Streptococcus (S.) pyogenes is usually associated with mild infections of the pharynx and skin.However,in some cases,this microorganism can cause potentially lethal invasive infections,such as bacteremic pneumonia,ski...Streptococcus (S.) pyogenes is usually associated with mild infections of the pharynx and skin.However,in some cases,this microorganism can cause potentially lethal invasive infections,such as bacteremic pneumonia,skin and soft-tissue infections,sepsis,meningitis,necrotizing fasciitis,and streptococcal toxic shock syndrome.^([1,2])Although S.pyogenes is currently considered a rare cause of pneumonia,with most cases occurring in patients following influenza,the mortality rate for invasive infections is high.^([3,4])We present a case of S.pyogenes bacteremic pneumonia in a woman with no severe comorbidities,which led to a fatal outcome 9h after admission to the hospital on the third day of the disease onset.展开更多
Tacrolimus (TAC) is increasingly used for immunosuppression in organ transplantation,dermatomyositis/polymyositis,and myasthenia gravis(MG) patients.^([1]) TAC has a narrow therapeutic window with overexposure leading...Tacrolimus (TAC) is increasingly used for immunosuppression in organ transplantation,dermatomyositis/polymyositis,and myasthenia gravis(MG) patients.^([1]) TAC has a narrow therapeutic window with overexposure leading to acute and chronic forms of adverse reactions (ADRs).After oral administration,TAC is predominantly absorbed in the duodenum and jejunum and has highly variable pharmacokinetics,particularly when diarrhea occurs.^([2,3]) Few data has been published on TAC overexposure following mild diarrhea.Mild diarrhea is relatively common and often unreported,which can easily be overlooked by physicians,especially in the emergency department.Here,we report the occurrence of serious ADRs to TAC after mild diarrhea in a MG patient with community-acquired pneumonia(CAP),including nephrotoxicity,metabolic abnormalities and severe immunosuppression.展开更多
Hospital-acquired infections(HAIs) are serious problems for healthcare systems, especially in developing countries where public health infrastructure and technology for infection preventions remain undeveloped. Here, ...Hospital-acquired infections(HAIs) are serious problems for healthcare systems, especially in developing countries where public health infrastructure and technology for infection preventions remain undeveloped. Here, we characterized how strategy and technology could be mobilized to improve the effectiveness of infection prevention and control in hospitals during the outbreaks of Ebola, Middle East respiratory syndrome(MERS), and severe acute respiratory syndrome(SARS) in Asia and West Africa. Published literature on the hospital-borne outbreaks of SARS, Ebola, and MERS in Asia and West Africa was comprehensively reviewed. The results showed that healthcare systems and hospital management in affected healthcare facilities had poor strategies and inadequate technologies and human resources for the prevention and control of HAIs, which led to increased morbidity, mortality, and unnecessary costs. We recommend that governments worldwide enforce disaster risk management, even when no outbreaks are imminent. Quarantine and ventilation functions should be taken into consideration in architectural design of hospitals and healthcare facilities. We also recommend that health authorities invest in training healthcare workers for disease outbreak response, as their preparedness is essential to reducing disaster risk.展开更多
The direct delivery of inhaled antibiotics to the respiratory tract has been a subject of enduring interest among medical practitioners and researchers due to the associated favorable pharmacokinetics.This interest ha...The direct delivery of inhaled antibiotics to the respiratory tract has been a subject of enduring interest among medical practitioners and researchers due to the associated favorable pharmacokinetics.This interest has been particularly pronounced in the context of critically illpatients,wherehealthcare-associatedpulmonary infections represent a significant challenge,driving continued exploration of inhaled antibiotics for intubated patients.Recent high-level evidence has shown a very promising application in the field of ventilator-associated pneumonia (VAP) prevention.^([1]).展开更多
BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marke...BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marker of mortality in patients with DM and CAP.METHODS:This retrospective study included CAP patients who were tested for HBP at intensive care unit(ICU)admission from January 2019 to April 2020.Patients were allocated to the DM or non-DM group and paired with propensity score matching.Baseline characteristics and clinical outcomes up to 90 days were evaluated.The primary outcome was the 10-day mortality.Receiver operating characteristic(ROC)curves,Kaplan-Meier analysis,and Cox regression were used for statistical analysis.RESULTS:Among 152 enrolled patients,60 pairs were successfully matched.There was no significant difference in 10-day mortality,while more patients in the DM group died within 28 d(P=0.024)and 90 d(P=0.008).In the DM group,HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors(median 182.21[IQR:55.43-300]ng/ml vs.median 66.40[IQR:34.13-107.85]ng/mL,P=0.019),and HBP levels could predict the 10-day mortality with an area under the ROC curve of 0.747.The cut-off value,sensitivity,and specificity were 160.6 ng/mL,66.7%,and 90.2%,respectively.Multivariate Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day(HR 7.196,95%CI:1.596-32.455,P=0.01),28-day(HR 4.381,95%CI:1.449-13.245,P=0.009),and 90-day mortality(HR 4.581,95%CI:1.637-12.819,P=0.004)in patients with DM.CONCLUSION:Plasma HBP at ICU admission was associated with the 10-day,28-day,and 90-day mortality,and might be a prognostic factor in patients with DM and CAP.展开更多
BACKGROUND:Streptococcus pneumoniae(S.pneumoniae)is a common pathogen that causes bacterial pneumonia.However,with increasing bacterial resistance,there is an urgent need to develop new drugs to treat S.pneumoniae inf...BACKGROUND:Streptococcus pneumoniae(S.pneumoniae)is a common pathogen that causes bacterial pneumonia.However,with increasing bacterial resistance,there is an urgent need to develop new drugs to treat S.pneumoniae infections.Nanodefensin with a 14-carbon saturated fatty acid(ND-C14)is a novel nanoantimicrobial peptide designed by modifying myristic acid at the C-terminus of humanα-defensin 5(HD5)via an amide bond.However,it is unclear whether ND-C14 is effective against lung infections caused by S.pneumoniae.METHODS:In vitro,three groups were established,including the control group,and the HD5 and ND-C14 treatment groups.A virtual colony-count assay was used to evaluate the antibacterial activity of HD5 and ND-C14 against S.pneumoniae.The morphological changes of S.pneumoniae treated with HD5 or ND-C14 were observed by scanning electron microscopy.In vivo,mice were divided into sham,vehicle,and ND-C14 treatment groups.Mice in the sham group were treated with 25μL of phosphate-buffered saline(PBS).Mice in the vehicle and ND-C14 treatment groups were treated with intratracheal instillation of 25μL of bacterial suspension with 2×108 CFU/mL(total bacterial count:5×10^(6) CFU),and then the mice were given 25μL PBS or intratracheally injected with 25μL of ND-C14(including 20μg or 50μg),respectively.Survival rates were evaluated in the vehicle and ND-C14 treatment groups.Bacterial burden in the blood and bronchoalveolar lavage fluid were counted.The lung histology of the mice was assessed.A propidium iodide uptake assay was used to clarify the destructive eff ect of ND-C14 against S.pneumoniae.RESULTS:Compared with HD5,ND-C14 had a better bactericidal eff ect against S.pneumoniae because of its stronger ability to destroy the membrane structure of S.pneumoniae in vitro.In vivo,ND-C14 significantly delayed the death time and improved the survival rate of mice infected with S.pneumoniae.ND-C14 reduced bacterial burden and lung tissue injury.Moreover,ND-C14 had a membrane permeation eff ect on S.pneumoniae,and its destructive ability increased with increasing ND-C14 concentration.CONCLUSION:The ND-C14 may improve bactericidal eff ects on S.pneumoniae both in vitro and in vivo.展开更多
目的探讨肺超声联合膈肌超声与COVID-19严重程度的相关性及其对无创通气治疗的指导价值。方法收集2022年12月至2023年2月在本院接受治疗的69例新型冠状病毒重症肺炎患者的临床资料。回顾性分析患者肺超声十二分区法评分(LUBS评分)、膈...目的探讨肺超声联合膈肌超声与COVID-19严重程度的相关性及其对无创通气治疗的指导价值。方法收集2022年12月至2023年2月在本院接受治疗的69例新型冠状病毒重症肺炎患者的临床资料。回顾性分析患者肺超声十二分区法评分(LUBS评分)、膈肌移动度(DE)、膈肌增厚分数(DTF)与重症肺炎临床预后的相关性。结果非重症组与重症组相比,LUBS评分(9分VS.15分),DE(1.2 cm VS.0.9 cm)与DTF(44.75%VS.37.98%),提示LUBS评分越高、DE与DTF越低,COVID-19病情越严重,差异均具有统计学意义(P<0.05)。LUBS评分的cut-off值为14、DE的cut-off值为1.0 cm、DTF的cut-off值为38%,三者联合评估更具价值。其中LUBS评分>14、DTF<38%、合并呼吸衰竭及糖尿病是COVID-19重症的独立危险因素。结论肺超声(LUBS评分)与COVID-19严重程度呈正相关,膈肌超声(DE、DTF)与COVID-19严重程度呈负相关,三者联合评估更具价值。LUBS评分>14、DTF<38%、合并呼吸衰竭及糖尿病是COVID-19重症的独立危险因素。展开更多
文摘Streptococcus (S.) pyogenes is usually associated with mild infections of the pharynx and skin.However,in some cases,this microorganism can cause potentially lethal invasive infections,such as bacteremic pneumonia,skin and soft-tissue infections,sepsis,meningitis,necrotizing fasciitis,and streptococcal toxic shock syndrome.^([1,2])Although S.pyogenes is currently considered a rare cause of pneumonia,with most cases occurring in patients following influenza,the mortality rate for invasive infections is high.^([3,4])We present a case of S.pyogenes bacteremic pneumonia in a woman with no severe comorbidities,which led to a fatal outcome 9h after admission to the hospital on the third day of the disease onset.
基金supported by the Clinical Research Foundation of Zhejiang Provincial Medical Association (2020ZYC-A113)。
文摘Tacrolimus (TAC) is increasingly used for immunosuppression in organ transplantation,dermatomyositis/polymyositis,and myasthenia gravis(MG) patients.^([1]) TAC has a narrow therapeutic window with overexposure leading to acute and chronic forms of adverse reactions (ADRs).After oral administration,TAC is predominantly absorbed in the duodenum and jejunum and has highly variable pharmacokinetics,particularly when diarrhea occurs.^([2,3]) Few data has been published on TAC overexposure following mild diarrhea.Mild diarrhea is relatively common and often unreported,which can easily be overlooked by physicians,especially in the emergency department.Here,we report the occurrence of serious ADRs to TAC after mild diarrhea in a MG patient with community-acquired pneumonia(CAP),including nephrotoxicity,metabolic abnormalities and severe immunosuppression.
基金supported by the Chinese Military System(Grant No.AWS16J023)
文摘Hospital-acquired infections(HAIs) are serious problems for healthcare systems, especially in developing countries where public health infrastructure and technology for infection preventions remain undeveloped. Here, we characterized how strategy and technology could be mobilized to improve the effectiveness of infection prevention and control in hospitals during the outbreaks of Ebola, Middle East respiratory syndrome(MERS), and severe acute respiratory syndrome(SARS) in Asia and West Africa. Published literature on the hospital-borne outbreaks of SARS, Ebola, and MERS in Asia and West Africa was comprehensively reviewed. The results showed that healthcare systems and hospital management in affected healthcare facilities had poor strategies and inadequate technologies and human resources for the prevention and control of HAIs, which led to increased morbidity, mortality, and unnecessary costs. We recommend that governments worldwide enforce disaster risk management, even when no outbreaks are imminent. Quarantine and ventilation functions should be taken into consideration in architectural design of hospitals and healthcare facilities. We also recommend that health authorities invest in training healthcare workers for disease outbreak response, as their preparedness is essential to reducing disaster risk.
文摘The direct delivery of inhaled antibiotics to the respiratory tract has been a subject of enduring interest among medical practitioners and researchers due to the associated favorable pharmacokinetics.This interest has been particularly pronounced in the context of critically illpatients,wherehealthcare-associatedpulmonary infections represent a significant challenge,driving continued exploration of inhaled antibiotics for intubated patients.Recent high-level evidence has shown a very promising application in the field of ventilator-associated pneumonia (VAP) prevention.^([1]).
基金supported by the National Key Research and Development Program of China(2021YFC2501800)Leader Project of Henan Province Health Young and Middle-aged Professor(HNSWJW2020013).
文摘BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marker of mortality in patients with DM and CAP.METHODS:This retrospective study included CAP patients who were tested for HBP at intensive care unit(ICU)admission from January 2019 to April 2020.Patients were allocated to the DM or non-DM group and paired with propensity score matching.Baseline characteristics and clinical outcomes up to 90 days were evaluated.The primary outcome was the 10-day mortality.Receiver operating characteristic(ROC)curves,Kaplan-Meier analysis,and Cox regression were used for statistical analysis.RESULTS:Among 152 enrolled patients,60 pairs were successfully matched.There was no significant difference in 10-day mortality,while more patients in the DM group died within 28 d(P=0.024)and 90 d(P=0.008).In the DM group,HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors(median 182.21[IQR:55.43-300]ng/ml vs.median 66.40[IQR:34.13-107.85]ng/mL,P=0.019),and HBP levels could predict the 10-day mortality with an area under the ROC curve of 0.747.The cut-off value,sensitivity,and specificity were 160.6 ng/mL,66.7%,and 90.2%,respectively.Multivariate Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day(HR 7.196,95%CI:1.596-32.455,P=0.01),28-day(HR 4.381,95%CI:1.449-13.245,P=0.009),and 90-day mortality(HR 4.581,95%CI:1.637-12.819,P=0.004)in patients with DM.CONCLUSION:Plasma HBP at ICU admission was associated with the 10-day,28-day,and 90-day mortality,and might be a prognostic factor in patients with DM and CAP.
基金supported by the National Natural Science Foundation of China(82072148)Zhejiang Provincial Basic Public Welfare Research Program of Zhejiang Province(LGF21H150002)+1 种基金Zhejiang Medicine and Health Science and Technology Project(2022RC245&2023KY255)Ningbo Municipal Natural Science Foundation(2023J134).
文摘BACKGROUND:Streptococcus pneumoniae(S.pneumoniae)is a common pathogen that causes bacterial pneumonia.However,with increasing bacterial resistance,there is an urgent need to develop new drugs to treat S.pneumoniae infections.Nanodefensin with a 14-carbon saturated fatty acid(ND-C14)is a novel nanoantimicrobial peptide designed by modifying myristic acid at the C-terminus of humanα-defensin 5(HD5)via an amide bond.However,it is unclear whether ND-C14 is effective against lung infections caused by S.pneumoniae.METHODS:In vitro,three groups were established,including the control group,and the HD5 and ND-C14 treatment groups.A virtual colony-count assay was used to evaluate the antibacterial activity of HD5 and ND-C14 against S.pneumoniae.The morphological changes of S.pneumoniae treated with HD5 or ND-C14 were observed by scanning electron microscopy.In vivo,mice were divided into sham,vehicle,and ND-C14 treatment groups.Mice in the sham group were treated with 25μL of phosphate-buffered saline(PBS).Mice in the vehicle and ND-C14 treatment groups were treated with intratracheal instillation of 25μL of bacterial suspension with 2×108 CFU/mL(total bacterial count:5×10^(6) CFU),and then the mice were given 25μL PBS or intratracheally injected with 25μL of ND-C14(including 20μg or 50μg),respectively.Survival rates were evaluated in the vehicle and ND-C14 treatment groups.Bacterial burden in the blood and bronchoalveolar lavage fluid were counted.The lung histology of the mice was assessed.A propidium iodide uptake assay was used to clarify the destructive eff ect of ND-C14 against S.pneumoniae.RESULTS:Compared with HD5,ND-C14 had a better bactericidal eff ect against S.pneumoniae because of its stronger ability to destroy the membrane structure of S.pneumoniae in vitro.In vivo,ND-C14 significantly delayed the death time and improved the survival rate of mice infected with S.pneumoniae.ND-C14 reduced bacterial burden and lung tissue injury.Moreover,ND-C14 had a membrane permeation eff ect on S.pneumoniae,and its destructive ability increased with increasing ND-C14 concentration.CONCLUSION:The ND-C14 may improve bactericidal eff ects on S.pneumoniae both in vitro and in vivo.
文摘目的探讨肺超声联合膈肌超声与COVID-19严重程度的相关性及其对无创通气治疗的指导价值。方法收集2022年12月至2023年2月在本院接受治疗的69例新型冠状病毒重症肺炎患者的临床资料。回顾性分析患者肺超声十二分区法评分(LUBS评分)、膈肌移动度(DE)、膈肌增厚分数(DTF)与重症肺炎临床预后的相关性。结果非重症组与重症组相比,LUBS评分(9分VS.15分),DE(1.2 cm VS.0.9 cm)与DTF(44.75%VS.37.98%),提示LUBS评分越高、DE与DTF越低,COVID-19病情越严重,差异均具有统计学意义(P<0.05)。LUBS评分的cut-off值为14、DE的cut-off值为1.0 cm、DTF的cut-off值为38%,三者联合评估更具价值。其中LUBS评分>14、DTF<38%、合并呼吸衰竭及糖尿病是COVID-19重症的独立危险因素。结论肺超声(LUBS评分)与COVID-19严重程度呈正相关,膈肌超声(DE、DTF)与COVID-19严重程度呈负相关,三者联合评估更具价值。LUBS评分>14、DTF<38%、合并呼吸衰竭及糖尿病是COVID-19重症的独立危险因素。
