin: n=3), hematological examination and X-ray image processing were performed for up to 24 h. Then the lungs were recovered and were evaluated by softex imaging after inflation and fixation. The hematological findings showed that PS-chitin and S-chitin did not prevent the decrease in white blood cell (WBC) count as seen in dogs administered chitosan, while P-chitin prevented such decrease in WBC count. The surface of the inflated and fixed lung specimens was hemorrhagic in the PS- and S-chitin groups as well as in the chitosan group, while the lung looked like normal in the P-chitin group. The pulmonary blood vessels of the chitosan group showed severe change while the P-chitin group showed no changes with softex findings. Furthermore, the pattern of histogram density obtained with image processing of thoracic X-ray in P-chitin group did not change among pre and post administration while chitosan group showed rightward movement and significant changes on parameters. The cause of which is attribured to an attenuation of X-ray permeability by angiectasis of the lung.     

Two‐sample nonparametric likelihood inference based on incomplete data with an application to a pneumonia study

The clinical pulmonary infection score (CPIS) and bronchoalveolar lavage (BAL) are important diagnostic variables of pneumonia for forcefully ventilated patients who are susceptible to nosocomial infection. Because of its invasive nature, BAL is performed for patients only if the CPIS is greater than a certain threshold value. Thus, CPIS and BAL are closely related, yet BAL values are substantially missing. In a randomized clinical trial, the control and oral treatment groups were compared based on the outcomes from these procedures. Because of the relevance of both outcomes with respect to evaluating the efficacy of treatments, we propose and examine a nonparametric test based on these outcomes, which employs the empirical likelihood methodology. While efficient parametric methods are available when data are observed incompletely, performing appropriate goodness‐of‐fit tests to justify the parametric assumptions is difficult. Our motivation is to provide an approach based on no particular distributional assumption, which enables us to use all observed bivariate data, whether completed or not in an approximate likelihood manner. A broad Monte Carlo study evaluates the asymptotic properties and efficiency of the proposed method based on various sample sizes and underlying distributions. The proposed technique is applied to a data set from a pneumonia study demonstrating its practical worth.