加替沙星治疗社区获得性下呼吸道感染60例临床观察

我科自2003年1月以来应用加替沙星治疗下呼吸道感染，取得较好疗效，现报告如下： 1资料与方法 1．1临床资料 选择我科下呼吸道感染住院病人60例，男40例，女20例，年龄19～86岁，平均52．5岁。其中COPD合并感染16例，社区获得性肺炎12例，支气管扩张并感染10例，肺癌并阻塞性肺炎8例，肺癌化疗后感染6例，肺脓肿10例。全部病例均有咳嗽、咳痰，发热36例，肺部实性罗音32例，胸部DR片示节段性实变22例，支气管肺炎型改变8例，囊腔内液平10例，     

呼吸道感染患者病原学调查分析

目的了解冬春季节医院呼吸道感染患者的病原体感染情况,为制定预防措施提供依据。方法选取2011年10月-2012年3月医院就诊的1 568例呼吸道急性感染患者,取其静脉血,用间接免疫荧光法(IFA)对其进行9种呼吸道病原体IgM抗体的检测,包括嗜肺军团菌血清1型(LP1)、肺炎支原体(MP)、Q热立克次体(COX)、肺炎衣原体(CPN)、腺病毒(ADV)、呼吸道合胞病毒(RSV)、甲型流感病毒(INFA)、乙型流感病毒(INFB)、副流感病毒(PIV),并对检测标本阳性的病例进行统计分析。结果 1 568份标本中9种病原体IgM抗体阳性共678例,阳性率为43.24%;病原体IgM阳性率由高到低排序依次为MP、LP1、INFB、RSV、ADV、CPN、COX、INFA、PIV,阳性率分别为13.20%、11.93%、8.74%、4.40%、1.98%、1.02%、0.83%、0.57%、0.57%;男性阳性率为25.08%,女性阳性率为37.79%,经χ2检验,两者阳性率比较,差异有统计学意义(P<0.05);不同年龄层次呼吸道病原体感染率不同,其中11¹8岁患儿病原体感染的阳性率最高为57.89%,4118岁患儿病原体感染的阳性率最高为57.89%,41⁵0岁其次,为42.37%。结论冬春季呼吸道感染患者中以感染肺炎支原体为主,嗜肺军团菌次之;不同性别在呼吸道病原体的总阳性率上表现出显著性差异,女性明显高于男性;1150岁其次,为42.37%。结论冬春季呼吸道感染患者中以感染肺炎支原体为主,嗜肺军团菌次之;不同性别在呼吸道病原体的总阳性率上表现出显著性差异,女性明显高于男性;11¹8岁学生集中在一起,易引起呼吸道病原体的传播。     

成人社会获得性呼吸道腺病毒感染临床描述性研究

目的　描述成人腺病毒 (ADV) 3型 (ADV3)、7型 (ADV7)和 11型 (ADV11)感染的规律和特点。方法　对 80 4例成人急性呼吸道感染和 15 6名同期平行健康对照采用酶联免疫吸附试验测定血清ADV3、ADV7、ADV11特异性IgM抗体。结果　 (1) 80 4例中 ,9.7%ADV3-IgM、6 .6 %ADV7-IgM、4.6 %ADV11-IgM、和 16 .0 %ADV3、ADV7和 /或ADV11-IgM阳性 ;(2 ) 13 .1%社会获得性肺炎、12 .5 %COPD急性加重、2 1.2 %哮喘急性发作、33 .3%支气管扩张、18.4%肺部感染、2 4.3%败血症、2 0 .0 %急性支气管炎、5 7.1%肾移植后病人血清ADV3、ADV7和 /或ADV11-IgM阳性 ;(3) 9.4%慢性肺心病ADV3-IgM阳性 ;15 .5 %哮喘、2 5 .9%支气管扩张ADV3-IgM阳性 ;11.1%支气管扩张ADV11-IgM阳性 ;7.4%COPD、11.1%支气管扩张ADV7-IgM阳性 ;(4)ADV3-IgM阳性 78例中 ,≤46岁组多数无基础疾病 ,>46岁各组病人 ,5 0 %～ 90 %有基础疾病 ;而ADV7、ADV11也有相似的分布 ;(5 )ADV3、ADV7和ADV11-IgM阳性多见于秋季、冬季和春季。结论 (1)ADV3、ADV7、ADV11是成人社会获得性呼吸道感染中重要的致病原 ;(2 )部分气流限制性疾病急性加重与ADV3、ADV7、ADV11感染有关 ;(3)ADV3、ADV7、ADV11感染与基础疾病和年龄有关 ;(4)ADV3、ADV7、ADV11感染在秋冬春季高发     

多中心ICU获得性下呼吸道感染监测报告

目的了解重症监护室(ICU)获得性下呼吸道感染情况及病原体分布特点,为采取预防控制措施和科学诊治患者提供依据。方法采用回顾性调查,收集某省32所医院ICU2013年全年医院感染目标性监测资料。结果 32所医院,ICU获得性下呼吸道感染发病率为5.79%,呼吸机使用率为31.25%,呼吸机相关性肺炎(VAP)发病率为26.93‰;呼吸机使用率与VAP发病率相关性分析(r=0.160,P=0.380),差异无统计学意义,两者无直线相关关系。共检出阳性菌株1 593株,其中以革兰阴性菌居多(1 207株,占75.77%),其次为革兰阳性菌(290株,占18.21%),真菌(94株,占5.90%),肺炎支原体和其他病原体(各1株,占0.12%)。下呼吸道感染病原体居前5位的分别是鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌、大肠埃希菌,分别占25.49%、15.26%、14.63%、13.37%和5.09%。结论 ICU目标性监测有助于了解医院获得性下呼吸道感染情况,各医院应针对本单位的监测结果 ,积极查找原因,并加强ICU医院感染控制标准规范的学习,开展目标性监测,提高ICU医务人员对VAP感染预防措施的认知程度与措施执行力。     

浙南地区呼吸道感染患儿非典型肺炎病原体感染的流行病学分析

目的研究浙南地区呼吸道感染儿童的流行病学情况。方法采用酶联免疫吸附法(ELISA)检测温州医科大学附属儿童医院上、下呼吸道感染的7 716例患儿,进行3种非典型呼吸道病原体的检测分析,具体为肺炎支原体(MP),肺炎衣原体(CP),嗜肺军团菌(LP)。结果 7 716例呼吸道感染患儿中存在的病原体抗体分别是肺炎支原体抗体3 545例(45.94%)、肺炎衣原体抗体1 545例(20.02%)、嗜肺军团菌抗体612例(7.93%)。肺炎三联总阳性率为73.89%,男性阳性率为74.57%(3 472/4 656),女性阳性率为72.88%(2 230/3 060),两者阳性比较差异有统计学意义(χ2=64.07,P0.01)。结论肺炎支原体、肺炎衣原体、嗜肺军团菌是浙南地区儿童非典型病原体感染的主要病原体,其中混合感染以肺炎支原体和肺炎衣原体感染为主,其分布特点具有年龄差异,应高度重视、科学诊疗。     

5种呼吸道病原体IgM抗体检测对呼吸道感染的诊断价值

目的探讨呼吸道病原体谱IgM抗体检测对呼吸道感染的诊断价值。方法回顾性分析2018年2月—2020年2月苏州市中西医结合医院收治的1 431例呼吸道感染患者的病历资料,用间接免疫荧光法检测肺炎支原体、肺炎衣原体、呼吸道合胞病毒、腺病毒、柯萨奇病毒B组共5种病原体的IgM。结果 1 431例呼吸道感染者中有490例检出呼吸道病原体IgM,总阳性率为34.24%。其中肺炎支原体IgM阳性率最高,为17.82%。IgM阳性样本中单一感染占69.39%,混合感染占30.61%。不同年龄段患者的肺炎支原体和腺病毒IgM阳性率差异有统计学意义(P0.05),18岁以下患者阳性率高于其他年龄组(P0.05);不同季节肺炎支原体和腺病毒IgM阳性率差异有统计学意义(P0.05)。结论引起呼吸道感染的病原体以肺炎支原体为主,检测5种呼吸道病原体IgM能区分不同病原体感染,为临床诊治提供依据。     

深圳儿童急性下呼吸道感染病原学监测

【目的】监测两年深圳地区儿童急性下呼吸道感染的病毒等病原分布情况及临床流行特点。【方法】2003年12月~2005年11月该地区确诊为急性下呼吸道感染的5 651例患儿,取静脉血用ELISA法同时检测5种呼吸道病毒及肺炎支原体、肺炎衣原体的特异性IgM。【结果】病原检测阳性者2 884例,总阳性率51.0%,其中混合感染1 061例,占18.8%,各病毒病原的检出率依次为流感病毒B(IFVB)927例(16.4%),腺病毒(ADV)291例(5.1%),呼吸道合胞病毒(RSV)253例(4.5%),副流感病毒(PIV)241例(4.3%),流感病毒A(IFVA)19例(0.3%);肺炎支原体(MP)2 440例(43.2%),肺炎衣原体(CP)33例(0.6%)。所有受检者中MP阳性者最多,达43.2%,3岁以上年龄段高达67.7%。2004年10月~2005年9月出现MP流行高峰,MP阳性者占受检者的40%以上胸片上表现为大叶性或节段性肺炎141例。毛细支气管炎中RSV的检出率7.6%。【结论】肺炎支原体可能是近年来深圳地区儿童急性下呼吸道感染的最常见病原,2004~2005年在深圳市儿童中出现一次流行,临床表现多样;病毒以IFVB最为多见,流行不明显,在每年高温季节(5~8月)检出率较高。     

病毒性下呼吸道感染

病毒性下呼吸道感染苏州医学院附属第二医院（２１５００４）胡华成祁丹青呼吸道的病毒感染十分常见，约占急性呼吸道感染的９０％，但主要以上呼吸道感染为主。病毒的下呼吸道感染（即病毒性肺炎）近年来的发病率也有增高的趋势，据病原学的研究表明，它约占社会获得性肺...     

儿童急性呼吸道感染标准病例管理

急性呼吸道感染是儿童时期的常见病 ,其中肺炎是发展中国家 5岁以下儿童死亡的第一位原因。据世界卫生组织统计 ,全世界每年约有 4 0 0万婴幼儿死于肺炎。我国每年约有 30万左右 5岁以下儿童死于肺炎 ,占西太平洋地区 5岁以下儿童肺炎死亡总数的 2 /3。 1990、1991年 30 0个妇幼卫生项目县和 2 7个儿童急性呼吸道感染监测县的基础调查表明 ,肺炎是婴幼儿死亡的第一位原因 ,占全部婴儿死亡率的 2 3.9% ,且其中约 80 %左右的婴儿死于家中或转院途中 ,因此早期诊断和治疗肺炎是降低婴幼儿死亡率的关键。世界卫生组织自 80年代以来即组织包括中…     

小儿急性呼吸道感染的预防与治疗

急性呼吸道感染 (ARI)是儿科的常见病与多发病[1] 。据统计 ,肺炎是全世界范围内 5岁以下儿童死亡的主要原因。在我国每年约有 3 0万 5岁以下儿童死于肺炎。每天约有 80 0～ 90 0名儿童死于肺炎。因此 ,加强对ARI的预防、进行合理有效的治疗是降低 5岁以下儿童死亡率有效途径。1　ARI的病因ARI是由多种致病微生物所引起。其中病毒所致者占 90 %以上 ,经病毒感染后 ,可继发细菌感染。再加上婴幼儿时期由于上呼吸道的解剖特点易患呼吸感染 ;此外 ,营养不良、维生素D缺乏性佝偻病、护理不同、环境因素等均可诱发此病。2　ARI的分类2 1…     

Definition of low respiratory tract infections

Lower respiratory tract infection is easily suggested on clinical signs (cough and sputum) associated with fever. To discriminate between pneumonia and acute bronchitis is crucial because of the mortality associated with pneumonia and of its specific management. Chest X-ray is a key exam for the diagnosis and should be performed on the basis of validated clinical signs that are however of weak diagnostic value. Clinical as well as radiological signs cannot be reliably used to identify the causative germ. Sputum examination, the search for pneumococcal and legionella urinary antigens are of good diagnostic value. An associated COPD may lead to an acute respiratory failure. Acute exacerbation of chronic bronchitis results from various causes but infection is involved in about 50% of the cases, mostly viral and most often due to a rhinovirus. Viral infection can be associated to bacterial infection and the most frequently isolated germs are Streptococcus pneumoniae, Haemophilus influenzae, and B. catarrhalis. Severity assessment relies on the value of basal FEV1 that is often non available. Therefore Afssaps suggests using a dyspnea index to assess exacerbation severity.     

Lower respiratory tract infections in adolescents

Lower respiratory tract infections are an important cause of morbidity and occasional mortality in adolescents. This article reviews lower respiratory tract infections by anatomic location. Laryngotracheitis, tracheitis, bronchitis, pneumonia, and parapneumonic effusions are discussed. Specific viral, bacterial, mycoplasmal, and chlamydial etiologies are discussed. The epidemiology and clinical manifestations of lower respiratory tract infections in adolescents are presented according to anatomic site. Treatment for the spectrum of lower respiratory tract infections is also reviewed. Treatment options include supportive care, humidification, corticosteroids, antivirals, antibiotics, and appropriate drainage. Appropriate drainage of parapneumonic effusions includes thoracentesis, closed-tube thoracostomy, and surgery (thoracoscopy or thoracotomy). Imaging modalities include conventional radiography, computed tomography, and ultrasonography. Emphasis is placed on the common lower respiratory tract infections that affect the normal adolescent population.     

Immunity and pathophysiology of respiratory tract infections

The respiratory tract is permanently exposed to infections that may remain localized (bronchitis, pneumonias) or become potentially invasive (bacteremia and meningitis). It can be considered as an immunologic organ the upper part of which, the tracheobronchial tree, has the same secretory epithelium as the naso-oropharynx and shares bronchial associated lymphoid tissue (BALT). In this tissue, secretory IgA are more abundant than IgG. It is colonized by a commensal bacterial flora, including some potentially pathogenic species (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis). The pulmonary compartment includes the bronchioles and the alveoli, the wall of which is made of pneumocytes, resident macrophages, plasmocytoid dendritic cells and T cells. This wall is protected by a film that contains microbicidal agents, such as surfactant and phospholipase A2. Immune defenses of the respiratory tract involve mechanical factors, mucociliary escalator, receptor and effector molecules of the innate immune system and, by the proximity of lymph and blood vessels, humoral and cellular effectors of adaptative immunity. However, this sophisticated respiratory tract immune system can be bypassed in the non immunized host by infections due to primary pathogens (tuberculosis, plague, whooping cough, influenza) and may be impaired by endogenous factors (genetic defects, iatrogenic disorders) or exogenous factors (chemical pollutants, respiratory viruses) making the host susceptible to occasional pathogens, including commensal organisms.     

Microbial interactions during upper respiratory tract infections

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus often colonize the nasopharynx. Children are susceptible to bacterial infections during or soon after upper respiratory tract infection (URI). We describe colonization with these 4 bacteria species alone or in combination during URI. Data were from a prospective cohort of healthy children 6 to 36 months of age followed up for 1 year. Analyses of 968 swabs from 212 children indicated that S. pneumoniae colonization is negatively associated with colonization by H. influenzae. Competitive interactions shifted when H. influenzae and M. catarrhalis colonized together. In this situation, the likelihood of colonization with all 3 species is higher. Negative associations were identified between S. pneumoniae and S. aureus and between H. influenzae and S. aureus. Polymicrobial interactions differed by number and species of bacteria present. Antimicrobial therapy and vaccination strategies targeting specific bacterial species may alter the flora in unforeseen ways.     

Branhamella catarrhalis and respiratory tract infections.

Branhamella catarrhalis, a Gram negative diplococci, is gaining increasing recognition as a respiratory pathogen. In this study 40 sputum samples were collected from patients with acute or chronic lower respiratory tract infections and 15 samples from healthy controls. Each sample was examined for the isolation and identification of B. catarrhalis and other respiratory pathogens. From the control group 3 strains of B. catarrhalis were encountered: two of these were of low number in the collected sample and the third was found in a sample containing low number of leukocytes and more than 10 BSE cells/HPF which indicate that the sample was just saliva. From the cases of this study B. catarrhalis was isolated from 7 sputum samples. It was of the same frequency of isolation as the other known respiratory pathogens, more in old age, smokers and ex-smokers and all the strains were in mixed infections. B. catarrhalis isolated in this study were susceptible to cephalosporin regardless of the production of Beta-lactamase.     

RICU患者下呼吸道感染的病原菌分析

目的探讨呼吸科重症监护病房(RICU)与普通病房下呼吸道感染的病原菌分布,并对比两个病房病原菌的耐药性,为临床合理应用抗菌药物提供参考。方法对呼吸科普通病房和RICU收治的364例下呼吸道感染的患者进行痰液培养,采用琼脂扩散法进行病原菌药敏试验,对比两个病房的病原菌分布及耐药性。结果普通病房共分离出病原菌451株,其中革兰阴性菌274株占60.75%,革兰阳性菌90株占19.96%,RICU共分离出病原菌278株,其中革兰阴性菌210株占75.54%,革兰阳性菌35株占12.59%,两个病房中均以革兰阴性菌感染为主,排前3位依次为铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌;铜绿假单胞菌和肺炎克雷伯菌对亚胺培南、舒巴坦、阿米卡星较敏感,耐药率<50.0%,RICU铜绿假单胞菌的耐药率明显较高。结论与普通病房相比,RICU中病原菌分布及耐药性均较高,革兰阴性菌是感染的主要致病菌,临床上应根据病原菌分布及其耐药性合理使用抗菌药物。