PDF(Pubmed)
Abstract：
UNASSIGNED: Adults with community-acquired pneumonia (CAP) in China suffer high morbidity. CAP is caused by a multitude of pathogens; however, pathogen-directed clinical symptoms are often lacking. Therefore, patients lacking an accurate microbiological diagnosis are administered with empirical antimicrobials.
UNASSIGNED: We collected bronchoalveolar lavage fluid, as well as clinical and laboratory data from 650 adult patients with CAP admitted to three hospitals in Hubei, Sichuan, and Zhejiang provinces in China. Specimens were cultured and tested using real-time reverse transcription qPCR (RT-qPCR) assays for the presence of 42 respiratory bacteria and viruses. CAP was investigated with respect to regions, genders, and age and patterns of infections or co-infections. Employing clinical guidelines adapted for diagnosis, we assessed retrospectively the appropriate pathogen-directed therapy and compared it with the initial empirical therapies.
UNASSIGNED: Our study identified that 21.38% (139/650) of the patients were classified as having Severe CAP (S-CAP), with a higher prevalence among males, older adults, and during the warm season. Bacterial pathogens were detected in 35.53% (231/650) of cases. K. pneumoniae, H. influenzae, and S. aureus were the most prevalent bacteria across different demographics and regions. Viral pathogens were found in 48.76% (317/650) of patients Epstein-Barr, Human rhinovirus, and Cytomegalovirus were the most common viruses. Co-infections were present in 24.31% (158/650) of cases, with viral-bacterial co-infections being the most frequent. The RT-qPCR demonstrated significantly higher detection rates for key pathogens compared to standard culture methods. It showed potential in optimizing antimicrobial prescriptions by allowing for de-escalation in 18.30% (95/518) of patients, among which reducing the number of excessive antibiotics mainly comprised decreasing the use of 2nd or 3rd generation cephalosporins (5.79%, 30/518) and β-lactamase inhibitor combinations.
UNASSIGNED: The study highlights the significant burden of S-CAP, particularly among specific demographics and seasons. The prevalence of bacterial and viral pathogens, along with the high rate of co-infections, emphasizes the need for comprehensive diagnostic approaches. The RT-qPCR assays emerge as a superior diagnostic tool, offering enhanced pathogen detection capabilities and facilitating more precise antimicrobial therapy. This could lead to improved patient outcomes and contribute to the rational use of antimicrobials, addressing the growing concern of antibiotic resistance.
UNASSIGNED: We collected bronchoalveolar lavage fluid, as well as clinical and laboratory data from 650 adult patients with CAP admitted to three hospitals in Hubei, Sichuan, and Zhejiang provinces in China. Specimens were cultured and tested using real-time reverse transcription qPCR (RT-qPCR) assays for the presence of 42 respiratory bacteria and viruses. CAP was investigated with respect to regions, genders, and age and patterns of infections or co-infections. Employing clinical guidelines adapted for diagnosis, we assessed retrospectively the appropriate pathogen-directed therapy and compared it with the initial empirical therapies.
UNASSIGNED: Our study identified that 21.38% (139/650) of the patients were classified as having Severe CAP (S-CAP), with a higher prevalence among males, older adults, and during the warm season. Bacterial pathogens were detected in 35.53% (231/650) of cases. K. pneumoniae, H. influenzae, and S. aureus were the most prevalent bacteria across different demographics and regions. Viral pathogens were found in 48.76% (317/650) of patients Epstein-Barr, Human rhinovirus, and Cytomegalovirus were the most common viruses. Co-infections were present in 24.31% (158/650) of cases, with viral-bacterial co-infections being the most frequent. The RT-qPCR demonstrated significantly higher detection rates for key pathogens compared to standard culture methods. It showed potential in optimizing antimicrobial prescriptions by allowing for de-escalation in 18.30% (95/518) of patients, among which reducing the number of excessive antibiotics mainly comprised decreasing the use of 2nd or 3rd generation cephalosporins (5.79%, 30/518) and β-lactamase inhibitor combinations.
UNASSIGNED: The study highlights the significant burden of S-CAP, particularly among specific demographics and seasons. The prevalence of bacterial and viral pathogens, along with the high rate of co-infections, emphasizes the need for comprehensive diagnostic approaches. The RT-qPCR assays emerge as a superior diagnostic tool, offering enhanced pathogen detection capabilities and facilitating more precise antimicrobial therapy. This could lead to improved patient outcomes and contribute to the rational use of antimicrobials, addressing the growing concern of antibiotic resistance.
摘要：
■在中国患有社区获得性肺炎（CAP）的成年人发病率很高。CAP是由多种病原体引起的；然而，通常缺乏针对病原体的临床症状。因此,缺乏准确微生物学诊断的患者接受经验性抗微生物药物治疗.
■我们收集了支气管肺泡灌洗液，以及湖北三家医院收治的650名成人CAP患者的临床和实验室数据，四川,和中国的浙江省。培养样本,并使用实时逆转录qPCR(RT-qPCR)测定法测试42种呼吸道细菌和病毒的存在。对CAP进行了地区调查，性别,以及感染或合并感染的年龄和模式。采用适合诊断的临床指南，我们回顾性评估了适当的病原体导向治疗,并将其与最初的经验性治疗进行了比较.
■我们的研究发现，21.38%（139/650）的患者被归类为严重CAP（S-CAP），男性患病率较高，老年人,在温暖的季节。35.53%(231/650)的病例检出细菌病原体。肺炎克雷伯菌，流感嗜血杆菌，金黄色葡萄球菌是不同人口统计学和地区最普遍的细菌。在48.76%(317/650)的患者中发现了病毒病原体,人类鼻病毒,巨细胞病毒是最常见的病毒。24.31%(158/650)的病例存在合并感染,病毒-细菌共感染是最常见的。与标准培养方法相比，RT-qPCR对关键病原体的检测率明显更高。通过允许18.30％（95/518）的患者降级，它显示了优化抗菌药物处方的潜力，其中减少过量抗生素的数量主要包括减少第二代或第三代头孢菌素的使用(5.79%，30/518）和β-内酰胺酶抑制剂组合。
■该研究强调了S-CAP的重大负担，特别是在特定的人口统计和季节。细菌和病毒病原体的流行，伴随着高感染率，强调需要全面的诊断方法。RT-qPCR检测是一种卓越的诊断工具，提供增强的病原体检测能力和促进更精确的抗菌治疗。这可以改善患者的预后，并有助于合理使用抗菌药物，解决日益增长的抗生素耐药性问题。
■我们收集了支气管肺泡灌洗液，以及湖北三家医院收治的650名成人CAP患者的临床和实验室数据，四川,和中国的浙江省。培养样本,并使用实时逆转录qPCR(RT-qPCR)测定法测试42种呼吸道细菌和病毒的存在。对CAP进行了地区调查，性别,以及感染或合并感染的年龄和模式。采用适合诊断的临床指南，我们回顾性评估了适当的病原体导向治疗,并将其与最初的经验性治疗进行了比较.
■我们的研究发现，21.38%（139/650）的患者被归类为严重CAP（S-CAP），男性患病率较高，老年人,在温暖的季节。35.53%(231/650)的病例检出细菌病原体。肺炎克雷伯菌，流感嗜血杆菌，金黄色葡萄球菌是不同人口统计学和地区最普遍的细菌。在48.76%(317/650)的患者中发现了病毒病原体,人类鼻病毒,巨细胞病毒是最常见的病毒。24.31%(158/650)的病例存在合并感染,病毒-细菌共感染是最常见的。与标准培养方法相比，RT-qPCR对关键病原体的检测率明显更高。通过允许18.30％（95/518）的患者降级，它显示了优化抗菌药物处方的潜力，其中减少过量抗生素的数量主要包括减少第二代或第三代头孢菌素的使用(5.79%，30/518）和β-内酰胺酶抑制剂组合。
■该研究强调了S-CAP的重大负担，特别是在特定的人口统计和季节。细菌和病毒病原体的流行，伴随着高感染率，强调需要全面的诊断方法。RT-qPCR检测是一种卓越的诊断工具，提供增强的病原体检测能力和促进更精确的抗菌治疗。这可以改善患者的预后，并有助于合理使用抗菌药物，解决日益增长的抗生素耐药性问题。
