Respiratory Department Research Articles

Microalbuminuria on admission for acute exacerbation of COPD as a predictor of all-cause mortality and future exacerbations

ObjectivesMicroalbuminuria (MAB) is a sensitive biomarker of cardiovascular risk that is directly associated with cardiovascular events and mortality. Recent studies have evaluated the presence of MAB in patients with stable...

Analysis of syphilis antibody screening results of outpatients and inpatients in a hospital in Beijing from 2016 to 2020

Objective: The results of syphilis antibody screening in Peking University Third Hospital from 2016 to 2020 were analyzed,to explore the characteristics of sex, age and distribution of patients with positive syphilis antibody. Methods: A retrospective study was conducted to collect the results of syphilis antibody in outpatients and inpatients of Peking University Third Hospital from 2016 to 2020. Syphilis antibodies were screened in 626 528 patients aged 1-98 years, 4 232 were retested positive by TPPA test, including 2 132 males (50.4%) and 2 100 females (49.6%). Chemiluminescence immunoassay (CMIA) was used for syphilis antibody screening, and Treponema pallidum particle agglutination (TPPA) test was used for reexamination. SPSS20.0 data statistical analysis software was used to analyze the detection rate, age, sex, department and clinical diagnosis of patients with positive syphilis antibody by χ² test. Results: Among 626 528 patients who were positive for treponema pallidum antibody screening, 4 232 were retested positive by TPPA test, accounting for 0.68% of the total number of patients tested. The number of syphilis tests increased year by year, however the positive detection rate decreased. The positive detection rate of syphilis antibody in 2020 decreased by 18.9% compared with 2016. The positive rate of syphilis antibody in male patients was higher than that in female patients, accounting for 0.80% and 0.59% of the total number of patients tested respectively. The positive rate of syphilis antibody of different genders increased with age, the total positive rate of 0-20, 21-40, 41-60, 61-80,>80 years old were 0.15%, 0.45%, 0.95%, 1.07% and 1.41%, respectively. While the increase rate of males was higher than that of females. The positive rate of male over 80 years old was 18.13 times of the group of 0-20 years old, and 5.54 times in women. The top 6 departments with positive syphilis antibody detection rate were emergency department, oncology department, respiratory department, geriatrics department, endocrinology department and neurology department, and the positive rates were 1.79% (104/5 810),1.46% (55/3 767),1.20% (74/6 167),1.20% (22/1 833),1.10% (32/2 909),1.09% (94/8 624), respectively. From the analysis of clinical diagnosis, the proportion of positive syphilis antibody in infertile patients (0.64%, 672/104 911) was higher than that in naturally conceived patients (0.10%, 24/23 969). Conclusions: From 2016 to 2020, the positive detection rate of syphilis antibody in Peking University Third Hospital decreased year by year. However, the positive detection rate increased with the age of patients. The positive rate of syphilis antibody in male was higher than that in female. The positive rate of syphilis antibody in pregnant women was lower than that in infertile patients.

Associations of Clinical Characteristics and Intestinal Flora Imbalance in Stable Chronic Obstructive Pulmonary Disease (COPD) Patients and the Construction of an Early Warning Model.

ObjectiveEstablish a simple predictive model and scoring rule that is suitable for clinical medical staff in respiratory departments to assess intestinal flora imbalance occurrence in stable chronic obstructive pulmonary disease (COPD) patients.MethodsFrom January 1, 2019, to December 31, 2020, COPD patients (195 cases) – who attended the Outpatient Department, Respiratory and Critical Care, Yixing Hospital, Jiangsu University – were enrolled in a cross-sectional study. Based on stool examination results, patients were divided into experimental (41 cases) and control (154 cases) groups. Single-factor and logistic regression analyses were performed with the baseline data of the two groups to obtain a new predictive model, which was further simplified.ResultsFive predictive factors composed the model: body mass index (BMI), serum albumin (ALB), Charlson’s Comorbidity Index (CCI), gastrointestinal symptom score (GSRs), and Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. The model to predict intestinal flora imbalance in stable COPD patients had an area under the ROC curve (AUC) of 0.953 [95% CI (0.924, 0.982)]. After simplifying the scoring rules, the AUC was 0.767 [95% CI (0.676, 0.858)].ConclusionIn the current study, we obtained a model that could effectively predict intestinal flora imbalance risk in stable COPD patients, being suitable for implementation in early treatments to improve the prognosis. Moreover, all indicators can be easily and simply obtained.

Silent Hypoxia in COVID-19: A Case Series

Background: The coronavirus disease 2019 (COVID-19) pandemic is an ongoing global crisis challenging the worldwide healthcare systems. Many patients present with a mismatch of profound hypoxemia and few signs of respiratory distress (i.e., silent hypoxemia). This particular clinical presentation is often cited, but data are limited. Main Body: We describe dyspnea sensation as assessed by using the BORG scale in pulmonary patients admitted to the emergency room during a 4-week period and transferred to the respiratory department of Siloah Hospital, Hannover, Germany. From October 1 to November 1, 2020, 82 patients with hypoxemia defined as oxygen demand to achieve an oxygen saturation (SpO₂) ≥92% were included. In 45/82 (55%) patients, SARS-CoV-2 was detected by PCR on admission. Among non-COVID patients, exacerbation of COPD was the main diagnosis (15/37, 41%). All subjects rated their perceived dyspnea using the modified Borg CR10 scale. Patients in the non-COVID group suffered from more dyspnea on the modified Borg CR10 scale (median 1, IQR: 0–2 vs. median 5, IQR: 3–6, p < 0.001). In multivariate analysis, “silent hypoxemia” as defined by the dyspnea Borg CR10 scale ≥5 was independently associated with COVID-19 and presence of severe hypocapnia with an odds ratio of 0.221 (95% confidence interval 0.054, 0.907, p 0.036). Conclusion: Among pulmonary patients with acute hypoxemia defined as oxygen demand, patients suffering from COVID-19 experience less dyspnea compared to non-COVID patients. “Silent” hypoxemia was more common in COVID-19 patients.

Research on Application of Psychological Nursing in Patients with Fever in Respiratory Department

Research on Application of Psychological Nursing in Patients with Fever in Respiratory Department

A pneumatocele observed in the thoracic cavity after bronchoalveolar lavage

A 76-year-old man was admitted to the respiratory medicine department with 5 days of a non-productive cough and exertional dyspnea. A computed tomography revealed multiple mild patchy consolidations in both lungs (Figure 1). Despite antibiotic therapy, there was poor improvement in laboratory and radiological parameters. A bronchoscopy was performed on day 5. The bronchoscopy was wedged in left B5 and a bronchoalveolar lavage (BAL) was performed. After the BAL, we noticed a fistula in the depth of left B5 and saw a structure like a pleural cavity in the back of the fistula (Figure 2). We diagnosed the patient’s condition as pneumatocele (PC). BAL showed 46% lymphocytes and the CD4/8 ratio as 3:7. These findings suggested cryptogenic organizing pneumonia (COP). It took 3 weeks for the PC to improve. Bilateral multiple consolidations improved after the administration of a steroid (PSL 0.5 mg/kg). PCs can occur in infections, chest trauma, barotrauma from mechanical ventilation, and bronchial interventions [1,2]. The mechanism of PC formation is closely related to that of a check valve. The check valve may be composed of exudate from inflammation and the destroyed wall of the respiratory tract [3]. In this case, it was considered that the wedged bronchoscopy and collapsed bronchial wall became the check-valve. PCs can be a severe condition including tension pneumothorax, bronchopleural fistula, and secondary infections [4]. In our case, as we were concerned about new complications due to the PC we did not prescribe a steroid for COP until the PC had improved. To our knowledge, no papers have reported internal observations of PC. We herein report the first case of PC observed in the thoracic cavity after BAL.

Prevention of Adverse Reactions of Antibiotics in a Respiratory Department

Prevention of Adverse Reactions of Antibiotics in a Respiratory Department

Modified high-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients undergoing bronchoscopy: a randomized clinical trial

BackgroundHypoxemia frequently occurs during bronchoscopy. High-flow nasal cannula (HFNC) oxygen therapy may be a feasible alternative to prevent the deterioration of gas exchange during bronchoscopy. With the convenience of clinical use in mind, we modified an HFNC using a single cannula. This clinical trial was designed to test the hypothesis that a modified HFNC would decrease the proportion of patients with a single moment of peripheral arterial oxygen saturation (SpO2) < 90% during bronchoscopy.MethodsIn this single-center, prospective randomized controlled trial, hospitalized patients in the respiratory department in need of diagnostic bronchoscopy were randomly assigned to a modified HFNC oxygen therapy group or a conventional oxygen therapy (COT) group. The primary outcome was the proportion of patients with a single moment of SpO2 < 90% during bronchoscopy.ResultsEight hundred and twelve patients were randomized to the modified HFNC (n = 406) or COT (n = 406) group. Twenty-four patients were unable to cooperate or comply with bronchoscopy. Thus, 788 patients were included in the analysis. The proportion of patients with a single moment of SpO2 < 90% during bronchoscopy in the modified HFNC group was significantly lower than that in the COT group (12.5% vs. 28.8%, p < 0.001). There were no significant differences in the fraction of inspired oxygen between the two groups. The lowest SpO2 during bronchoscopy and 5 min after bronchoscopy in the modified HFNC group was significantly higher than that in the COT group. Multivariate analysis showed that a baseline forced vital capacity (FVC) < 2.7 L (OR, 0.276; 95% CI, 0.083–0.919, p = 0.036) and a volume of fluid instilled > 60 ml (OR, 1.034; 95% CI, 1.002–1.067, p = 0.036) were independent risk factors for hypoxemia during bronchoscopy in the modified HFNC group.ConclusionsA modified HFNC could decrease the proportion of patients with a single moment of SpO2 < 90% during bronchoscopy. A lower baseline FVC and large-volume bronchoalveolar lavage may predict desaturation during bronchoscopy when using a modified HFNC.Trial registration ClinicalTrials. Gov: NCT02606188. Registered 17 November 2015.

Explore the Predictive Value of Peripheral Blood Cell Parameters in Refractory Mycoplasma pneumoniae Pneumonia in Children Over 6 Years Old.

Background: To determine the predictive value of peripheral blood cell parameters for refractory Mycoplasma pneumoniae pneumonia (RMPP) in children over 6 years old.Methods: A retrospective study was conducted in children with RMPP admitted to the respiratory department of Tianjin Children's Hospital from September 2017 to September 2019, and non-refractory Mycoplasma pneumoniae pneumonia (NRMPP) was selected by the propensity score method and matched according to the ratio of 1:1.5. We analyzed the differences in clinical characteristics, peripheral blood cell parameters, imaging findings, and treatments between the two groups, and further determined the predictive value of peripheral blood cell parameters on RMPP.Results: There were 76 patients in the RMPP group and 114 patients in the NRMPP group. We found that the RMPP group has a longer clinical course and a higher incidence of intrapulmonary and extrapulmonary complications (p < 0.01). Moreover, the proportion of children in the RMPP group who received immunotherapy (such as glucocorticoid, gamma immunoglobulin) and fiberoptic bronchoscopy intervention was higher than that in the NRMPP group (p < 0.01). Meanwhile, the level of neutrophil, neutrophil/lymphocyte ratio (NLR), platelet count/lymphocyte ratio (PLR), mean platelet volume/lymphocyte ratio (MPVLR), C-reactive protein (CRP), lactic dehydrogenase (LDH), and interleukin (IL)-6 in the RMPP group was significantly higher (p < 0.01) than those in the NRMPP group. The incidence of pulmonary consolidation, atelectasis, and pleural effusion was also higher in the RMPP group (p < 0.05). ROC curve and binary logistic regression analysis showed that NLR > 3.92 (OR = 3.243; 95% CI = 1.485–7.081; p = 0.003), MPVLR > 5.29 (OR = 2.700; 95% CI = 1.258–5.795; p = 0.011), and pleural effusion (OR = 3.023; 95% CI = 1.424–6.420; p = 0.004) were significant factors in predicting RMPP. Our study showed that NLR had higher accuracy in predicting RMPP than CRP.Conclusions: The parameters of peripheral blood cells might be a predictor of RMPP. NLR > 3.92, MPVLR > 5.29, and pleural effusion might have important predictive value for RMPP in children over 6 years old.

Clinical Treatment and Observation of Chronic Cough in Respiratory Department

Clinical Treatment and Observation of Chronic Cough in Respiratory Department

The negative health effects of having a combination of snoring and insomnia.

Insomnia and snoring are common sleep disorders. The aim was to investigate the association of having a combination of insomnia symptoms and snoring with comorbidity and daytime sleepiness. The study population comprised 25,901 participants (16-75 years, 54.4% women) from 4 Swedish cities, who answered a postal questionnaire that contained questions on snoring, insomnia symptoms (difficulties initiating and/or maintaining sleep and/or early morning awakening), smoking, educational level, and respiratory and nonrespiratory disorders. Snoring was reported by 4,221 (16.2%), while 9,872 (38.1%) reported ≥ 1 insomnia symptom. A total of 2,150 (8.3%) participants reported both insomnia symptoms and snoring. The association with hypertension (adjusted odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-1.6), chronic obstructive pulmonary disease (adjusted OR, 1.8; 95% CI, 1.3-2.4), asthma (adjusted OR, 1.9; 95% CI, 1.6-2.3), daytime sleepiness (adjusted OR, 7.9; 95% CI, 7.1-8.8), and the use of hypnotics (adjusted OR, 7.5; 95% CI, 6.1-9.1) was highest for the group with both insomnia symptoms and snoring. Participants with both snoring and insomnia run an increased risk of hypertension, chronic obstructive pulmonary disease, asthma, daytime sleepiness, and use of hypnotics. It is important to consider snoring in patients seeking medical assistance for insomnia and, vice versa, in patients with snoring inquiring about insomnia. Hägg SA, Ilieva E, Ljunggren M, etal. The negative health effects of having a combination of snoring and insomnia. J Clin Sleep Med. 2022;18(4):973-981.

A Study on Effectiveness and Outcomes of Educational Inhaler Technique Counselling in Respiratory Department by Clinical Pharmacist

Abstract: Background: The correct inhalation technique is a crucial factor governing the efficiency of inhaled medication and is critical in ensuring optimal medication conveyance to the lungs. It is imperative to use the inhaler properly and to have sufficient knowledge, so we conducted this study to assess technique and provide education on Inhaler techniques in patients with respiratory disease. Materials and Methods: A Cross-sectional interventional study was conducted at the Department of Respiratory Medicine, Dhiraj Hospital, Vadodara, from October 2019 to March 2020. The inhalation technique was evaluated by specific checklist (NHS Liverpool Clinical Commissioning Group- inhaler device checklist). Patients having incorrect inhaler techniques were counselled along with physical demonstration of the proper inhaler technique. A pre-and post-intervention score was compared to evaluate the benefit of the intervention. Results: A total of 120 patients were enrolled in the study. Before counseling, 11.67%, 58.33%, and 30% of patients had poor, moderate, and good inhaler technique, respectively, while post counseling, 87.50%, 12.50%, and 0% had good, moderate, and poor inhaler technique, respectively. Pearson correlation coefficient (r) value of 0.6686 depicts strong positive correlation between pre-and post-intervention mean scores with significant p-value. Literacy and age showed considerable impact on inhaler techniques. Conclusion: Overall, the majority of patients had erroneous inhaler technique, however after counseling a dramatic surge in the number of patients having correct inhaler technique was beheld, which suggests that clinical pharmacist’s frequent counselling is indispensable and can improve efficacy and therapeutic outcomes. Key words: Asthma, COPD, Respiratory, Inhaler, Intervention, NHS checklist.

AKT 3 Induced Hepatitis: Case Report

Abstract: As tuberculosis is a global health problem. Non-adherence related to treatment regimen and inappropriate prescription of tuberculosis therapy may be one of the major contributing factors in public health. Hepatotoxicity is leading adverse effect of first line anti tuberculosis medication. They do not cause hepatotoxicity in all patients but there are many reported cases which showed hepatotoxicity due to antituberculosis drugs. This adverse effect occurs due to individual drug metabolize by alternative pathways. A 24-year-old female came to respiratory department with complains of dry cough and generalized weakness since one month, pedal edema for three days, breathlessness, chest pain and weight loss. She was known case of systemic lupus erythematosus with vitamin B12 deficiency with Hypothyroidism. She had recurrent tuberculosis in the last 15 days and for that she was put on isoniazid, rifampicin, ethambutol, pyrazinamide combination (HRZE regimen). Her laboratory reports suggest she developed hepatitis for which antituberculosis drugs were suspected. She was put on alternative regimen (streptomycin, levofloxacin, ethambutol and ethambutol). After stopping potent hepatotoxic medication, she started reliving symptoms of hepatitis. The early diagnosis of reaction and close monitoring of patient prevented the seriousness of reaction in this case. Key words: Tuberculosis, Anti Koch Therapy, Hepatotoxicity, Isoniazid, Rifampin.

P5‐73: Clinical characteristics of pulmonary melioidosis diagnosed at respiratory Department of the Tertiary Hospital in Southern Vietnam

P5‐73: Clinical characteristics of pulmonary melioidosis diagnosed at respiratory Department of the Tertiary Hospital in Southern Vietnam

Ventilation in patients with stage IIIB or above lung cancer.

BackgroundTo investigate the distribution of lung function and ventilation dysfunction in patients with locally advanced and advanced lung cancer, and the correlation with clinical factors.MethodsA retrospective study was conducted on patients who were discharged from the respiratory department of our hospital and diagnosed with locally advanced (IIIB, IIIC) or advanced (IVA, IVB) lung cancer from October 2013 to October 2020. Demographic information, clinical data, and lung function assessments were recorded, and the proportion and type of ventilation dysfunction and the correlations between them and clinical factors were statistically analyzed.ResultsA total of 130 patients were included. Han nationality accounted for 99.2%, and males accounted for 79.2% of patients. The average age was 68.48±10.77 years old. In terms of the stage of lung cancer, the proportion of locally advanced IIIB/IIIC was 34.6%, and the proportion of advanced IVA/IVB was 65.4%. The lung function results were as follows: forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) was 72.27% (62.35%, 79.60%), FEV1/vital capacity (VC) was 71.35% (61.78%, 79.20%), FEV1 was 1.72±0.64 L, VC was 2.44±0.70 L, and total lung volume (TLC) was 4.41±0.97 L. Obstructive, restrictive, and mixed ventilation dysfunction accounted for 23.1%, 26.9%, 27.7%, respectively, and 93.1% had not received lung function screening or treatment before. A total of 42 cases (32.3%) had moderate or above obstruction or mixed (mainly obstruction) ventilation dysfunction. The most common symptoms were cough (88.1%), expectoration (71.4%), and dyspnea (40.5%). The chi-square test showed that male, ≥70 years old, smoking history, smoking index ≥800 years, accompanied by airway diseases [chronic obstructive pulmonary disease (COPD)/asthma/chronic bronchitis], and computed tomography (CT) with atelectasis accounted for a higher proportion (P<0.05). Logistic regression showed that age (P=0.003), smoking history (P=0.04), atelectasis (P=0.004), and associated airway diseases (P=0.001) were significant related factors.ConclusionsSome patients with locally advanced or advanced lung cancer have ventilation dysfunction, especially moderate or above obstruction or mixed (mainly obstruction) ventilation dysfunction. For vulnerable populations such as males, the elderly, long-term heavy smokers, patients with airway diseases, or patients with atelectasis on CT, lung function assessment and intervention should be improved to further manage the symptom control and quality of life of patients with this type of lung cancer.

Étude D-CBP : Évaluation des délais de prise en charge du cancer broncho- pulmonaire au sein du service de Pneumologie et d’Oncologie Thoracique du CHU de Caen

Lung cancer is the leading cause of cancer-related death. Delays may have an impact on patient survival. The objective of this study was to evaluate the diagnostic and therapeutic management times for patients admitted for lung cancer treatment in the Respiratory Department of CHU de Caen Normandie. This is a retrospective, single-center and observational study, conducted on all patients treated for lung cancer from June 2017 to January 2018 in our department of pneumology in the Caen Normandie CHU. The main median times were investigated were: Global Time (abnormal imaging-treatment), Diagnosis time (abnormal imaging-diagnosis) and Treatment Time (diagnosis-treatment). One hundred and twenty-seven (127) patients were included. Median global time was 55.5 days [31,25; 393], median diagnosis time was 22 days [13; 49], and median treatment time was 24.5 days [12,25; 45]. Our treatment times are consistent with those previously published. Areas for improvement are being developed in accordance with the 2014-2019 cancer plan, in particularly the creation in our institution of a specific care pathway for patients with lung cancer.

Knowledge of chronic obstructive pulmonary disease, presence of chronic respiratory symptoms and use of spirometry among the Spanish population: CONOCEPOC 2019 study

ObjectiveThe aim of this study was to analyze current data on the population's level of knowledge about COPD and to evaluate certain diagnostic interventions, such as the use of spirometry. Material and methodsAn epidemiological, observational, cross-sectional study by telephone interview, with random dialing of landline telephone numbers, was conducted in November 2019, in a nationally representative sample of adults over 40 years of age. ResultsFrom a total of 51,079 telephone calls, a total of 1920 individuals responded. Mean age was 61.9 years and 31.6% were men. Overall, 19.4% were current smokers and 13.4% reported respiratory disease (5% reported COPD). In total, 27.9% had spontaneous knowledge of COPD, which is a relative increase from the 17% observed in 2011. The most frequent information channel was the media (35.5%), with a significant presence of social networks and the Internet (25.7%). Almost one fifth (18.1%) had chronic respiratory symptoms. Of these, 59.3% had requested medical care, and 66.2% had undergone spirometry. Spirometry was performed less frequently in subjects treated in primary care compared to respiratory medicine departments (51.9% versus 79.1%; P < .001). ConclusionsKnowledge of COPD is still scarce, and strategies are needed to increase awareness and the importance of assessing respiratory symptoms and increased use of spirometry.

High-resolution computed tomography (HRCT) analysis in anti-synthase antibody syndrome with organizing pneumonia

ObjectiveThe organizing pneumonia (OP) pattern is the second most common finding in anti-synthase antibody syndrome (ASS), and nonspecific interstitial pneumonia (NSIP) is the most common finding. This study analysed the OP score changes by semiquantitative and quantitative analysis methods and the correlation between the high-resolution computed tomography (HRCT) indexes and the pulmonary function test parameters (PFTs) in ASS patients. MethodsData from ASS-OP patients admitted to the respiratory department of Ping Jin Hospital from October 2014 to June 2020 were retrospectively reviewed and analysed. ResultsFourteen ASS-OP patients were recruited for this study. (1) In method-1, the consolidation (CO) score and the mean lung attenuation (MA) of poorly aerated and fibrosis lung fields (MAfibrosis) (r=0.56, P=0.04), the ground-glass opacity (GGO) score and the MA of non-aerated lung fields (MAnonaerated) (r=−0.64, P=0.01), and the CO plus the GGO (CG) score and the MAnonaerated (r=−0.59, P=0.03) of the lung fields had liner correlations. In method-2, the GGO score to the MAnonaerated (r=−0.58, P=0.03), and the CG (r=−0.68, P=0.01) score to the MAnonaerated had liner correlations. The FVC% (r=0.68, P=0.01) and FEV1% (r=0.64, P=0.01) to the MAfibrosis had good linear correlations. (2) Compared to the values before treatment, the CO pattern score, volume and weight percentages of the extracted whole lung volume with attenuation values of the nonaerated area (Vnonated%, Wnonaerated%), the volume of poorly aerated and fibrosis lung tissue (Vfibrosis%, Wfibrosis%), the weight percentages of normal aerated lung (Wnormal%), and the MAfibrosis exhibited significant differences during the 3–6 month follow-up period. ConclusionThe GGO and CO scored by the semiquantitative or quantitative analysis methods was similar. The HRCT quantitative analysis parameters showed a good correlation with the PFTs in ASS-OP patients, can provide an accurate OP pattern interpretation, and may be used as a monitoring and therapeutic indicator for ASS-OP patients.

"Overview of Carbapenem-Resistant Enterobacteriaceae"

Min Shi* and Xiang-qun Fang Author Affiliations Department of Respiratory and Critical Care Medicine, Second Medical Center of Chinese PLA General Hospital, China Received: October 05, 2021 | Published: October 11, 2021 Corresponding author: Min Shi, Department of Respiratory and Critical Care Medicine, Second Medical Center of Chinese PLA General Hospital, No. 28 of Fuxing Street, Haidian District, Beijing, 100853, China DOI: 10.26717/BJSTR.2021.39.006285

Empirical antibiotic usage and bacterial superinfections in patients with COVID-19 in Japan: A nationwide survey by the Japanese Respiratory Society.

An internet questionnaire survey for investigating empirical antibiotic usage and bacterial superinfections in patients with coronavirus disease-2019 (COVID-19) in Japan was conducted among the chief physicians of respiratory disease departments of 715 Japanese Respiratory Society-certified hospitals using Google Forms between January 28, 2021 and February 28, 2021. Responses to the questionnaire survey were obtained from 198 of 715 hospitals (27.6%). The survey revealed that the complication incidences of community-acquired pneumonia; hospital-acquired pneumonia, including ventilator-associated pneumonia; and sepsis were 2.86, 5.59, and 0.99%, respectively, among patients with moderate/severe and critical COVID-19. Bacterial co-infection and secondary infection rarely affected patients with COVID-19 in Japan, and the isolated pathogens were not specific to these patients. Moreover, the anti-inflammatory effects of macrolides for COVID-19 were not observed in several studies. These results might be useful in clinical practice for COVID-19.