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.     

上呼吸道感染引发小儿急性外耳道炎的临床研究

目的 研究上呼吸道感染引发小儿急性外耳道炎的临床治疗效果,从而找到有效的治疗方案.方法 随机选择80例上呼吸道感染引发小儿急性外耳道炎患儿,按照不同的治疗方法分为观察组和对照组进行研究,每组各40例;观察组采用炎琥宁注射液治疗,对照组采用阿奇霉素注射液治疗,观察比较两组患者的疗效.结果 观察组的总有效率达95.0％,高于对照组的77.5％,治疗后患儿体温观察组为37.1℃,对照组为37.75℃,观察组的疗效比对照组有明显提高,差异有统计学意义(P＜0.05);在治疗后的3d,观察组退热率为85.0％明显好于对照组的52.5％,两组比较差异有统计学意义(P＜0.05).结论 及时采用炎琥宁注射液治疗上呼吸道感染引发的小儿急性外耳道炎有很好的疗效,值得临床推广.     

Antibiotic use in upper respiratory tract infections in New Zealand

Upper respiratory tract infections (URTIs) are a common reasonfor presentation to general practitioners. The current studyused computerised consultation records of 100 222 patients from17 general practices in New Zealand for the 12-month period1 July 1991–30 June 1992. URTIs were noted in 8.9% ofall consultations: 44.1% of cases were children aged less than10 years. Females presented more frequently than males for allages above five years. Fifteen different antibiotics were prescribedfor URTIs, but in 22.5% of cases no antibiotic was prescribed.There was no statistically significant difference in the likelihoodof a successful outcome with or without antibiotic therapy (²= 0.76, P > 0.05). The treatment failure profile of someantibiotics highlights the need for more prescriber education,especially as the range of medications available for generalpractitioner prescribing increases.     

Clinical judgment predicts culture results in upper respiratory tract infections

BACKGROUND: We wanted to describe the natural history, familial transmission, microbiology, and accuracy of clinical judgment of potential pathogens of respiratory tract infections in a community family practice. METHODS: The study was a prospective case series in which consecutive patients requesting treatment for respiratory tract infections were evaluated after nurse triage during 3 fall-spring months in a solo family practice in suburban Cleveland, Ohio. According to the physician's usual practice, patients were classified into high-, medium-, and low-risk groups for bacterial illness based on their clinical signs and symptoms. Cultures were performed and sensitivities were determined for pathogens from the infected throat, nasopharynx, conjunctiva, or other sites. Patient symptoms and well-being were scored at the initial visit and at 3, 7 and 14 days later. RESULTS: There were 111 illness episodes in 86 patients; 94% had cultures taken, of which 38% grew a potentially pathogenic bacteria, most commonly group A streptococci, Branhamella catarrhalis or Staphylococcus aureus. The physician's judgment of bacterial infection was associated (P < .001) with having a positive culture (sensitivity 53%, specificity 78%, positive and negative predictive values 60% and 73%, respectively). A positive culture was associated with 2 of 16 signs or symptoms: purulent discharge from any site or a red swollen eye. There was no association of treatment status with clinical outcomes during 2 weeks of follow-up observation. CONCLUSION: Infection with a potentially pathogenic bacteria is difficult to determine solely by clinical signs and symptoms, but clinical judgment is associated with positive culture results. The effect of selective treatment of upper respiratory tract infection based on clinical signs and symptoms and patient and family culture results remains to be determined, but using clinical judgment could result in more selective antibiotic use than found in current practice patterns.     

How family physicians distinguish acute sinusitis from upper respiratory tract infections: a retrospective analysis

BACKGROUND: The purpose of our study was to examine how physicians diagnose sinusitis in practice. We addressed three specific questions: (1) what clinical factors do physicians look for in evaluating and caring for patients with suspected sinusitis, (2) to what extent do physicians use transillumination and radiograph evaluations in diagnosing sinusitis, and (3) how does the diagnosis of sinusitis influence the decision to prescribe antibiotic therapy? METHODS: We conducted a retrospective review using charts from 25 local family physicians who volunteered to participate in the study. After selecting a random sample of charts of adult patients treated for sinusitis and for upper respiratory tract infection (URI) by each physician, we reviewed the charts to determine the nature of the information collected to differentiate between sinusitis and URI. RESULTS: Rhinorrhea, sinus tenderness, visualization of purulent secretions, and a history of sinusitis were significant predictors of the diagnosis of sinusitis. Antibiotics were prescribed for 98.4% of patients with sinusitis and 13.1% of patients with URI. CONCLUSIONS: This sample of physicians based the diagnosis of sinusitis on three prominent clinical findings, which were also significant factors in diagnosing sinusitis in previous studies. The history of sinusitis might influence patient and physician expectations for the diagnosis.     

社会获得性呼吸道感染社会获得性呼吸道感染病原学变迁

1　社会获得性呼吸道感染 (CAP)病原的变迁我在 1 95 0年任住院医生时 ,新入院的呼吸道感染病人的 2 5 %为典型肺炎 ,即胸片示大叶性肺炎 ,当时基本上均为肺炎双球菌肺炎 (即目前的肺炎链球菌肺炎 ) ,约 1 5 %为化脓性肺炎或肺脓肿 ,大多为金黄色葡萄球菌 (金葡菌 )引起 ,约 3 5 %为各类型的肺结核 ,约 1 5 %为非典型肺炎即胸片示肺内未构成叶、段实变的小片阴影 ,多由病毒、支原体、衣原体等引起 ,还有约 1 0 %为寄生虫引起 ,包括阿米巴肝脓肿并胸腔感染、肺脓肿 ,胸片示肺多发性结节状病变 ,有疫水接触史的血吸虫 ,咳果酱痰 ,有到过疫区…     

Persistence of upper respiratory tract infections in a cohort followed from childhood to adulthood

OBJECTIVE: To assess (1) prevalences of recurrent URTIs (rURTIs) and relapsing/persistent rURTIs and associated medical consumption between 0 and 21 years of age and (2) whether rURTIs experienced in early life predispose to upper airway disease later in life. METHODS: A cohort of all children born in Nijmegen, The Netherlands, between September 1982 and September 1983, was assessed repeatedly from 2 to 21 years of age with questionnaires regarding infections of the upper respiratory tract (URTIs), use of antibiotics, ENT operations and known risk factors for URTIs. RESULTS: One hundred and sixty-one of the 693 cohort member (23%) suffered from relapsing rURTIs between 0 and 21 years of age, whereas only 7 (1%) suffered from persistent rURTIs throughout this period. Two hundred and six (30%) had used antibiotics more than once; and 220 (32%) had undergone at least one ENT operation. Of the 166 participants with rURTI between 8 and 21 years, 140 (84%) had had rURTI before. CONCLUSIONS: rURTIs are highly prevalent throughout early life and associated medical consumption is substantial. The challenge therefore is to develop therapeutic/preventive strategies that will prevent rURTIs in the first years of life.     

Echinacea purpurea is ineffective for upper respiratory tract infections in children

QuestionHow safe and effective is Echinacea purpurea at reducing the duration and severity of upper respiratory tract infections in children?Study designMulticentre randomised controlled trial.Main resultsThere was no significant difference in duration or severity of symptoms with Echinacea purpurea compared with placebo in children with upper respiratory tract infection (median duration of symptoms (95% CI): 9 days (8 to 10 days) with Echinacea vs. 9 days (8 to 10 days) with placebo; P=0.89; median severity of symptoms (95% CI): 33 (29 to 40) with Echinacea vs. 33 (30 to 38) with placebo; P=0.69). Rash occurred in significantly more children receiving Echinacea compared with placebo (reports of rash: 24 with Echinacea v 10 with placebo; P=0.008).Authors’ conclusionsEchinacea purpurea is ineffective for treating upper respiratory tract infections in children aged 2 to 11 years.     

反复上呼吸道感染患儿危险因素分析

目的探讨反复上呼吸道感染患儿高危因素,以期为降低患儿反复上呼吸道感染提供参考。方法选取227例3⁶岁反复上呼吸道感染患儿资料(感染组)及277名儿童保健科进行健康体检的正常儿童(对照组),调查人口学特征、父母育儿方式、父母文化程度、儿童营养状况、儿童生活环境等因素,检测全血微量元素含量,分析引起反复上呼吸道感染的危险因素。结果非条件logistic回归分析显示,户外活动每天<2h、年抗菌药物使用次数≥3次、父母有过敏史、家庭成员吸烟、母亲文化程度高中以上是患儿反复发生上呼吸道感染的独立危险因素(P<0.05),其中母亲文化程度高为保护因素;两组锌、铁、钙、铜、镁含量比较差异有统计学意义(P<0.05)。结论多种危险因素引起小儿反复上呼吸道感染发生,母亲文化程度高有利于降低小儿反复上呼吸道感染的发生。     

医院急诊内科上呼吸道感染应用抗菌药物调查分析

目的 了解医院急诊内科上呼吸道感染治疗抗菌药物的使用情况,促进临床合理使用抗菌药物.方法 提取医院2010年7-9月急诊内科诊断为上呼吸道感染的处方1635张,根据药品说明书及相关资料,对抗菌药物使用的品种、抗菌药物金额、给药频次、联用情况进行分析评价.结果 使用抗菌药物处方总计1104张,抗菌药物使用率为67.52％,涉及6类24个品种,主要是头孢菌素类、大环内酯类和青霉素类等;其中,一联用药1042张,占94.38％,二联用药62张,占5.62％,无≥三联用药.结论 头孢菌素类抗菌药物使用比例较大,存在病原学送检率低、给药途径等不尽合理的问题,需进一步规范管理,促进抗菌药物合理使用.     

广东某学院大学生上呼吸道感染调查

目的对广东某校大学生的上呼吸道感染病例进行调查分析。方法选择2011年1月—2013年12月广东某校卫生所诊断为＂上呼吸道感染＂的大学生,回顾性分析其发病情况、临床症状、相关因素及防治等。结果广东某校大学生上呼吸道感染为常见病、多发病,学生发病与生活习惯、环境、气候、季节等因素相关,临床症状包括鼻塞、流涕、咽痛、咳嗽、发热等。结论上呼吸道感染是广东某校常见病、多发病,应注重宣教、预防和治疗相结合。     

Cod liver oil, young children, and upper respiratory tract infections

Cod liver oil contains long-chain omega-3 fatty acids, as well as vitamins D and A. It was a traditional source of vitamin D in the United States and was used to prevent and treat rickets. In our clinical research, we used liquid cod liver oil of adequate purity and acceptable taste for infants and young children, as well as a children's multivitamin/mineral supplement with selenium and other trace metals. In a cluster-randomized study of pediatric visits for upper respiratory illness during the winter and early spring, these nutritional supplements decreased mean visits/subject/month by 36%-58%. Cod liver oil is culturally valued and has been used as a folk remedy by many low-income minorities in the United States. Nutritional supplements cannot be purchased with SNAP benefits (formerly called food stamps). Inclusion of cod liver oil in state Medicaid formularies would make it available to low-income children, whose families may not be able to pay for it out-of-pocket.     

唇裂患儿术前上呼吸道感染的原因及对策

目的 探讨唇裂患儿术前上呼吸道感染的相关原因,并提出相应的预防对策,以供临床参考.方法 选取2008年1月-2011年12月进行唇裂手术的患儿131例,选用经过岗前培训的专门调查人员对唇裂患儿术前上呼吸道感染的原因进行调查.结果 131例被调查唇裂患儿中手术前发生上呼吸道感染58例,术前上呼吸道感染率为44.27％,与术前上呼吸道未感染患儿平均住院时间相比,术前上呼吸道感染患儿平均住院时间明显较长,差异有统计学意义(P＜0.05);在影响58例术前上呼吸道感染的医院相关因素中,环境改变造成患儿上呼吸道感染率最高,为48.28％,其次为饮食变化的因素,为29.31％;在影响58例术前上呼吸道感染的患儿因素中,免疫力低下造成患儿上呼吸道感染率最高,为51.72％,其次为患儿鼻腔相对短小、鼻道狭窄因素,为31.03％.结论 加强患儿及其家属的心理护理,提高患儿住院环境质量,增强患儿饮食,合理应用抗菌药物,均有利于患儿术前上呼吸道感染的降低,促进患儿手术的顺利进行及术后的康复.     

北京市三级综合医院急性上呼吸道感染患者头孢菌素应用的流行病学分析

目的 了解北京市综合医院急性上呼吸道感染患者头孢菌素类抗菌药物的应用情况.方法 利用北京市十所三级综合医院城镇职工医疗保险数据资料,选取其中诊断为急性上呼吸道感染的急诊病例作为研究样本,对头孢菌素类抗菌药的使用频率及种类进行描述与分析.结果 共纳入135 979例急性上呼吸道感染急诊病例资料,病例年龄为(43.6±16.2)岁,男性占42.7％.抗菌药物总体使用率为71.2％,其中头孢菌素类抗菌药的使用率为55.3％.急性扁桃体炎头孢菌素的使用率最高为64.6％,其余依次为急性喉炎和气管炎63.6％,急性会厌炎59.0％,急性鼻窦炎57.9％,普通感冒53.4％,急性鼻咽炎51.9％.在使用头孢菌素类抗菌药的病例中,有45.8％的病例使用了注射剂.头孢菌素的应用种类以第二代应用最多(J01DB,56.1％),其余依次为第三代(J01DD,42.8％)、第一代(J01DB,1.2％)和第四代(J01DE,0.0％).结论 目前我国急性上呼吸道感染病例头孢菌素使用率较高,需要进一步加强对抗菌药物临床应用的监督、检查和管理.