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ABSTRACT: Appropriate antimicrobial therapy of community-acquired pneumonia (CAP) is mainly based on the distribution of etiology and antimicrobial resistance of major pathogens. We performed a prospective observational study of adult with CAP in 36 hospitals in China.
Etiological pathogens were isolated in each of the centers, and all of the isolated pathogens were sent to Zhongshan Hospital for antimicrobial susceptibility tests using agar dilution.
A total of 593 patients were enrolled in this study, and 242 strains of bacteria were isolated from 225 patients. Streptococcus pneumoniae (79/242, 32.6%) was the most frequently isolated pathogen, followed by Haemophilus influenzae (55/242, 22.7%) and Klebsiella pneumoniae (25/242, 10.3%). Totally 527 patients underwent serological tests for atypical pathogens; Mycoplasma pneumoniae and Chlamydia pneumoniae infections were identified in 205 (38.9%) and 60 (11.4%) patients respectively. Legionella pneumophila infections were identified in 4.0% (13/324) of patients. The non-susceptibility rate of isolated Streptococcus pneumoniae to erythromycin and penicillin was 63.2% and 19.1% respectively. Six patients died from the disease, the 30-day mortality rate was 1.1% (6/533).
The top three bacteria responsible for CAP in Chinese adults were Streptococcus pneumonia, Haemophilus influenza and Klebsiella pneumonia. There was also a high prevalence of atypical pathogens and mixed pathogens. The resistance rates of the major isolated pathogens were relatively low except for the high prevalence of macrolide resistance in Streptococcus pneumoniae.
Chinese medical journal 09/2012; 125(17):2967-72. · 0.86 Impact Factor
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Zhonghua yi xue za zhi 01/2012; 92(2):76-85.
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You-Ning Liu,
Dan-Yang She,
Tie-Ying Sun,
Zhao-Hui Tong,
Bei He,
Yi Xiao, Li-Xian He,
Jie-Ming Qu,
Xiao-Qing Liu,
Er-Ran Li,
Ping Chen,
Zhong-Sen Ma,
Yi Shi,
Yu-Lin Feng,
Shu-Juan Jiang,
Sheng-Dao Xiong,
Cheng-Ping Hu
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ABSTRACT: To investigate the pathogens, clinical manifestations, prognosis of and the risk factors for pulmonary mycosis in China.
All cases of pulmonary mycosis from 16 centers in 10 cities from Jan. 1998 to Dec. 2007 that met the diagnostic criteria were included for clinical, microbiological and radiological analysis.
Totally 474 cases of pulmonary mycosis were retrieved. The top 5 pulmonary mycosis was pulmonary aspergillosis (180 cases, 37.9%), pulmonary candidiasis (162 cases, 34.2%), pulmonary cryptococcosis (74 cases, 15.6%), pneumocystis carinii pneumonia (23 cases, 4.8%) and pulmonary mucormycosis (10 cases, 2.1%). The constituent ratio in the last 3 years was similar to that in the former 7 years. The main pathogens of pulmonary candidiasis were Candida albicans (308/474, 65.0%) and Candida tropicalis (57/474, 12.0%), which were sensitive to common azoles. Compared with bacterial pneumonia, pulmonary mycosis showed more symptoms of hemoptysis (147/474, 31.0%) and pleural effusion (95/474, 20.0%), and less radiological specificity. Classical halo sign (4/474, 0.8%) and crescentic sign (17/474, 3.6%) were only shown in several cases of pulmonary mycosis. The most common underlying diseases were tumor (including solid tumor and malignant hematological diseases) (94/474, 19.8%), chronic obstructive pulmonary disease (52/474, 11.0%), pulmonary tuberculosis (50/474, 10.5%) and diabetes (48/474, 10.1%). Compared with the other common pulmonary mycosis, pulmonary cryptococcosis affected younger patients, and more cases were community-acquired, but fewer cases with underlining diseases or compromised immune function, and had a better prognosis.
The ahead five species of pulmonary mycosis in China were orderly pulmonary aspergillosis, pulmonary candidosis, pulmonary cryptococcosis, pneumocystis carinii pneumonia and pulmonary mucormycosis. The main pathogens of pulmonary candidosis were Candida albicans and Candida tropicalis, which were sensitive to common azoles. Compared with the other common pulmonary mycosis, pulmonary cryptococcosis catch younger patients, had more community-acquired cases, and had better prognosis.
Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases 02/2011; 34(2):86-90.
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Ping-hai Zhang,
Bi-jie Hu, Li-xian He,
Hua-yin Li,
Bao-qing Wang,
Xue-hua Chen,
Jue Pan,
Hong-ni Jiang,
Chun-mei Zhou,
Xiao-dong Gao,
Hong-mei Xie,
Sheng-lei Huang,
Wen-song Xia,
Li-li Tao,
Chun-xue Bai
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ABSTRACT: To further elucidate the CT characteristics and diagnostic approaches to non-acquired immune deficiency syndrome patients with pulmonary cryptococcosis.
The histories of forty-two pulmonary cryptococcosis (PC) patients diagnosed in Zhongshan Hospital from 2003-2008 were collected and analyzed for demography data, underlying conditions, clinical symptoms, chest CT and diagnostic studies.
None of the 42 PC patients had avian or its feces contacting history, and 71.4% (30/42) of them were immunocompetent. The most frequent CT lesions were multiple nodules (67.9%) with peripheral predominance (67.9%), and cavitations (50%) often presented within them. Masses/consolidation (31.4%) and patching lesions (2.9%) could exist occasionally. Positive detection rates of non-aggressive examinations including sputum, bronchoalveolar lavage fluid and bronchofibroscopy aspiration were 4.3%, 8.3% and 6.3% respectively, while those of aggressive approaches including transbronchial lung biopsy (TBLB), thin needle aspiration biopsy (TNAB) and pneumonectomy by surgery were 64.7%, 64.3% and 100% respectively. Non-aggressive serum cryptococcus antigen test was performed in 14 patients who had been diagnosed by histopathology or pathogen culture, and all of them were positive.
Our study suggests that PC is common in immunocompetent population. Avian or its feces contacting is not so important as used opinion to PC differential diagnosis. CT characteristics of PC are diversiform and always change very slowly. Besides the most frequent multiple nodules with subpleural predominance, pulmonary lesions can present as masses, consolidation or patching. Aggressive techniques such as TBLB and TNAB are benefit to clinical diagnosis of PC, and non-aggressive serum cryptococcus antigen test may be promising for its early diagnosis as well as clinical course follow-up and therapeutic effect evaluation.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 06/2009; 48(5):362-6.
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ABSTRACT: The aim of this study was to investigate endocytosis, MHC-II expression and co-stimulatory molecule expression, as well as interleukin-12 (IL-12) production, in bone marrow dendritic cells (DCs) derived from endotoxin tolerant mice.
Endotoxin tolerance was induced in C57BL/10J mice through four consecutive daily intraperitoneal injections of 1.0 mg/kg of 055:B5 Escherichia coli lipopolysaccharide (LPS). Bone marrow DCs were isolated in the presence of GM-CSF and IL-4 and purified by anti-CD11c Micro beads. FITC-dextran uptake by DCs was tested by flow cytometric analysis and the percentage of dextran-containing cells was calculated using a fluorescence microscope. The expression of surface MHC-II, CD40, CD80, and CD86 was also detected by flow cytometric analysis. An ELISA was used for the measurement of IL-12 production by DCs with or without LPS stimulation.
Endotoxin tolerance was successfully induced in C57BL/10J mice, evidenced by an attenuated elevation of systemic TNF-alpha. DCs from endotoxin tolerant mice possessed enhanced dextran endocytosis ability. The expression of surface MHC-II and CD80 was higher in DCs from endotoxin tolerant mice than in DCs from control mice, whereas the expression of CD40 and CD86 was not altered. Compared with DCs from normal control mice, DCs from endotoxin tolerant mice produced less IL-12 after subsequent in vitro stimulation with LPS.
These data suggest enhanced endocytosis, selective up-regulation of MHC-II and CD80 and IL-12 suppression in DCs during in vivo induction of endotoxin tolerance.
Acta Pharmacologica Sinica 05/2009; 30(5):582-8. · 1.95 Impact Factor
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ABSTRACT: Studying the proven and probable invasive pulmonary aspergillosis (IPA) cases of some hospitals in Shanghai to provide evidence for the improvement of IPA clinical diagnosis and therapy.
Forty-nine IPA cases were retrospectively analyzed for demography data, host factors, underlying conditions, chest CT, microorganism and histopathology examination, as well as therapy and clinical outcome.
Of 49 subjects including 19 (38.8%) proven and 30 (61.2%) probable IPA, 3 patients (6.1%) had no host factors, 25 patients (51.0%) had IPA associated host factors and underlying conditions, while 21 patients (42.9%) had uncertain fundamental diseases. Chest CT evaluation demonstrated that radiological lesions include nodules in 29 patients, patching in 15, mass in 12, consolidation in 10, cavitation in 34, Halo sign in 19, air bronchogram in 18, crescentic sign in 6, bilateral in 33 and multifocal lesions in 38. The yielding rate of fungus culture in sputum was 26.5% (13/49), and in bronchoalveolar lavage fluid was 66.7% (10/15). Eleven of thirty-six patients (30.6%) had positive results of serum galactomannan antigen tests. Nineteen of twenty-one patients (90.5%) were proven as IPA by lung histologic examinations. Aspergillus fumigatus was the most common pathogen 81.0% (17/21). The responding rate to initial anti-fungus therapy was 50% (21/42).
Our study suggests that in IPA patients, bilateral, multifocal and nodular lesion could be the most common radiological characteristic, while Halo and crescentic sign occur occasionally. Invasive technologies are more valuable to IPA diagnosis.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 01/2009; 47(12):1017-21.
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ABSTRACT: To determine if NOD2 is involved in host recognition of Aspergillus fumigatus (Af) conidia.
An Af conidia pulmonary infection murine model was established by intranasal inoculation of Af conidia suspensions. Protein levels of NOD2 in lung tissue were determined by immunohistochemistry. A549 and phorbol-12-myristate 13-acetate (PMA)-activated THP-1 cell lines were treated with heat-killed Af conidia, then the presence of NOD2 protein in these cell lines was detected by Western blotting. The ability of muramyl dipeptide (MDP) to induce the secretion of TNF-alpha after incubation with heatkilled Af conidia was measured by enzyme-linked immunosorbent assay.
The expression of NOD2 protein in lung tissue increased after Af conidia infection. Heat-killed Af conidia significantly upregulated NOD2 protein expression in A549 cells and PMA-activated THP-1 cells. Additionally, Af conidia in conjuction with MDP, significantly increased the secretion of TNF-alpha in A549 cells and PMA-activated THP-1 cells.
Af conidia upregulates NOD2 protein expression in vitro and in vivo. These findings indicate that NOD2 protein may respond to Af conidia.
Acta Pharmacologica Sinica 11/2008; 29(10):1202-8. · 1.95 Impact Factor
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ABSTRACT: The down-regulation of constitutive nitric oxide synthase (cNOS) and up-regulation of inducible nitric oxide synthase (iNOS) are associated with the allergen-provocated airway hyperresponsiveness (AHR). This study aimed to determine whether their alteration also plays an important role in the AHR induced by lipopolysaccharide (LPS).
Hartley male guinea pigs, weighing between 250 g and 350 g, were injected with LPS at a dose of 1 mg/kg every 24 hours for three days. A non-selective NOS inhibitor, N(omega)-nitro-L-arginine methyl ester (L-NAME), or a selective inducible NOS inhibitor, aminoguanidine (AG), were used thirty minutes before each injection of LPS. Airway reactions, nitric oxide (NO) production and inflammatory changes were detected 24 hours after the last dose of LPS.
AG significantly decreased the NO production in the bronchoalveolar lavage fluid (BALF) and sharply reduced the intensity of bronchoconstriction to histamine challenge. L-NAME also significantly decreased the NO production in the BALF, but had no effect on airway reactions or, perhaps, a tendency to enhance the intensity of AHR.
The data suggest that inducible NOS contributes to the AHR induced by repetitive intraperitoneal LPS, and constitutive NOS was also involved.
Chinese medical journal 10/2008; 121(17):1693-7. · 0.86 Impact Factor
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ABSTRACT: Aim: To determine if NOD2 is involved in host recognition of Aspergillus fumigatus (Af) conidia. Methods: An Af conidia pulmonary infection murine model was established by intranasal inoculation of Af onidia suspensions. Protein levels of NOD2 in lung tissue were determined by immunohistochemistry. A549 and phorbol-12-myristate 13-acetate (PMA)-activated THP-1 cell lines were treated with heat-killed Af conidia, then the presence of NOD2 protein in these cell lines was detected by Western blotting. The ability of muramyl dipeptide (MDP) to induce the secretion of TNF- after incubation with heat-killed Af conidia was measured by enzyme-linked immunosorbent assay. Results: The expression of NOD2 protein in lung tissue increased after Af conidia infection. Heat-killed Af conidia significantly upregulated NOD2 protein expression in A549 cells and PMA-activated THP-1 cells. Additionally, Af conidia in conjuction with MDP, significantly increased the secretion of TNF- in A549 cells and PMA-activated THP-1 cells. Conclusion:Af conidia upregulates NOD2 protein expression in vitro and in vivo. These findings indicate that NOD2 protein may respond to Af conidia.
Acta Pharmacologica Sinica 09/2008; 29(10):1202 - 1208. · 1.95 Impact Factor
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ABSTRACT: To study the role of microorganisms in the gastro-intestinal (GI) tract in the development of ventilator-associated pneumonia (VAP).
Forty-four healthy New Zealand white rabbits were randomly divided into a control group (n = 2), a mechanical ventilation (MV) group (n = 5), a mechanical ventilation with bacterial gastric inoculation (B) group (n = 11), a mechanical ventilation with bacterial gastric inoculation plus mosapride citrate (P) group (n = 13), and a mechanical ventilation with bacterial gastric inoculation plus loperamide (I) group (n = 13). 5% NaHCO3 was used to remain the pH value of gastric juices higher than 3.0. The flora in oropharynx, bronchi, and gastric juices were monitored during mechanical ventilation (MV). The pulmonary score and bacterial culture of the lung were performed at the end of mechanical ventilation.
The incidence of lung infection caused by gastric bacterial inoculation was 10.8% (4/37). Taken together, mosapride citrate and loperamide didn't alter the incidence of VAP (chi2 = 0.83, P > 0.05), however, the occurrence of lung infection caused by inoculated bacteria in P group was lower than that in I group [(0.0%, 0/13) vs (23.1%, 3/13), chi2 = 4.55, P < 0.05]; the time of the emergence of the gastric inoculated bacteria in oropharynx in P group was later than that in I group; and the pulmonary score of B group was higher than that of MV group.
Bacteria in the GI tract were not the main source of early-onset VAP, however, they may contribute to the development of late-onset VAP. Gastrointestinal dynamic promoting drugs, which enhance gastrointestinal motility, are useful to reduce the incidence of VAP caused by bacteria colonized in the digestive tract.
Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases 08/2008; 31(7):509-12.
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ABSTRACT: To investigate the incidence and the risk factors for hospital-acquired pneumonia (HAP) in the elderly in Shanghai.
This was a multicenter prospective clinical cohort study. A total of 5299 patients more than 65 years old, admitted into 31 secondary or tertiary hospitals in Shanghai, were enrolled. Measurements of the demographic and potential risk factors reflecting illness severity, nutrition, drug exposure, surgery and ventilation were performed. Pneumonia was classified by the definition of Chinese Medical Association. Risk factors were analyzed by univariate Pearson Chi-squared test and multivariable logistic regression analysis with backward (Likelihood ratio).
Of the enrolled patients, 2805 male and 2494 female, 255 (4.81%) developed hospital-acquired pneumonia. The incidence was 46.75/1000 hospitalizations. Among them 38 died; and the rough mortality was 14.90%. The incidence of HAP was higher in ICU (21.43%), hematology (12.17%), chest surgery (11.41%), and respiratory medicine (7.92%) departments. The mean of acute physiology and chronic health evaluation (APACHE II) score was 8.3 +/- 3.4 (5 - 31). Multivariable logistic regression analysis with backward (Wald) method found that admission into secondary hospitals, admission into ICU, history of chronic obstructive pulmonary disease > or = 10 years, immunosuppression, administration of antibiotics, insertion of nasogastric tube, mechanical ventilation, administration of H-2 antagonists or antacid and < or = 7 d, central nervous system diseases, depressed level of consciousness, supine position, albumin < 35 g/L were independent risk factors of HAP in the elderly.
Hospital-acquired pneumonia in the elderly was the usual type of nosocomial infections. The risk factors identified from this study may prove useful to target future clinical interventions to prevent HAP in the elderly.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 01/2008; 47(1):31-5.
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ABSTRACT: To assess the value of comprehensive prevention measures to ventilator-associated pneumonia (VAP) of patients more than 60 years old and to investigate the pathogenesis of VAP.
With a prospective, randomized, case-control design, patients more than 60 year of age with expected mechanical ventilation > 48 h were randomly assigned to a control group receiving a standard endotracheal tube or a comprehensive intervention group including semi-recumbent, mosapride citrate, and endotracheal tube for continuous subglottic secretions drainage. The duration of mechanical ventilation, length of ICU/hospital stay, the incidence, mortality, contributable mortality, relative risk as well as the bacterial concordance in gastric juice or lower respiratory tract between two groups were compared. The rates of methylene blue found in lower respiratory tract were also observed.
Eighty-six cases were enrolled in this trial, including 41 in the intervention group and 45 in the control group. The duration of mechanical ventilation, length of ICU/hospital stay in the intervention group were all less than the control group. However, no significant difference existed in mortality and attributable mortality. Same types of bacterial pathogens were found between gastric juice and lower respiratory tract of the VAP patient. The RR of the incidence of VAP in two groups was 0.259 (95% CI 0.106 - 0.634). The rate of the same bacterial type or methylene blue detected in lower respiratory tract/oropharynx under microscope in the intervention group were lower than the control group (P < 0.05).
The comprehensive prevention measures can reduce the incidences of VAP. The astro-pulmonary route is one of the pathogenesis of VAP.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 10/2006; 45(9):717-20.
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ABSTRACT: The number of immunosuppressed patients has increased in the past decades. Among them Pseudomonas aeruginosa (P. aeruginosa) is one of the leading bacteria for pneumonia that are associated with poor prognosis. However, the pathogenesis of P. aeruginosa pneumonia in immunosuppressed patients is not understood completely. Previous reports showed keratinocyte growth factor (KGF) is associated with lung injury in immunocompetent hosts. In this study, we investigated the different reactions of lung injury, lung pathology and KGF expressions in P. aeruginosa pneumonia between immunosuppressed and immunocompetent rats.
Immunosuppression of male rats was induced by injecting immunosuppressive subcutaneously. Pneumonia was established by instilling P. aeruginous tracheally. The immunocompetent rats were the control group. Survival rate, lung histopathology, pulmonary permeability and oedema, KGF mRNA and protein expressions in lungs of both groups were investigated.
The survival rate of immunosuppressed group was lower than that of immunocompetent group (33.3% vs 83.3%). After exposure to bacteria, pulmonary permeability and wet/dry ratio in immunosuppressed group were higher than those in immunocompetent group. Pulmonary congestion and haemorrhage were more intensive in immunosuppressed group compared to immunocompetent group. Apoptosis and necrosis were also observed in infected lungs of immunosuppressed rats. Although we detected KGF expressions in lungs of both groups after infection, the expressions of KGF protein and mRNA gene in immunosuppressed group were much lower than in immunocompetent group.
Compared with immunocompetent group, there was more intensive lung injury in immunosuppressed group. Severe lung injury may contribute to the poor prognosis of pneumonia. KGF expressions of pneumonia in immunosuppressed rats were less than those in immunocompetent ones.
Chinese medical journal 10/2006; 119(17):1421-9. · 0.86 Impact Factor
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ABSTRACT: To investigate the incidence, the risk factors and the outcome of nosocomial tracheobronchitis (NTB) in patients age over 65 years of age receiving mechanical ventilation (MV).
Using prospective cohort study to collect and analyse the clinical information of elderly patients who received mechanical ventilation in surgical intensive care unit (ICU) of Zhongshan Hospital, from November 2002 to July 2004. Patients with first episodes of NTB were compared with those without NTB by univariate analysis and logistic regression.
There were 35 elderly patients diagnosed as having NTB (53.0%). The differences in serum albumin, nasal feeding, the length of ICU stay, the duration of MV days, the acute physiology and chronic health evaluation II (APACHE II) score and the kinds of the antibiotic used between patients with NTB and without NTB were significant. The results of the univariate analysis showed that nasal feeding, low serum albumin, the duration of the MV>4 days, the length of ICU stay >9 days, the kinds of antibiotics used and the APACHE II score higher than 9 were the risk factors of NTB. However the logistic regression suggested that nasal feeding, MV days >4 days, nasal feeding and the kinds of the antibiotics used >2 are the independent risk factors of NTB.
There is high incidence of NTB in ventilated patients in surgical ICU. Low albumin level, nasal feeding, prolonged MV and ICU stay days, high APACH II score and administration of too much antibiotics are the important risk factors of NTB.
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 06/2006; 18(6):342-5.
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ABSTRACT: To study the pulmonary inflammatory reaction induced by N-protein of SARS-CoV in rat models and the effects of glucocorticoids on the inflammatory reaction.
The pulmonary inflammatory reaction in rat models were induced by intratracheal instillation of N-protein of SARS-CoV with a dose of 0.2 mg/kg. The rats were randomly divided into four groups: normal saline control group (Nc group), N-protein group 1 (P1 group, 6 h), N-protein group 2 (P2 group, 24 h), and N-protein + dexamethasone group (P + D group, dexamethasone 10 mg/kg intraperitoneally). The blood samples, bronchial alveolar lavage fluid (BALF) and lung tissue were collected after challenge. The cytological and histopathologic changes of lung tissues were observed and the wet/dry ratios (W/D) of lung tissue were determined. The interleukin (IL)-6, IL-10 and transforming growth factor-beta1 (TGF-beta1) of serum and BALF were measured by ELISA.
(1) Compared with the percentage of peripheral blood lymphocytes in Nc group [(68.42 +/- 13.07)%], that in P2 group [(50.50 +/- 14.36)%] was significantly decreased (P < 0.05); compared with Nc group and P2 group, that in P + D group was furthermore significantly decreased (P < 0.01). Compared with the total WBC of peripheral blood in Nc group [(5.86 +/- 2.25) x 10(9)] and P2 group [(4.83 +/- 1.49) x 10(9)], that in P + D group [(1.96 +/- 1.30) x 10(9)] was significantly decreased (P < 0.01). (2) Compared with the total WBC of BALF in Nc group [(95 +/- 29) x 10(7)], that in P2 group [(160 +/- 60) x 10(7)] was significantly increased (P < 0.05); but compared with P2 group, that in P + D group [(62 +/- 23) x 10(7)] was significantly decreased (P < 0.05). Analysis of BALF differential cell counts showed that the majority of cells were alveolar macrophages in all groups. (3) The W/D ratios of lung tissue in both P1 and P2 group [(5.18 +/- 0.29) and (5.19 +/- 0.34), respectively] after N-protein challenge were significantly increased than that in Nc groups [(4.77 +/- 0.27), P < 0.05]; the W/D ratio in P + D group (4.70 +/- 0.18) was significantly decreased than that in P2 group (P < 0.01). (4) Compared with Nc group, the levels of IL-6, IL-10, TGF-beta1 in both serum and BALF of P1 group were significantly increased (P < 0.01), and the levels of these cytokines in P2 group were significantly higher than those in P1 group (P < 0.01), but significantly lower in P + D group compared with P2 group (P < 0.01).
The N-protein of SARS-CoV had pathogenicity and could induce obvious pulmonary inflammatory reaction and acute lung injury, which were related to the increase and imbalance of pro-inflammatory and anti-inflammatory cytokines. Glucocorticoids could effectively alleviate the pulmonary inflammatory reaction induced by N-protein of SARS-CoV.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 01/2006; 44(12):890-3.
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ABSTRACT: To evaluate the efficacy and safety of Teicoplanin (TEC) in the treatment of Chinese patients with moderate and severe Gram positive (G(+)) coccus infections.
A prospective, multicenter, non-comparator control, open-label drug clinical trial of phase IV was conducted.
Totally 156 cases with established and highly suspected G(+) coccus infections are enrolled. Mean age was 53.6 +/- 20.9 (9-93). The infections included: lower respiratory tract infections (66.0%), sepsis (9.0%), catheters-associated infections (5.1%), endocarditis (1.9%), leucopenia with fever (14.1%), bone-joint infections (1.3%), skin-soft tissue infections (7.7%), and other infections (10.9%). Eighty seven point eight percent of the patients suffered from severe underlying diseases, 28.2% (44/156) had immunocompromised conditions. 69.2% had received antibiotics previously (57.4% with cephalosporins and 28.7% with carbapenem, respectively). One hundred and thirty strains of G(+) cocci were isolated from 123 patients (78.8%). Among them methicillin-resistant Staphylococcus aureus (MRSA) accounted for 90.7% (49/54) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) 88.2% (30/34). The TEC susceptibility test for 105 strains showed that all of the Staphylococci and Enterococci were susceptible. In 121 strains tested for vancomycin, all of the Staphylococci but only 78.3% (18/23) of the Enterococci were susceptible. There were 18 strains of Gram negative bacilli and 1 strain of Candida A. isolated concomitantly with G(+) cocci from 17 cases. The total clinical effectiveness was 82.1% by ITT (156 cases) analysis and 85.2% by PP (135 cases) analysis, respectively. Bacteriologic eradication rate was 87.7%. Thirty three patients with negative culture result were empirically treated with TEC and had 96.8% of clinical effectiveness. The efficacy of TEC to different infections was similar. The total adverse effects, such as decrease in blood cells and transient abnormal liver functions, accounted only for 1.28%.
Teicoplanin was a very effective antibiotic for G(+) coccus infections and safe for patients. In highly suspected infections with methicillin-resistant Staphylococci or Enterococci, TEC may be a choice for initial empirical treatment.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 06/2005; 44(5):337-41.
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ABSTRACT: To evaluate the therapeutic role of antioxidant intervention in granulocytopenia rats with pseudomonas aeruginosa pneumonia.
90 male Sprague-Dawley rats were randomly divided into two groups. Group A: the control granulocytopenia group, in which the granulocytopenia was induced by using cyclophosphamide and cortisone acetate. Group B: the antioxidant intervention group, in which the granulocytopenia model was the same as group A, while peritoneal injection of NAC 150 mg.kg(-1).d(-1) half an hour after the immunocompromised model was reproduced, and the injection was continued for a consecutive 7 days, and NAC was injected once more half an hour before bacterial tracheal inoculation. The model of pulmonary infection was established by using standard a strain of pseudomonas aeruginosa. The time-course of the following was observed 0 h before bacterial inoculation, and 6 h, 9 h, 24 h, 48 h and 72 h after infection: the peripheral white blood cells, mortality, oxidant/antioxidant indexes, bacterial burden of lung tissue homogenate, pulmonary vascular permeability and lung wet/dry weight ratio, and the pulmonary histopathological changes.
The peripheral white blood cells of both groups were less than 4 x 10(9)/L. The concentration of superoxide dismutase in both serum and lung tissue in group B were higher than that in group A, while concentration of malondialdehyde in group B was lower than that in group A. Pulmonary vascular permeability and lung wet/dry ratio of group B were much lower than that of group A. There was no difference in bacterial burden of lung tissue between the two groups. Group B showed a lower mortality than group A (16.3% vs 23.4%). Lung histopathological observation showed that lung injury, pulmonary congestion and hemorrhage were more serious or obvious in group A as compared with group B. Apoptotic bodies were found in the lung epithelial cells of Group A.
Antioxidant intervention can alleviate lung injury in the granulocytopenia rats with pseudomonas aeruginosa pneumonia. It may become an important subsidiary approach to pneumonia in granulocytopenia patients.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 12/2004; 43(11):853-6.
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ABSTRACT: To investigate the role of dendritic cells (DCs) in host defense against aspergillus, and how corticosteroids hydrocortisone (HC) affects host anti-aspergillus immunity at the DCs level.
Mouse bone marrow-derived DCs were generated ex vivo and the uptake of inactivated Aspergillus fumigatus conidia (iAfc) by DCs was assayed using McFarland standard. Cytokine production by DCs or by splenic T cells were measured using ELISA method.
DCs were capable of ingesting iAfc efficiently. HC significantly inhibited the capacity of DCs to phagocytose iAfc. After stimulated with iAfc in vitro, DCs secreted IL-12 and IFN-gamma, but did not secret IL-10. 10(-5) mol/L HC down-regulated IL-12 and IFN-gamma production by DCs, but it didn't affect IL-10 production. After the mice were inoculated with iAfc-pulsed DCs, their splenic T cells secreted IFN-gamma upon the re-stimulation with iAfc in vitro. In contrast, after the mice were inoculated with iAfc-HC-pulsed DCs, the splenic T cells showed significantly decreased IFN-gamma secretion upon the same stimulation, but the secretion of IL-10 was increased.
DCs might act as effector cells in host defense against aspergillus, and initiate anti-aspergillus Th1 type immunity. HC inhibited the above functions of DCs and skew the immunity response towards Th2 type. iAfc-pulsed DCs might be useful for promoting the anti-aspergillus immunity of immunocompromised host.
Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases 08/2004; 27(7):449-54.
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ABSTRACT: To study the risk factors of ventilator-associated pneumonia (VAP) in intensive care unit (ICU), in order to offer basic epidemiological data for the prevention of VAP in ICU.
A prospective cohort study on VAP was carried out in intubated or tracheotomied patients in ICU of Fudan University Zhongshan Hospital from Dec.1999 to Feb. 2001. Single factor analysis and muti-variable logistic regression analysis were adopted to identify the possible risk factors of VAP.
(1) Ninety-eight patients were enrolled in this study, of which 52 were diagnosed as having VAP. The incidence of VAP was 53.1%. The incidence of VAP was 32.4 cases per 1000 intubation days. (2) Single factor analysis showed that history of chronic obstructive pulmonary emphysema, use of H2-receptor blocker, the days of antibiotic use, the types of antibiotics, enteral feeding, APACHEII scores, the duration of mechanic ventilation, pH of gastric juice, hypoalbuminemia, tracheotomy, reintubation, colonization of gram negative bacilli in oropharynx, and conscious disturbance were related to the occurrence of VAP. (3) Multi-variable logistic analysis showed statistical significance in combination of over two types of antibiotics (OR = 7.59, 95% CI 4.31 - 38.29), reintubation (OR = 4.73, 95% CI 2.33 - 11.67), APACHE II scores over 15 (OR = 2.02, 95% CI 1.59 - 26.74), pH of gastric juice over 4 (OR = 1.23, 95% CI 1.02 - 1.54) and prolongation of mechanic ventilation (OR = 1.15, 95% CI 1.01 - 3.75).
Various factors contributed to VAP in ICU. Further clinical trials are needed for evidence of the above-mentioned possible risk factors.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 06/2004; 43(5):325-8.
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ABSTRACT: To investigate the risk factors for gastric bacterial colonization and its role in the endogenous pathogenesis of ventilator-associated pneumonia (VAP).
The type and concentration of gastric colonized bacteria and its relationship with the time when samples were collected, and with the type and occurrence order of the pathogens detected in samples from lower respiratory tract after the onset of VAP were analyzed dynamically in the patients with tracheal-intubation or tracheotomy in intensive care unit (ICU).
(1) The isolation rate of colonized bacteria in gastric cavity was associated with the pH of gastric juice. When the pH of gastric juice was > 4, the isolation rate of Gram-negative bacilli (GNB) in gastric cavity markedly increased, achieving 52.5% in VAP group, and the incidence of VAP was higher (P = 0.017). The pH value of gastric juice was positively correlated with the logarithmic concentration of GNB in gastric cavity (P = 0.001). (2) As the duration of intubation prolonged, the isolation rate of enterobacteriaceae in VAP group increased, which was 45.2% on the fifth day of intubation. In contrast, the isolation rate in non-VAP group was 11.1% (P < 0.01). (3) The colonization of enterobacteriaceae in gastric cavity was 1 - 2 days earlier than that in oropharynx. The order was statistically significant (P = 0.015). (4) The reverse order of stomach-pharynx-lower respiratory tract colonization was found in 12 cases of the total 52 VAP patients and the order of stomach to lower respiratory tract colonization was found in 3 cases.
(1) The pH value of gastric juice proved to be the major factor which influenced the colonization of bacteria especially GNB in gastric cavity. (2) The gastric cavity was probably a colonization place of GNB especially enterobacteriaceae. (3) The enterobateriaceae in gastric cavity tended to colonize reversely to oropharynx. (4) The phenotypic analysis of the pathogens showed that the reverse stomach-pharynx-lower respiratory tract infection route existed in VAP patients.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 02/2004; 43(2):112-6.
