Proteína C reactiva y escala SOFA: una simple escala como factor predictivo temprano de la necesidad de cuidados críticos en los pacientes con neumonía causada por COVID-19 en España

ObjectiveTo identify potential markers at admission predicting the need for critical care in patients with COVID-19 pneumonia.Material and methodsAn approved, observational, retrospective study was conducted between March 15 to April 15, 2020. 150 adult patients aged less than 75 with Charlson comorbidity index ≤ 6 diagnosed with COVID-19 pneumonia were included. Seventy-five patients were randomly selected from those admitted to the critical care units (critical care group [CG]) and seventy-five hospitalized patients who did not require critical care (non-critical care group [nCG]) represent the control group. One additional cohort of hospitalized patients with COVID-19 were used to validate the score.Measurements and main resultsMultivariable regression showed increasing odds of in-hospital critical care associated with increased C-reactive protein (CRP) (odds ratio 1.052 [1.009-1.101]; P = .0043) and higher Sequential Organ Failure Assessment (SOFA) score (1.968 [1.389-2.590]; P < .0001), both at the time of hospital admission. The AUC-ROC for the combined model was 0.83 (0.76-0.90) (vs AUC-ROC SOFA P < .05). The AUC-ROC for the validation cohort was 0.89 (0.82-0.95) (P > 0.05 vs AUC-ROC development).ConclusionPatients COVID-19 presenting at admission SOFA score ≥ 2 combined with CRP ≥ 9,1 mg/mL could be at high risk to require critical care.     

血必净注射液联合利奈唑胺治疗重症肺炎有效性及安全性的Meta分析

目的 评价血必净注射液联合利奈唑胺治疗重症肺炎的有效性与安全性。方法 检索中国知网（CNKI）、万方数据库（Wanfang）、维普数据库（VIP）、中国生物医学文献数据库（CBM）、Cochrane Library、PubMed、Web of Science和Embase数据库,检索时限为各数据库建库至2022年6月,收集血必净注射液联合利奈唑胺治疗重症肺炎的随机对照试验,采用Review Manager 5.4.1对纳入文献进行质量评价、数据整合分析和偏倚风险评估;Stata14.0进行敏感性分析。结果 共纳入12项随机对照试验,涉及949例患者,观察组478例,对照组471例。Meta分析结果显示,观察组的临床总有效率[RR=1.24, 95%CI (1.18, 1.31), P<0.000 01]、细菌清除率[RR=1.38, 95%CI (1.22, 1.55), P<0.000 01]显著高于对照组。观察组的血常规恢复正常时间[MD=-1.38, 95%CI (-1.55,-1.20), P<0.000 01]、体温恢复正常时间[MD=-1.68, 95%C...     

儿童肺炎支原体感染的临床特征及混合感染相关因素研究

目的 了解儿童肺炎支原体（Mp）感染的临床特征,分析Mp与其他病原体混合感染的相关因素,为完善儿童社区获得性肺炎（CAP）防治提供证据支持。方法 基于在苏州大学附属儿童医院（SCH）开展的急性呼吸道感染病例监测,筛选2018-2021年在SCH住院的<16岁CAP病例,采用统一的调查表收集研究对象基本情况、基础疾病史、临床表现等信息,通过医院检验信息系统查询研究对象的病原检测结果,比较Mp、细菌、病毒等病原体感染者的临床特征,比较Mp混合其他病原感染对病情严重性的影响,采用logistic回归模型分析Mp混合其他病原感染的相关因素。结果 共收集8 274名CAP住院病例,其中Mp阳性2 184例（26.4%）;Mp检出率女童高于男童（P<0.001）,随月龄增加而升高（P<0.001）,夏秋季高于冬春季（P<0.001）。喘息、气促、喘鸣音及肺部呈片状阴影的发生率,以及发热和住院天数等指标在Mp、细菌和病毒感染病例中的差异均有统计学意义（均P<0.05）。<60月龄Mp混合感染病例出现喘息症状及痰鸣音和喘鸣音的比例高于单纯感染病例,≥60月龄混合感染病例较Mp单纯感染更易出现气促症状（均P<0.05）。多因素logistic回归模型分析显示,男童（aOR=1.38,95%CI：1.15~1.67）、<6月龄（aOR=3.30,95%CI：2.25~4.89）、6~月龄（aOR=3.44,95%CI：2.63~4.51）、24~月龄（aOR=2.50,95%CI：1.90~3.30）、48~71月龄（aOR=1.77,95%CI：1.32~2.37）和3个月内呼吸系统感染史（aOR=1.28,95%CI：1.06~1.55）为Mp混合其他病原感染的相关因素。结论 Mp是导致儿童CAP住院的主要病原体,单纯Mp感染病例较细菌、病毒感染病例发热天数更长;Mp常与细菌和病毒混合感染,男童、<72月龄和3个月内呼吸系统感染史是Mp混合感染的相关因素。     

The impact of 10-valent pneumococcal conjugate vaccine upon hospitalization rate of children with pneumonia in different Brazilian administrative regions

BackgroundStreptococcus pneumoniae is the most frequent bacterial causative agent of pneumonia. Due to its significant contribution to the morbidity and mortality profile and the country’s economy, the 10-valent pneumococcal vaccine (PCV10) was introduced in Brazil in 2010. Brazil is divided into five administrative regions which differ in social-economic indices among each other. Estimates of PCV10 impact on hospitalization rates due to pneumonia stratified by distinct Brazilian regions are limited. We assessed this issue.MethodsThis is a population-based ecological investigation. Data about hospitalizations due to pneumonia, asthma or urinary tract infection (UTI) among patients aged under 20 years in the pre-exposure (2003–2009) and in the post-exposure (2011–2017) periods were retrieved from the National Health System – Hospital Information System (SIH-SUS) database. The total resident population by age group in each year was retrieved from the Brazilian Institute for Geography and Statistics database. Hospitalization rates were estimated for each Brazilian region and the rates obtained in the pre-exposure and in the post-exposure periods were compared by Prais-Winsten regression. The Human Development Index (HDI) evolved differently in the distinct regions during the study period.ResultsOverall, hospitalization rates due to pneumonia declined by 34.5%. Similar trends were observed for hospitalization rates due to asthma and UTI. The same pattern was observed in each Brazilian region. However, the North region was the only one that presented an exponential incidence decline pattern, which could be explained by PCV10 implementation (declined by 10.8% in the quadratic regression, p < 0.01). Only in the North region, significant decline was observed among patients aged 0–4 years (-12.5%; p = 0.01), 5–9 years (-38.5%; p < 0.01) or 10–14 years (-10.7%; p = 0.03).ConclusionSignificant variation in the downward trend of hospitalization rate was only found in the North region, which evolved from very low HDI in 2003; medium HDI in 2010 to high HDI in 2017.     

重症肺炎机械通气患者早期肺功能康复研究进展

重症肺炎好发于中老年群体,发病机制为人体发生病原体感染所致的毒血症、血液循环障碍,临床症状包括体温升高、咳嗽、咳痰、血压低、休克等。随着病情继续发展,易导致患者呼吸衰竭,危及生命。所以当前临床主张采用机械通气法干预重症肺炎相关症状,促使患者可正常通气,呼吸疲劳得以较快改善,肺功能逐渐恢复,进一步提升患者疾病预后疗效。机械通气又称辅助通气,是采用机械手段来帮助或代替自主呼吸,近年来应用于重症患者,效果较为理想。本文检索了多名学者关于重症肺炎患者机械通气治疗期间的早期肺功能康复情况研究文章,对于早期肺功能康复疗法的相关内容进行了综述,希望可以为后续更多接受机械通气治疗的重症肺炎患者提供早期肺功能康复干预的方法指导。     

Evaluation of effectiveness,safety and cost-benefit of the 23– valent pneumococcal capsular polysaccharide vaccine for HIV-Infected patients

IntroductionDue to the lack of understanding of the protective effects and safety of 23-valent pneumococcal polysaccharide vaccine (PPV23) in immune-deficient populations, the vaccination rate of PPV23 among HIV-infected patients is still very low in China. The main objectives of this study were to determine whether the efforts to assess measures for the prevention of pneumococcal pneumonia are still worthwhile, and provide designated vaccination program of HIV-infected persons for government policy based on.Methods60 HIV-infected adults in Lanshan county who had never been vaccinated with any pneumococcal vaccine were enrolled in this study, voluntary vaccination of PPV23 and One-year follow-up after vaccination can be completed.Result76.67% patients (46/60) had serologic response at 12 months after vaccine, CD4 count(≤500 cells/ul or > 500 cells/ul) and Month from diagnosis to first antiviral therapy (≤1 month or > 1 month) were related to antibody responses (p < 0.05).In this study, PPV23 was well tolerated, no adverse reaction was reported.11 Streptococcus pneumoniae pneumonia (9.17%,11/120) occurred in the Unvaccinated group and 1 case(1.67%,1/60)in the vaccination group within one year after vaccination(Fisher's exact probability, P = 0.225). The VE was 81.79%. The per capita benefit was 39.32 dollars, the benefit-cost ratio = 1.19. There are significant statistical differences between the vaccinated group and the non-vaccinated group in outpatient costs (p < 0.05, 95 %CI: 9.29–32.11), Medicine costs (p = 0.017, 95 %CI: 2.47–24.44), and disease related indirect costs (p = 0.038, 95 %CI: 0.93–33.63) within one year of vaccination.ConclusionOur study results showed that PPV23 can be safely and effectively administered to HIV-1 infected individuals and effectively preventing Streptococcal pneumonia. Considering the cost-benefit of vaccination among HIV-infected persons, as it has been reported in our study, it is necessary to promote the widespread use of the vaccine among HIV-infected persons in the future.     

Long-term population impact of infant 10-valent pneumococcal conjugate vaccination on invasive pneumococcal disease in adults in Finland

BackgroundLimited data are available on long-term indirect effects of ten-valent pneumococcal conjugate vaccine (PCV10) programmes. We evaluated changes in invasive pneumococcal disease (IPD) incidence, mortality, and serotype distribution in adults up to 9 years after infant PCV10 introduction.MethodsCulture-confirmed IPD cases ≥18 years (n = 5610; 85% were pneumonia) were identified through national, population-based laboratory surveillance; data were linked with population registry to conduct nationwide follow-up study. In a time-series model, we compared serotype-specific IPD incidence and associated 30-day mortality rates before and after PCV10 by using negative binomial regression models.ResultsDuring pre-PCV10 period (7/2004–6/2010), overall IPD incidence in adults ≥18 years increased yearly by 4.8%. After adjusting for trend and seasonality, the observed PCV10 serotype IPD incidence in 7/2018–6/2019 was 90% (12/100,000 person-years) lower than the expected rate without PCV10 program. Non-PCV10 serotype incidence was 40% (4.4/100,000 person-years) higher than expected; serotypes 3, 19A, 22F, and 6C accounted for most of the rate increase. However, incidence of non-PCV10 IPD levelled off by end of follow-up. The observed-expected incidence rate-ratio (IRR) was 0·7 (95 %CI 0·5–0.8) for all IPD and 0·7 (95 %CI 0·3–1·3) for IPD-associated 30-day mortality. Case-fatality proportion decreased from 11·9% to 10.0% (p < 0.01). In persons ≥65 years, the IRR was 0·7 (95 %CI 0·5–0.95).ConclusionsSignificant indirect effects were seen for vaccine-serotype IPD and for overall IPD in all adult age groups. For non-vaccine IPD, the incidence stabilized 5 years after infant PVC10 program introduction, resulting in a steady state in which non-vaccine IPD accounted for nearly 90% of overall IPD. Substantial pneumococcal disease burden remains in older adults.     

A critical assessment of published guidelines and other decision-support systems for the antibiotic treatment of community-acquired respiratory tract infections

Guidelines are an important means by which professional associations and governments have sought to improve the quality and cost-effectiveness of disease management for infectious diseases. Prescribing of initial antibiotic therapy for community-acquired respiratory tract infections (RTIs) is primarily empiric and physicians may often have a limited appreciation of bacterial resistance. Recent guidelines for managing RTIs have adopted a more evidence-based approach. This process has highlighted important gaps in the existing knowledge base, e.g. concerning the impact of resistance on the effectiveness of oral antibiotics for outpatient community-acquired pneumonia and the level of resistance that should prompt a change in empiric prescribing. In upper RTIs, the challenge is to identify patients in whom antibiotic therapy is warranted. Concentrated, sustained efforts are needed to secure physicians' use of guidelines. The information should be distilled into a simple format available at the point of prescribing and supported by other behavioral change techniques (e.g. educational outreach visits). Advances in information technology offer the promise of more dynamic, computer-assisted forms of guidance. Thus, RTI prescribing guidelines and other prescribing support systems should help control bacterial resistance in the community. However, their effect on resistance patterns is largely unknown and there is an urgent need for collaborative research in this area. Rapid, cost-effective diagnostic techniques are also required and new antibiotics will continue to have a role in disease management.     

COPD并发呼吸机相关肺炎的病原学分析

目的：分析慢性阻塞性肺病（COPD）有创机械通气并发呼吸机相肺炎（VAP）的病原以及药敏情况。方法：回顾分析年来本院肺科重症监护病房（RICU）内收治的28例VAP患者的临床资料、病原菌构成以及药敏结果。结果VAP的发生率为66．7％,共培养出细菌91株,真菌10株,其中革兰氏阴性杆菌（GNB）64株（70．3％）,革兰氏阴性球菌（GPC）27 株（29．7％）。COPD并发VAP居首位的细菌是嗜麦芽穿食单孢菌。结论COPD有效机械通气并发VAP以及GNB为主,VAP发生后细菌的耐药率普遍较高。在治疗VAP时应重视病原菌培养和药敏试验结果,合理应用抗生素。     

老年人肺癌并发院内获得性肺炎的临床研究

目的为探讨老年人肺癌院内获得性肺炎的临床特点、病原菌及耐药情况,为临床提供依据。方法分析72例老年人肺癌并发院内获得性肺炎的临床资料。结果老年人肺癌平均住院日期延长,化疗时不合理使用抗菌药物,发生院内获得性肺炎的机会最大。主要病原菌为G~-杆菌占80.70％,其中以铜绿假单胞菌、肺炎克雷伯氏菌为主,其次为表皮葡萄球菌占10.53％。病原菌对氨苄青霉素、哌拉西林、头孢菌素耐药性增加,对亚胺培南、万古霉素、阿米卡星敏感。病死率达30.56％。结论老年人肺癌免疫功能低下,住院日期延长,不合理使用抗生素是造成院内感染的主要因素。病原菌的耐药率呈增加趋势,病死率较高。