Oral versus intravenous antibiotics for community acquired lower respiratory tract infection in a general hospital: open,randomised controlled trial.

OBJECTIVE--To see whether there is a difference in outcome between patients treated with oral and intravenous antibiotics for lower respiratory tract infection. DESIGN--Open controlled trial in patients admitted consecutively and randomised to treatment with either oral co-amoxiclav, intravenous followed by oral co-amoxiclav, or intravenous followed by oral cephalosporins. SETTING--Large general hospital in Dublin. PATIENTS--541 patients admitted for lower respiratory tract infection during one year. Patients represented 87% of admissions with the diagnosis and excluded those who were immunocompromised and patients with severe life threatening infection. MAIN OUTCOME MEASURES--Cure, partial cure, extended antibiotic treatment, change of antibiotic, death, and cost and duration of hospital stay. RESULTS--There were no significant differences between the groups in clinical outcome or mortality (6%). However, patients randomised to oral co-amoxiclav had a significantly shorter hospital stay than the two groups given intravenous antibiotic (median 6 v 7 and 9 days respectively). In addition, oral antibiotics were cheaper, easier to administer, and if used routinely in the 800 or so patients admitted annually would lead to savings of around 176,000 pounds a year. CONCLUSIONS--Oral antibiotics in community acquired lower respiratory tract infection are at least as efficacious as intraveous therapy. Their use reduces labour and equipment costs and may lead to earlier discharge from hospital.     

颅脑损伤患者下呼吸道感染病原菌分布及耐药性分析

目的 探讨桐乡市第一人民医院颅脑损伤患者下呼吸道感染病原菌的分布及耐药性,帮助临床合理使用抗菌药物.方法 采用VITEK-2细菌鉴定及药敏分析系统,对113例颅脑损伤患者下呼吸道感染痰标本分离出的病原菌进行鉴定和耐药性分析.结果 113例患者中共分离出病原菌179株,其革兰阴性杆菌122株,占68.1%,以肺炎克雷伯菌...     

Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database

Objective To determine the extent to which antibiotics reduce the risk of serious complications after common respiratory tract infections.Design Retrospective cohort study.Setting UK primary care practices contributing to the general practice research database.Data source 3.36 million episodes of respiratory tract infection.Main outcome measures Risk of serious complications in treated and untreated patients in the month after diagnosis: mastoiditis after otitis media, quinsy after sore throat, and pneumonia after upper respiratory tract infection and chest infection. Number of patients needed to treat to prevent one complication.Results Serious complications were rare after upper respiratory tract infections, sore throat, and otitis media, and the number needed to treat was over 4000. The risk of pneumonia after chest infection was high, particularly in elderly people, and was substantially reduced by antibiotic use, with a number needed to treat of 39 for those aged ≥65 and 96-119 in younger age groups. Conclusion Antibiotics are not justified to reduce the risk of serious complications for upper respiratory tract infection, sore throat, or otitis media. Antibiotics substantially reduce the risk of pneumonia after chest infection, particularly in elderly people in whom the risk is highest.     

Antibiotics in bacterial acute respiratory tract infection in children]

The data on changes in the susceptibility of the most frequent respiratory tract pathogens i.e. Pneumococcus spp. and Haemophilus influenzae within the last 15 years and Streptococcus spp., Staphylococcus spp. and Moraxella spp. at the present time as well as recommendations based on the original and some literature data on the choice of the antibacterial drugs for the initial treatment of bacterial complications of acute respiratory tract viral infections such as otitis, sinusitis and pharyngitis are presented. The necessity of decreasing the unjustified use of antibiotics in cases of uncomplicated acute respiratory tract viral infections is indicated.     

ICU开放人工气道患者下呼吸道病原菌分布及耐药性分析

目的了解重症监护室（ICU）开放气道患者下呼吸道感染病原菌分布及耐药特点,为临床用药提供依据。方法回顾性分析2007年1月至2008年12月,重症监护室开放气道患者下呼吸道感染者的痰标本418株病原菌进行鉴定及药敏试验。结果革兰阴性杆菌占69．6％,其中铜绿假单胞菌27．02％,其次为鲍曼不动杆菌20．16％。革兰阳性球菌占20．16％,以金黄色葡萄球菌为主占12．5％,真菌10．24％。结论目前重症监护室下呼吸道致病菌以G^-杆菌为主,细菌的耐药性严重,应根据药敏试验选择抗生素。     

ICU患者呼吸道感染病原菌的分布及耐药性监测

目的了解华中科技大学同济医学院附属同济医院ICU患者呼吸道感染病原菌的分布及细菌耐药性特征,指导临床合理、科学地使用抗菌药物,为有效控制危重患者肺部感染提供依据。方法回顾分析该院2004年1月至2008年12月ICU患者呼吸道感染的病原菌分布情况,并分析其耐药性变化。结果该院ICU患者呼吸道感染病原菌主要为鲍曼不动杆菌(aba)、铜绿假单胞菌(pae)和金葡菌(sau),其中泛耐药菌株有增多趋势。耐苯唑西林金葡菌(MRSA)的检出率在77.5%~100%。药敏数据显示,pae对常用抗菌药物耐药率均较高,在25.5%~95.3%;aba仅对头孢哌酮/舒巴坦耐药率低,为12.2%,但中敏率较高,为41.7%,对其他常用抗菌药物耐药率均较高。MRSA对所有的β-内酰胺类抗菌药物均耐药,苯唑西林敏感的金葡菌(MSSA)对青霉素和红霉素耐药率较高,分别为97.1%和47.2%,对其他常用抗菌药物较敏感。结论该院ICU患者呼吸道感染以aba、pae和sau为主,且耐药现象严重,对临床常用抗菌药物有多重耐药现象,临床医生应根据药敏结果合理使用抗菌药物。     

嗜麦芽窄食单胞菌感染的临床特征、高危因素及预后分析

目的了解嗜麦芽窄食单胞菌感染的临床特点、危险因素、预后及耐药现状,为有效预防和治疗该病原菌感染提供依据。方法收集2013年11月至2014年4月浙江大学医学院附属第一医院收治的129例细菌培养为嗜麦芽窄食单胞菌患者的临床资料进行回顾性统计分析。结果 129例细菌培养确诊嗜麦芽窄食单胞菌感染患者平均年龄（65.1±17.0）岁,包括下呼吸道感染和非呼吸道感染患者分别为100例和29例,下呼吸道感染患者存在原发肺部疾病的患病率、ICU入住率、气管切开比例、广谱抗生素的使用率、患病年龄等均高于非呼吸道感染患者（P〈0.05）。而非呼吸道感染患者的外科手术、无菌腔内置管比例及免疫抑制剂使用率高于下呼吸道感染患者（P〈0.05）。嗜麦芽窄食单胞菌感染后选择敏感抗生素治疗的患者的死亡率明显低于未选择敏感抗生素的患者（15.0%/30.4%,P〈0.05）。结论原发肺部疾病、入住ICU、气管切开、广谱抗生素使用、年龄大是下呼吸道感染嗜麦芽窄食单胞菌的高危因素,外科手术、无菌腔内置管、免疫抑制剂使用是非呼吸道感染嗜麦芽窄食单胞菌的高危因素。使用敏感抗生素可以降低嗜麦芽窄食单胞菌感染患者的死亡率。     

外科危重病人呼吸道院内感染的调查分析

目的：了解外科危重病人呼吸道院内感染致病菌及其细菌耐药性情况．为临床防治提供依据。方法：对我院SICU1997年1月～1999年12月三年间从痰标本中所分离的致病菌及其细菌耐药性进行回顾性调查。结果：外科危重病人呼吸道内感染仍以G^-菌为主,占58．0％,其次真菌25．4％、G^ 菌16．6％,致病菌前四位分别铜绿假单胞菌、白色念珠菌、嗜麦芽窄食黄单胞菌和耐甲氧西林金黄色葡萄球菌。体外药物敏感试验显示主要的致病菌均呈多重耐药特性。结论：本SICU呼吸道院内感染的致病菌仍以G^-菌为主,致病菌呈多重耐药特性,掌握本科室呼吸道内感染致病菌谱及其耐药特性具有重要意义。     

Viral and atypical bacterial detection in acute respiratory infection in children under five years

Background

Acute respiratory infection (ARI) is a leading cause of morbidity and mortality in children worldwide. This study aimed to determine the viral and atypical bacterial causes of different severities and clinical manifestations of ARI in preschool children from low-income families in North-East Brazil.

Methods

Clinical/demographic data and nasopharyngeal aspirates (NPA) were prospectively collected from children <5 years presenting with ARI over one year to a paediatric A&E department. Disease severity was grouped according to presence of lower respiratory tract signs, need for hospital admission and need for oxygen. Clinical manifestation of ARI was based on discharge diagnosis from hospital with four conditions predominating: bronchiolitis, pneumonia, episodic viral wheeze/asthma and upper respiratory tract infection. Multiplex PCR was used to detect 17 common respiratory viral and atypical bacterial pathogens in NPA.

Findings

407 children with a median age of eight months were recruited. Pathogens were detected in 85·5% samples with co-infection being particularly common (39·5%). Respiratory Syncytial Virus (RSV; 37%), Adenoviruses (AdV; 25%), Rhinoviruses (hRV; 19%), Bocavirus (hBoV; 19%), human Meta-pneumovirus (hMPV; 10%) and Mycoplasma pneumoniae (Mpp; 10%) were most prevalent. Detection and co-infection rates were similar in all severities and clinical manifestations of ARI apart from RSV, which was associated with more severe disease and specifically more severe cases of bronchiolitis, and Mpp, which was associated with more severe cases of pneumonia. Mpp was detected in 17% of children admitted to hospital with pneumonia.

Interpretation

This study underlines the importance of viral and atypical bacterial pathogens in ARI in pre-school children and highlights the complex epidemiology of these pathogens in this age group. Generally, viruses and atypical bacteria were detected in all severities and clinical manifestations of ARI but RSV and Mpp were associated with more severe cases of bronchiolitis and pneumonia respectively.     

Altered function in CD8+ T cells following paramyxovirus infection of the respiratory tract

For many respiratory pathogens, CD8+ T cells have been shown to play a critical role in clearance. However, there are still many unanswered questions with regard to the factors that promote the most efficacious immune response and the potential for immunoregulation of effector cells at the local site of infection. We have used infection of the respiratory tract with the model paramyxovirus simian virus 5 (SV5) to study CD8+ T-cell responses in the lung. For the present study, we report that over time a population of nonresponsive, virus-specific CD8+ T cells emerged in the lung, culminating in a lack of function in approximately 85% of cells specific for the immunodominant epitope from the viral matrix (M) protein by day 40 postinfection. Concurrent with the induction of nonresponsiveness, virus-specific cells that retained function at later times postinfection exhibited an increased requirement for CD8 engagement. This change was coupled with a nearly complete loss of functional phosphoprotein-specific cells, a response previously shown to be almost exclusively CD8 independent. These studies add to the growing evidence for immune dysregulation following viral infection of the respiratory tract.     

Etiologic profile and antimicrobial susceptibility of community-acquired urinary tract infection in two Cameroonian towns

ABSTRACT: BACKGROUND: Urinary tract infection (UTI) represents one of the most common diseases encountered in community medical practice. In resource poor settings, treatment is usually empiric due to the high cost and long duration required for reporting diagnosis by culture and antibiotic susceptibility testing. With the growing problem of drug resistance knowledge of antibiotic susceptibility pattern is pertinent for successful eradication of invading pathogens. Our study, the first of its kind in Cameroon, analyzed the distribution and antibiotic susceptibility of bacteria causing community-acquired urinary tract infection (CAUTI) in two towns (Bamenda and Buea) with a large number of young and middle aged persons, to provide data that could guide empiric treatment. FINDINGS: We cultured 235 urine specimens and analyzed the antibiotic susceptibility of isolates by the disc diffusion technique. Uropathogens were recovered from 137 (58.3%), with prevalence rates in Buea and Bamenda being 65.9% and 54% respectively. Predominant pathogens were Escherichia coli (31.4%), Klebsiella oxytoca (25.5%) and Staphylococcus spp (24.1%). Geographic variation in uropathogen distribution and antibiotic susceptibility was observed, and a significant difference in pathogen distribution with respect to gender. The 20-39 years age group had the highest prevalence of infection. All pathogens isolated were detected in this group. Isolates exhibited low susceptibility to antibiotics tested. Bamenda isolates generally exhibited lower susceptibility compared to those from Buea. CONCLUSION: Regional variation in etiology of CAUTI and antibiotic susceptibility observed in our study emphasizes the need to establish local and national antimicrobial resistance monitoring systems in Cameroon to provide information for the development of CAUTI treatment guidelines.     

下呼吸道真菌感染的临床特点及耐药性分析

目的探讨住院患者下呼吸道真菌感染的临床特点,对其耐药性进行分析,以指导临床合理用药。方法回顾性调查2008年1月至2009年12月间安徽医科大学第一附属医院发生下呼吸道真菌感染的病例,并进行统计学分析。结果 374例下呼吸道真菌感染患者检出白色念珠菌253例(67.6%),光滑念珠菌74例(19.8%),热带念珠菌28例(7.5%),克柔念珠菌10例(2.7%),其他假丝酵母菌3例(0.8%),毛霉菌4例(1.1%),烟曲霉菌2例(0.5%)。本组资料药敏结果显示各种真菌对多种抗真菌药物敏感率较高,其中两性霉素B、伏立康唑和氟康唑的敏感率较高,而伊曲康唑的耐药率最高,达到12.2%。结论下呼吸道真菌感染仍以白色念珠菌感染为主,光滑念珠菌和热带念珠菌其次,3种念珠菌占总分离真菌的94.9%,5种抗真菌药物的耐药率以伊曲康唑最高,社区获得性感染患者预后明显优于医院感染患者。     

Risk factors for lower respiratory complications of rhinovirus infections in elderly people living in the community: prospective cohort study.

OBJECTIVE: To assess the role of rhinoviruses in elderly people living in the community. DESIGN: Prospective community based surveillance of elderly people, without intervention. Subjects were telephoned weekly to identify symptomatic upper respiratory tract infections. Symptoms and impact of illnesses were monitored, and specimens were collected for diagnostic serology and human rhinovirus polymerase chain reaction. SETTING: Leicestershire, England. SUBJECTS: 533 subjects aged 60 to 90. MAIN OUTCOME MEASURES: Symptoms, restriction of activity, medical consultations, and antibiotic use during 96 rhinovirus infections. Adjusted odds ratios for lower respiratory syndromes with respect to smoking and health status. RESULTS: A viral cause was established in 211 (43%) of 497 respiratory illnesses; rhinoviruses were identified in 121 (24%) and as single pathogens in 107. The median duration of the first or only rhinovirus infection in the 96 people with 107 rhinovirus infections was 16 days; 18 of the 96 patients were confined to bed and 25 were unable to cope with routine household activities. Overall, 60 patients with rhinovirus infections had lower respiratory tract syndromes; 41 patients consulted their doctor, 31 of them (76%) receiving antibiotics. One patient died. Logistic regression analysis showed that chronic medical conditions increased the estimated probability of lower respiratory rhinovirus illness by 40% (95% confidence interval 17% to 68%) and smoking by 47% (14% to 90%). There were almost six times as many symptomatic rhinovirus infections as influenza A and B infections. CONCLUSIONS: Rhinoviruses are an important cause of debility and lower respiratory illness among elderly people in the community. Chronic ill health and smoking increase the likelihood of lower respiratory complications from such infections. The overall burden of rhinovirus infections in elderly people may approach that of influenza.     

伴下呼吸道多重耐药菌感染的 慢性阻塞性肺病患者病原菌分布及危险因素分析

目的 探讨伴下呼吸道多重耐药菌感染的慢性阻塞性肺病(COPD)患者病原菌分布及其危险因素。方法 选取2017年1月至2018年6月我院收治的138例COPD伴下呼吸道感染患者作为研究对象,根据下呼吸道分泌物是否分离出多重耐药菌将患者分为多重耐药组(MDR组,71例)和非多重耐药组(NMDR组,67例)。采用全自动细菌鉴定仪对菌种进行鉴定,采用K-B纸片法进行药敏试验,并分析多重耐药菌感染的危险因素。结果 多重耐药组患者共分离出84株病原菌,其中革兰阴性菌所占比例最高,为58.33%;革兰阳性菌与真菌分别占22.62%和19.05%。MDR组与NMDR组患者在COPD分级、住院时间、机械通气治疗、侵入性操作、长期使用糖皮质激素、长期使用抗菌药物及糖尿病史方面差异均有统计学意义(P0.05)。多因素Logistic回归分析显示机械通气治疗、侵入性操作、使用糖皮质激素、长期使用抗菌药物及糖尿病史是多重耐药菌感染的独立危险因素(P0.05)。结论 COPD伴下呼吸道多重耐药菌感染病原菌以革兰阴性菌为主,机械通气治疗、侵入性操作、长期使用糖皮质激素、长期使用抗菌药物及糖尿病史是发生感染的独立危险因素。建议根据病原菌种类选择相应的敏感药物,并采取针对危险因素的有效措施。     

神经外科颅内出血患者下呼吸道感染病原菌的耐药性监测

目的了解神经外科重症监护室（NICU）颅内出血患者下呼吸道感染病原菌的种类及耐药情况,为临床合理用药提供依据。方法对2010年1月至2011年1月颅内出血的患者,其下呼吸道感染病原菌的种类及耐药性进行回顾性分析。结果分离出的374例病原菌中以革兰阴性杆菌为主,占81．8％,革兰阳性球菌占4．0％,真菌占14．2％。分离率较高的细菌依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、嗜麦芽窄食单胞菌、金黄色葡萄球菌。其中,产超广谱β-内酰胺酶（ESBLs）的肺炎克雷伯菌的检出率为50．0％;耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为73．3％。鲍曼不动杆菌和铜绿假单胞菌对丁胺卡那、妥布霉素、多粘菌素B有较好的敏感性;而金黄色葡萄球菌对复方新诺明、呋喃妥因、万古霉素耐药率较低。结论NICU颅内出血患者下呼吸道感染以多重耐药的革兰阴性杆菌为主,临床应根据药敏结果合理用药,控制和减少感染的发生。     

下呼吸道不动杆菌医院感染的危险因素及耐药性分析

目的了解引起下呼吸道医院感染的不动杆菌耐药现状及存在的危险因素。方法用常规的方法对下呼吸道的标本进行病原菌的培养及分离,用全自动微生物分析仪VITEK 2对细菌进行鉴定及药物敏感性试验,同时对由不动杆菌引发的158例院内感染患者的危险因素进行分析。结果不动杆菌引起下呼吸道医院感染相关的危险因素主要为使用糖皮质激素类药物或机械插管或患有糖尿病等;除亚胺培南、左氧氟沙星、头孢吡肟、头孢哌酮、头孢哌酮/舒巴坦及头孢他啶等对不动杆菌有较好的体外抗菌活性外(耐药率小于40.0%),临床常用的其他多种抗菌药物耐药较严重,耐药率均在40.0%以上。结论糖皮质激素,机械插管,糖尿病等是不动杆菌引起下呼吸道医院感染的主要危险因素,不动杆菌对临床常用的抗生素有多重耐药性。     

以儿童呼吸道感染为主的非典型EBV感染报道

目的报道儿童EBV感染所致的临床疾病谱与年龄特点,以进一步提高对EBV感染诊治水平.方法回顾性分析了EBV-VCA-IgM或EBV-DNA-PCR诊断的690例儿童EBV感染的疾病分布和年龄分布特点.结果EBV感染儿童非典型传染性单核细胞增多症患儿422例,占61.16%,非典型EBV感染268例,占38.84%.非典型EBV感染中以呼吸道感染最为多见,为191例,占非典型EBV感染的71.27%.其他为皮炎或口炎、血小板减少性紫癜、腹泻病、川畸病、肠系膜或颈淋巴结炎、肾炎或肾病和CNS感染等.EBV感染致传染性单核细胞增多症和呼吸道感染在各年龄组的分布差异无显著性,EBV感染男女比为1.79：1.结论儿童EBV感染所致疾病多样,累及系统多,非典型表现以呼吸道感染为主.传染性单核细胞增多症和呼吸道感染在各年龄组间差异无显著性.     

76例恶性肿瘤患者院内深部真菌感染调查

目的探讨深部真菌感染对于恶性肿瘤患者的影响,以及住院期间应注意的问题。方法调查分析2005年1月到2008年12月期间住院的76例恶性肿瘤患者院内深部真菌感染情况,分析患者一般状态、诊治方法的影响。结果76例患者中真菌感染的部位以呼吸道为主（70．9％）,泌尿系次之（17．7％）;病原学检测标本共培养出真菌79株,以白色念珠菌占第1位（60．8％）,热带念珠菌占第2位（21．5％）;老年（≥60岁）、一般状态评分（Ps评分）〉2分、晚期肿瘤差异均有显著性;多数有侵入性操作者（100％）、经过抗生素治疗者（97．4％）、经过激素治疗者（90．8％）和经过放化疗治疗者（82．9％）。结论肿瘤患者的年龄、病情分期、一般状态是本组病例发生院内深部真菌感染的基本病因,抗生素不合理使用及住院期间侵入性操作、既往放化疗及激素治疗等医疗措施是院内深部真菌感染的危险因素。     

小儿下呼吸道感染痰培养标本病原菌构成分析

目的了解小儿下呼吸道感染病原菌的分布及对常用抗菌药物的耐药状况。方法对2710例小儿下呼吸道感染患者痰标本进行培养,用VITEK-2Compact微生物鉴定系统鉴定菌种和药敏试验,WHO-NET5．4软件对数据进行分析。结果共分离病原菌675株,革兰阴性杆菌457株,占67．7％,主要为大肠埃希菌、肺炎克雷伯菌;革兰阳性球菌159株,占23．5％,主要为金黄色葡萄球菌、肺炎链球菌;真菌59株,占8．7％,主要为白色假丝酵母菌。结论小儿下呼吸道感染病原菌以革兰阴性杆菌为主,耐药性较为严重,应不断加强耐药性监测,合理使用抗菌药物。