Cases Of Community-acquired Pneumonia Research Articles

Remdesivir: Preliminary Data and Clinical Use Versus Recommended Use.

* Abbreviations: COVID-19 — : coronavirus disease 2019 FDA — : Food and Drug Administration Remdesivir inhibits viral replication of severe acute respiratory coronavirus 2 in vitro and has been shown to reduce time to recovery in adults with coronavirus disease 2019 (COVID-19). It is currently the only antiviral approved by the Food and Drug Administration (FDA) for the treatment of COVID-19.1–4 Although remdesivir is being used in children with COVID-19, it is not approved for patients <12 years of age. Fortunately, if treatment with remdesivir of COVID-19 meets key assumptions, the drug may qualify for the extrapolation pathway, whereby efficacy data in adults can be used to support efficacy in children. However, safety data cannot be extrapolated; population-specific safety data are needed to support FDA labeling for pediatric use. Thus, we read with anticipation the safety data on compassionate use of remdesivir in 77 children with severe COVID-19 presented by Goldman et al5 in this issue of Pediatrics . Goldman et al5 describe low rates of adverse events, including elevated liver aminotransferase levels and anemia, similar to the safety profile seen in adults receiving remdesivir. In light of these data, we will consider whether the concept of extrapolation could be used to support efficacy of remdesivir in children … Address correspondence to Danny K. Benjamin, MD, PhD, Duke Clinical Research Institute, Durham Centre, Suite 800, 300 W Morgan St., Durham, NC 27701. E-mail: danny.benjamin{at}duke.edu

Clinico- bacteriological profile of Community Acquired Pneumonia (CAP) in children aged 3-59 months: A cross sectional study

Background: Worldwide community-acquired pneumonia (CAP) is the major cause of high mortality among under five children in India. After introduction of Pneumococcal and H. influenzae vaccination there is paucity of data regarding etiological profile of pneumonia.&#x0D; Aims and Objective: To evaluate the Clinico- epidemiological profile and etiology of community acquired pneumonia in children.&#x0D; Materials and Methods: We enrolled children aged 3-59 months with CAP (based on WHO criteria of tachypnea with cough or breathing difficulty) over 18 months and recorded presenting symptoms, clinical signs and chest radiography. We performed blood and nasopharyngeal swab (NPS) bacterial culture simultaneously to detect etiological agent of community acquired pneumonia in children.&#x0D; Results: Out of 150 cases of CAP, 90 % of caeses had cough and fever and nearly 80-90% cases had tachypnea and crackles on examination. Radiological findings suggestive of pneumonia was seen in 86% cases . Most common organism isolated was S aureus in both NPS culture (18.7 %) and blood culture (14.7 %). Other common organisms detected in NPS culture were S pneumoniae (6%), E Coli (4.7%), Klebsiella (4.7%), CONS (3.3%), and Pseudomonas (2.7%). In blood culture the common organism detected after S aureus was E coli (5.3%), S pneumoniae (3.3%), Klebsiella (3.3%), CONS( 3.8%), and Pseudomonas (2.5%).&#x0D; Conclusions: We observed that S aureus was the predominant etiological organism isolated in both blood and nasopharyngeal swab bacterial culture in patients suffering from community-acquired pneumonia.

A complicated case of community-acquired pneumonia

A complicated case of community-acquired pneumonia

Clinical metagenomics assessments improve diagnosis and outcomes in community-acquired pneumonia

BackgroundIdentifying the causes of community-acquired pneumonia (CAP) is challenging due to the disease’s complex etiology and the limitations of traditional microbiological diagnostic methods. Recent advances in next generation sequencing (NGS)-based metagenomics allow pan-pathogen detection in a single assay, and may have significant advantages over culture-based techniques.ResultsWe conducted a cohort study of 159 CAP patients to assess the diagnostic performance of a clinical metagenomics assay and its impact on clinical management and patient outcomes. When compared to other techniques, clinical metagenomics detected more pathogens in more CAP cases, and identified a substantial number of polymicrobial infections. Moreover, metagenomics results led to changes in or confirmation of clinical management in 35 of 59 cases; these 35 cases also had significantly improved patient outcomes.ConclusionsClinical metagenomics could be a valuable tool for the diagnosis and treatment of CAP.Trial registrationTrial registration number with the Chinese Clinical Trial Registry: ChiCTR2100043628.

The Evolution and Distribution of Pneumococcal Serotypes in Adults Hospitalized With Community-Acquired Pneumonia in Spain Using a Serotype-Specific Urinary Antigen Detection Test: The CAPA Study, 2011-2018.

BackgroundSpain introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in the childhood National Immunization Program in 2015–2016 with coverage of 3 doses of 94.8% in 2018. We assessed the evolution of all pneumococcal, PCV13 vaccine type (VT), and experimental PCV20-VT (PCV13 + serotypes 8, 10A, 11A, 12F, 15B, 22F, 33F) hospitalized community-acquired pneumonia (CAP) in adults in Spain from 2011–2018.MethodsA prospective observational study of immunocompetent adults (≥18 years) admitted to 4 Spanish hospitals with chest X-ray–confirmed CAP between November 2011 and November 2018. Microbiological confirmation was obtained using the Pfizer serotype-specific urinary antigen detection tests (UAD1/UAD2), BinaxNow test for urine, and conventional cultures of blood, pleural fluid, and high-quality sputum.ResultsOf 3107 adults hospitalized with CAP, 1943 were ≥65 years. Underlying conditions were present in 87% (n = 2704) of the participants. Among all patients, 895 (28.8%) had pneumococcal CAP and 439 (14.1%) had PCV13-VT CAP, decreasing from 17.9% (n = 77) to 13.2% (n = 68) from 2011–2012 to 2017–2018 (P = .049). PCV20-VT CAP occurred in 243 (23.8%) of those included in 2016–2018. The most identified serotypes were 3 and 8. Serotype 3 accounted for 6.9% (n = 215) of CAP cases, remaining stable during the study period, and was associated with disease severity.ConclusionsPCV13-VT caused a substantial proportion of CAP in Spanish immunocompetent adults 8 years after introduction of childhood PCV13 immunization. Improving direct PCV13 coverage of targeted adult populations could further reduce PCV13-VT burden, a benefit that could be increased further if PCV20 is licensed and implemented.

Features of Hematological and Hemostasiological Parameters in Coronavirus Infection COVID-19 and Community-Acquired Pneumonia

Against the background of priority attention paid to the COVID-19 pandemic, there are also cases of community-acquired pneumonia of a different genesis. Identification of the features of lung lesions in such diseases is relevant during the spread of seasonal respiratory infections. The comparative study of the dynamics of hematological and hemostasiological parameters of blood in patients with pneumonia of various origins is of interest in terms of searching for predictors of the prognosis of the diseases development.Aim. To compare the features of clinical symptoms, hematological and hemostasiological parameters in patients with pneumonia caused by COVID-19 and in patients with community-acquired pneumonia.Materials and methods. During cross-sectional study two groups were formed: group 1 consisted of 92 patients diagnosed with moderate community-acquired pneumonia caused by COVID-19 infection; group 2 included 40 patients diagnosed with moderate community-acquired bilateral polysegmental pneumonia.Results. It was found that patients with COVID-19 had an older age (69 vs 39.3 years), a lower body temperature at admission (37.5 vs 38.85 °C), a lower percentage of reduced oxygen saturation (less than 89 % in 5.4 % of cases vs 10 % of cases). In most cases, the average values of some hematological parameters in patients with COVID-19 did not go beyond the reference range. Leukopenia (below 4 × 109 cells/l) and lymphopenia (below 1.1 × 109 cells/l) were observed in 26 % and 38 % of cases respectively; thrombocytopenia (less than 100 × 109 cells/l) – in 12.2 % of cases; hyperfibrinogenemia (more than 4 g/l) – in 65.3 % of cases. A direct correlation was found between platelet levels and leukocytes (R = 0.53; p &lt; 0.001) and lymphocytes (R = 0.29; p = 0.06). Compared with the patients of the group 2,on average, patients with COVID-19 had significantly lower levels of leukocytes and lymphocytes (2.5 times each; p &lt; 0.001) and an increased level of fibrinogen (by 45 %; p &lt; 0.001).Conclusion. In patients with pneumonia caused by COVID-19, we revealed the particular features of clinical symptoms, hematological and hemostasiological blood parameters compared to community-acquired nonspecific pneumonia.

Epidemiological risks and lessons from the first wave of new coronavirus infection (COVID-19) in medical organizations

BACKGROUND:Health workers, who have been at the forefront of efforts to counter the COVID-19 pandemic, have become one of the main risk groups for SARS-CoV-2 infection. The study of the incidence of a new coronavirus infection of medical workers and the development of measures to protect them is an urgent task.&#x0D; AIMS:Study of epidemiological risks and features of the incidence of COVID-19 in medical organizations for the development of proposals for the adjustment of preventive and anti-epidemic measures in the context of a new wave of coronavirus infection.&#x0D; MATERIALS AND METHODS:We examined reporting forms an overview of cases with positive COVID-19 (138 items), an overview of cases of community-acquired pneumonia with positive COVID-19 (138 units), the card of epidemiological investigation of the disease COVID-19 health workers (386 units of information), copies of Acts of epidemiological investigation of infectious (parasitic) diseases, establishing causal relationships (47 units of information), copies of extraordinary reports about the emergency situation of sanitary-and-epidemiologic nature (47 items).&#x0D; RESULTS:The incidence of COVID-19 among healthcare workers (40.1) correlated with the same indicator in the adult population and was 2.6 times higher. The incidence of pneumonia and COVID-19 deaths in health care workers and adults did not differ. The complete set of personal protective equipment was observed in contact with the sick from 100.0 to 62.5% in various departments. More than half of the affected employees had a source of infection in the immediate environment, in 63.2% of cases it was colleagues. The most likely places of infection were places of work (66.8%) and places of residence (30.3%).&#x0D; CONCLUSIONS:The epidemic process of coronavirus infection among employees of medical organizations correlated with theincidence of adult population had a higher incidence rate than among them, without differing in severity and outcomes of COVID-19.The prevalence of morbidity in medical organizations was the predominance among the affected employees of medical organizations. Conditions that contribute to infection were various violations of preventive and anti-epidemic measures, including the use of personal protective equipment.

Epidemic process of respiratory infections and particulate matter as a route for transmission of multidrug-resistant microorganisms in medical organisations

Aim. To study the trends in the prevalence of respiratory tract infections in the population of Kemerovo Region and to interrogate the particulate matter as a possible route for the transmission of multidrug-resistant microorganisms into medical organisations.Materials and Methods. We investigated the prevalence of acute respiratory infections and community-acquired pneumonia among the population of Kuzbass (Kemerovo Region) according to the offcial medical records collected from 2004 to 2020. The study included 10,320,384 cases of acute respiratory infections, 145,357 cases of community-acquired pneumonia, 344,703 hospitalisations of the adults (subjects ≥ 18 years of age) and 75,041 hospitalisations of children (&lt; 18 years of age). Collection of particulate matter samples (n = 97) was performed using sterile gloves and containers from ventilation grilles and adjacent air ducts of the exhaust ventilation systems in various healthcare settings. Bacterial composition of the dust was examined using a VITEK 2 Compact biochemical analyzer. Viral diversity was screened by polymerase chain reaction.Results. Over the study period, respiratory infections were common in Kemerovo Region (average prevalence 22,155.9 per 100,000 population) and showed an increasing incidence. Frequency of respiratory infections among the hospitalised patients was 207.14 per 1,000, being 1.63-fold higher in children than in adults (304.15 and 186.02, respectively). In 2020, the proportion of cefotaxime-resistant Klebsiella spp. was 26.20% that was strikingly high compared to 2019. Hospital particulate matter frequently (71.13% samples) harboured multidrug-resistant microorganisms.Conclusions. High prevalence and morbidity from respiratory infections in Kemerovo Region are combined with high prevalence and biodiversity of airborne microorganisms, in particular multidrug-resistant microbes contaminating the hospital particulate matter.

Hospitalization of mild cases of community-acquired pneumonia decreased more than severe cases during the COVID-19 pandemic

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has affected all healthcare systems. This study aimed to assess the impact of the COVID-19 pandemic on the number and severity of cases of community-acquired pneumonia (CAP) in Japan. MethodsUsing claims data from the Quality Indicator/Improvement Project (QIP) database, urgent cases of inpatients for CAP from 01 August 2018 to 30 July 2020 were included. The monthly ratios of inpatient cases were compared from August 2018 to July 2019 and August 2019 to July 2020 as a year-over-year comparison. These ratios were also compared according to the “A-DROP” severity score, and an interrupted time series (ITS) analysis was performed to evaluate the impact of the COVID-19 pandemic on the monthly number of inpatient cases. ResultsThis study included a total of 67,900 inpatient cases for CAP in 262 hospitals. During the COVID-19 pandemic (defined as the period between March and July 2020) the number of inpatient cases for CAP drastically decreased compared with the same period in the previous year (–48.1%), despite a temporary reduction in the number of other urgent admissions. The number of inpatient cases decreased according to the severity of pneumonia. Milder cases showed a greater decrease in the year-over-year ratio than severe ones: mild –55.2%, moderate –45.8%, severe –39.4%, and extremely severe –33.2%. The ITS analysis showed that the COVID-19 pandemic significantly reduced the monthly number of inpatient cases for CAP (estimated decrease: –1233 cases; 95% CI –521 to –1955). ConclusionsThis study showed a significant reduction in the number of inpatient cases for CAP during the COVID-19 pandemic in Japan. The milder cases showed a greater decrease in the year-over-year ratio of the number of inpatient cases.

Azygos Continuation of the Inferior Vena Cava: Potential for Misdiagnosis as Lung Neoplasm.

The azygos venous system is an accessory venous pathway supplying an important collateral circulation between the superior and inferior vena cava (IVC). We report a case of complicated community-acquired pneumonia with interruption of the IVC with azygos continuation that was misdiagnosed as lung neoplasm. The aim of this case report is to emphasize the importance of recognizing an enlarged azygos vein at the confluence with the superior vena cava and in the retrocrural space to avoid misdiagnosis as a right-sided para-tracheal mass. The angiographic features and clinical importance of this condition are discussed. An enlarged azygos vein at the confluence with the superior vena cava and in the retrocrural space can be misdiagnosed as a right-sided para-tracheal mass/neoplasm or retrocrural adenopathy.Biopsy is the most important tool to confirm the diagnosis of malignancy but could be catastrophic in this situation.Re-imaging after treatment for infection and pneumonia could potentially avoid this error.

Lung ultrasound compared to chest X-ray for the diagnosis of CAP in children.

Community-acquired pneumonia (CAP) represents one of the most common infectious diseases among children. Diagnosis of CAP is mainly clinical. Chest X-ray (CXR) remains the gold standard for the diagnosis in severe or controversial conditions. Recently, some authors have focused on the application of ultrasound in lung diseases but the role of lung ultrasound (LUS) in the diagnosis of CAP is still debated. We aimed to study the concordance between LUS and CXR in evaluating specific signs of CAP. As a secondary aim, we sought to determine the sensitivity and specificity of LUS in CAP diagnosis compared with CXR. Finally, we evaluated the role of LUS during the follow up. We enrolled 68 children (<16years old) hospitalized from October 2018 to September 2019 with a clinical and radiological diagnosis of CAP (cases: N = 41), or with no respiratory diseases (controls: N = 27), in whom a CXR was performed for clinical indications. All the children underwent LUS during hospitalization. The average time needed to perform LUS was 5-10min for each child, and 19/41 cases were re-evaluated by LUS and CXR 30days after discharge. Lung ultrasound confirmed CAP diagnosis in 40/41 patients. Concordance between the two techniques was K = 0.88 for the right lung and K = 0.70 for the left lung. Lung ultrasound showed a sensitivity of 97% and a specificity of 96% compared with CXR. At the follow up, sensitivity increased to 100% while specificity was 94%. Our study showed a potential benefit of LUS compared with CXR in the diagnosis and the follow up of CAP.

Predictors of 30-day readmission following hospitalisation with community-acquired pneumonia

BackgroundThere is a paucity of UK data to aid healthcare professionals in predicting which patients hospitalised with community-acquired pneumonia (CAP) are at greatest risk of 30-day readmission and to determine...

Проявления эпидемического процесса внебольничных пневмоний в период эпидемии COVID-19 на территории Российской Федерации

COVID-19 belongs to the group of acute respiratory infections and it is often complicated with pneumonia. This study aimed to investigate manifestations of community-acquired pneumonia (CAP) epidemic process during the COVID-19 epidemic in the Russian Federation. We analyzed the official statistical data reporting the incidence of CAP in the Russian Federation in 2013–2020 and incidence of COVID-19 as registered in March–July 2020. The mean average annual CAP incidence rate that we calculated and the 2020 CAP incidence prediction allowed assessing the relationship between CAP and COVID-19. It is shown that the long-term dynamics of the incidence of CAP in the Russian Federation is characterized by a pronounced upward trend with an average annual growth rate of 6.4%. The share of adult population among the CAP cases is the largest; on average, it is 64.7% (95% CI [63.1; 66.3]). In 2020, against the background of SARS-CoV-2 circulation, the discrepancy between the actual incidence of CAP and the predicted figures reached and exceeded 558% (in July 2020). As the COVID-19 epidemic developed, the incidence of CAP was registered to increase. There was established a direct and significant correlation between the incidence of CAP and COVID-19 (rxy = 0.932; p &lt;0.01).

Exclusion of bacterial co-infection in COVID-19 using baseline inflammatory markers and their response to antibiotics.

BackgroundCOVID-19 is infrequently complicated by bacterial co-infection, but antibiotic prescriptions are common. We used community-acquired pneumonia (CAP) as a benchmark to define the processes that occur in bacterial pulmonary infections, testing the hypothesis that baseline inflammatory markers and their response to antibiotic therapy could distinguish bacterial co-infection from COVID-19.MethodsRetrospective cohort study of CAP (lobar consolidation on chest radiograph) and COVID-19 (PCR detection of SARS-CoV-2) patients admitted to Royal Free Hospital (RFH) and Barnet Hospital (BH), serving as independent discovery and validation cohorts. All CAP and >90% COVID-19 patients received antibiotics on hospital admission.ResultsWe identified 106 CAP and 619 COVID-19 patients at RFH. Compared with COVID-19, CAP was characterized by elevated baseline white cell count (WCC) [median 12.48 (IQR 8.2–15.3) versus 6.78 (IQR 5.2–9.5) ×106 cells/mL, P < 0.0001], C-reactive protein (CRP) [median 133.5 (IQR 65–221) versus 86.0 (IQR 42–160) mg/L, P < 0.0001], and greater reduction in CRP 48–72 h into admission [median ΔCRP −33 (IQR −112 to +3.5) versus +14 (IQR −15.5 to +70.5) mg/L, P < 0.0001]. These observations were recapitulated in the independent validation cohort at BH (169 CAP and 181 COVID-19 patients). A multivariate logistic regression model incorporating WCC and ΔCRP discriminated CAP from COVID-19 with AUC 0.88 (95% CI 0.83–0.94). Baseline WCC >8.2 × 106 cells/mL or falling CRP identified 94% of CAP cases, and excluded bacterial co-infection in 46% of COVID-19 patients.ConclusionsWe propose that in COVID-19, absence of both elevated baseline WCC and antibiotic-related decrease in CRP can exclude bacterial co-infection and facilitate antibiotic stewardship efforts.

The search for novel treatment strategies for Streptococcus pneumoniae infections.

ABSTRACTThis review provides an overview of the most important novel treatment strategies against Streptococcus pneumoniae infections published over the past 10 years. The pneumococcus causes the majority of community-acquired bacterial pneumonia cases, and it is one of the prime pathogens in bacterial meningitis. Over the last 10 years, extensive research has been conducted to prevent severe pneumococcal infections, with a major focus on (i) boosting the host immune system and (ii) discovering novel antibacterials. Boosting the immune system can be done in two ways, either by actively modulating host immunity, mostly through administration of selective antibodies, or by interfering with pneumococcal virulence factors, thereby supporting the host immune system to effectively overcome an infection. While several of such experimental therapies are promising, few have evolved to clinical trials. The discovery of novel antibacterials is hampered by the high research and development costs versus the relatively low revenues for the pharmaceutical industry. Nevertheless, novel enzymatic assays and target-based drug design, allow the identification of targets and the development of novel molecules to effectively treat this life-threatening pathogen.

Стартовая антибактериальная терапия при внебольничной пневмонии у детей: результаты многоцентрового исследования

Community-acquired pneumonia (CAP) is one of the leading reasons for background prescribing antibacterial therapy (ABT) in pediatric practice. In 2015, the Russian Pediatric Respiratory Society published a guideline on CAP in children. Objective. To assess compliance with the recommendations of starting ABT for CAP of pediatric inpatients in various regions of the Russia. Materials and methods. We reviewed the medical records of pediatric patients with CAP who were hospitalized in 2017–2018. The study was in 6 regions of the Russia. A total of 793 cases of CAP were studied in children aged 1 month to 16 years. We analyzed data from patients, such as demographic indicators, severity of the disease, the presence and nature of complications, and starting ABT. Results. The patient’s age ranged from 1 month to 16 years (average – 4.33 years). The amount of cases of severe CAP was 5.55%, in the remaining 94.45% of cases there was a moderate CAP. Complications were present among 3.91% of patients. The overwhelming majority of patients received parenteral ABT (more than 89%). In the majority of cases, third-generation cephalosporins (65.2%) were used as starting therapy. Amoxicillin was prescribed in only 4.04% of patients. The combination therapy was used in 13.27% of cases (beta-lactam with macrolides or aminoglycosides used most often). We found a significant discrepancy between the actual practice of the recommendations: excessive use of parenteral and combined ABT, private prescription of 3rd generation cephalosporins and rare prescription of amoxicillin, the use of aminoglycosides (including as monotherapy). Conclusion. The use of antibiotics for CAP in children in Russia is often incorrect, which can reduce the effectiveness of treatment and contribute to an increase in antimicrobial resistance. Increased education of pediatricians in ABT and the introduction of antibiotic control is required to address this problem. Key words: children, community-acquired pneumonia, antibiotic therapy

FEATURES OF THE COURSE OF COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN WITH CEREBRAL PALSY

Сerebral palsy (CP) occupies a significant place in the structure of neurological pathology of childhood, which is connected with comorbid pathology, such as pneumonia, which is characterized by a long and atypical course, and associates with frequent development of complications. Aims. The aim was to determinate the main features of the course and identify microbiological agents of community-acquired pneumonia(CAP) in children with cerebral palsy. Methods. The cases of CAP in children with of cerebral palsy was retrospectively studied. Children with CAP have been treated in the Children's City Clinical Hospital No. 3 of the Odessa between 2018 to 2020. The main typical clinical signs were analyzed. The microbiological agents were investigated by the microbiological examination of sputum. Results. CAP in children with cerebral palsy has its own specific features. Onset of the disease is characterized by a significant severity of the general condition, rapid progression of intoxication in children with cerebral palsy. Resistant agents and Candida albicans were identified in children with cerebral palsy. Conclusions. The studied features will help pediatricians in the assessment of CAP in patients with cerebral palsy, and it will be useful in the management of antibiotic therapy in this patients.

Внебольничная пневмония с исходом в абсцесс средней доли легкого на фоне хронической обструктивной болезни легких

Objective of the Paper: To demonstrate the issues with diagnosis and therapy in complicated community-acquired pneumonia associated with chronic obstructive pulmonary disease (COPD). Key Points. Community-acquired pneumonia is one of the most common diseases. Of special interest are patients with comorbidities, since they have more risk factors of poor prognosis. This article describes a clinical case of complicated community-acquired pneumonia associated with COPD. Despite an adequate therapy, the patient developed an acute middle lobe abscess requiring surgery, as the patient had confounding factors. Conclusion. Timely diagnosis and an early adequate therapy allow improving the condition and quality of life of the patient and preventing severe complications. Keywords: pneumonia, abscess, antibacterials, chronic obstructive pulmonary disease.

Prevalence and Viral Etiology of Community-Acquired Pneumonia in Children in Suzhou, China

Introduction: Children with community-acquired pneumonia (CAP) in Soochow University Affiliated Children's Hospital account for 85% of the annual pediatric CAP cases in Suzhou, China. It is essential to explore viral etiology in children with CAP in the local place. In this study, we aimed to expand our understanding of the viral epidemiology in children with CAP in this area by comparing seasonal and clinical characteristics of respiratory viruses from patients at this hospital. Methods: Clinical and laboratory data were collected for 22,825 children with radiologically-confirmed CAP who were admitted to our hospital from January 2010 to December 2014. On the day of admission, sputum specimens were cultured as per routine practice and tested for the respiratory syncytial virus (RSV), influenza A and B (Inf-A and Inf-B), parainfluenza virus 1 to 3 (PInf1-3), and adenovirus (ADV) by direct fluorescent antibody tests and for human bocavirus (HBoV), Mycoplasma pneumonia (MP) and Chlamydophila pneumonia (CP) by real-time fluorescence quantitative polymerase chain reaction. Bacterial infection was examined by conventional bacteriological identification methods. Results: Of the 22,825 nasopharyngeal secretion samples, 6,314 (27.66%) had evidence of viral infection. Respiratory viruses caused CAP at a high rate in children under 1 year of age (66.7%). The peak rate of respiratory virus detection occurs in winter. RSV, HBoV, and PInf3 are the most common viral pathogens of CAP in children in the Soochow area. The epidemic season of RSV was winter and autumn, that of HBoV was summer and autumn, and that of Pinf3 was summer. Conclusion: In the Soochow area, a substantial proportion of childhood CAP is due to viruses. The viral pathogens vary by season and clinical feature. Physicians must know their local epidemiology if they want to prevent and treat patients successfully.

Factors afffecting the treatment success of patients followed in the intensive care unit with community-acquired pneumonia

BACKGROUND: Pneumonia developing in the community is defined as community-acquired-pneumonia (CAP) and causes serious mortality. We aimed to investigate the characteristics and factors affecting the treatment success of severe CAP patients in the intensive care unit (ICU). MATERIALS AND METHODS: Demographic characteristics (age and gender), presence of comorbidity, duration of ICU and intubation, laboratory data, chest X-ray findings, mechanical ventilation (MV) supports, presence of sepsis, septic shock, requirement of inotropic, reintubation, tracheostomy, microbiological etiology in cultures, nutritional characteristics, and mortality of 121 CAP cases who were admitted to our ICU within 4 years were recorded retrospectively. Pneumonia severity index, predisposition, infection, response, organ dysfunction (PIRO), confusion, urea, respiratory rate, blood pressure-Age (CURB-65), and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were examined. RESULTS: Mortality in male gender was found to be higher (P = 0.009). It was determined that the nonsurvivor patients stayed longer in the ICU (P = 0.006). Mortality rate was higher in patients with bilateral and multilobar infiltration (P CONCLUSIONS: It was concluded that male gender, intubation, tracheostomy, supports of MV and inotropic, presence of sepsis, septic shock and multilobar, bilateral infiltration and pleural effusion on chest X-ray, low levels of pH, pO2, SaO2, and SpO2 may be factors affecting mortality in CAP patients in the ICU, PCT values, APACHE II, CURB-65, and PIRO scores can be used as a marker to predict mortality.