Rate Of Lower Respiratory Tract Infections Research Articles

Analysis of the Current Situation and Risk Factors of Lower Respiratory Tract Infection among ICU Patients in Guizhou, China During 2019–2022

Objective: This study aims to explore the prevalence, features, and risk factors of lower respiratory tract infections (LRTIs) in the intensive care unit (ICU) of a newly established hospital in Zunyi City. The goal is to devise strategies for preventing LRTIs in the ICU of new hospitals, thereby mitigating the incidence of nosocomial LRTIs in ICU patients. Methods: A case-control study was conducted from March 2019 to December 2022 to investigate the incidence rate of LRTIs in the ICU of a newly constructed hospital in Zunyi City. Patients with LRTIs constituted the case group, while those without LRTIs constituted the control group, where a 1:1 matching principle was adhered to. A single-factor chi-squared (χ2) test was employed to analyze the risk factors, with independent risk factors being explored using a multivariate logistic regression analysis. Results: A total of 169 strains of pathogenic bacteria were isolated, comprising 66.28% gram-negative bacteria, 17.75% gram-positive bacteria, and 15.97% fungi. The most prevalent pathogens included Acinetobacter baumannii (43.20%), Candida albicans (10.65%), and Pseudomonas aeruginosa (8.88%). Of the 82 strains infected by multidrug-resistant bacteria in patients with LRTIs, 81.7% were carbapenem-resistant Acinetobacter baumannii, 9.8% were multidrug-resistant Pseudomonas aeruginosa, and 6.1% were carbapenem-resistant Escherichia coli. Identified risk factors included smoking history, total hospitalization days, ICU stay length, hypoproteinemia, indwelling gastric tube, intubation type, duration of mechanical ventilation, usage of antibacterial drugs, and administration of protein drugs (P < 0.05). Multivariate logistic regression analysis demonstrated that these factors were independent risk factors for nosocomial LRTIs in ICU patients (P < 0.05). Conclusion: ICU patients in our hospital were mainly infected by carbapenem-resistant Acinetobacter baumannii. To prevent LRTIs in patients, tailored preventive measures should be developed and the rational use of antibacterial drugs should be promoted.

Issue Information

Cover Legend The global disease burden of lower respiratory infections for both sexes in 204 countries and territories: The age‐standardized mortality rate of lower respiratory infection (LRI) in 2019 (Top); The estimated annual percentage change (EAPC) of LRI mortality from 1990 to 2019 (Bottom). See Kang et al., p 170.image

Causes of Lower Respiratory Tract Infections and the Use of Diagnostic Biomarkers in Blood Samples from Children in Hohhot, Inner Mongolia, China, Between July 2019 and June 2020.

BackgroundLower respiratory tract infection (LRTI) in children is due to various pathogens. Appropriate diagnosis and early treatment are important for reducing the mortality rate of LRTI. Data on the epidemiology profiles of LRTI are scarce in northern China. The aim of this study was to provide data on the pathogen pattern of LRTI in hospitalized children in Hohhot, Inner Mongolia, China.Material/MethodsFrom July 2019 to June 2020, nasopharyngeal swabs were collected from 265 children in Hohhot with LRTI, and pathogens were detected with RT-PCR and PCR. The correlations among procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC) with acute respiratory infections were evaluated.ResultsThe highest prevalence of LRTI was detected in 2- to 6-year-old children (149, 56.2%) in winter. Eleven respiratory pathogens were evaluated, and respiratory syncytial virus, Streptococcus pneumoniae and Haemophilus influenza were the most common pathogens in this region. Single viruses, bacteria, mycoplasma, and multiple pathogens were identified in 24.2, 15.8, 5.3, and 54.7% of patients, respectively. The mean blood biomarker values of patients with LRTI were significantly different from those of healthy children. Furthermore, The AUCs were 0.90, 0.74, and 0.84 for bacteria, virus, and mycoplasma PCT values, which were significantly higher than that of WBC and CRP.ConclusionsThis evaluation of the regional pattern of pathogens in children with acute respiratory infections and the correlation with blood biomarkers provides valuable information for the prevention and treatment of LRTI in children.

Lower respiratory tract infection hospitalizations among American Indian/Alaska Native adults, Indian Health Service and Alaska Region, 1998–2014

Objectives: This study describes the changes in lower respiratory tract infection (LRTI) rates from 1998 to 2014 among hospitalized American Indian/Alaska Native (AI/AN) adults residing in Alaska and other Indian Health Service (IHS) regions.Methods: Age-adjusted hospital discharge rates and rate ratios were calculated from the IHS Direct and Contract Health Services Inpatient Dataset, IHS National Patient Information Reporting System for AI/AN adults ≥18 years, hospitalized at an IHS-operated, tribally operated, or contract hospital with an LRTI-associated diagnosis during 1998–2014.Results: Overall, there were 13 733 LRTI-associated hospitalizations in Alaska (1998–2014), with an age-adjusted rate of 13.7/1000 adults. Among non-Alaska (non-AK) AI/AN, there were a total of 79 170 hospitalizations, with a rate of 8.6/1000 adults. In the pre-PCV7 and pre-PCV13 periods, LRTI rates were higher in Alaska (AK) AI/AN (12.4 and 14.1, respectively) when compared to non-AK AI/AN (10.1 and 9.1, respectively) (P < 0.0001). In the post-PCV7 and post-PCV13 periods, LRTI rates were also higher in AK (13.5 and 15.0, respectively) compared to non-AK (9.2 and 7.3, respectively) (P < 0.0001).Conclusions: Over the study period, a 26% increase in rates of LRTI among adult AI/AN residing in AK compared with a 38% decrease in rates among AI/AN residing in non-AK were observed. This disparity is likely due to a variety of factors such as tobacco use, crowding, etc. Strategies to reduce LRTI in AI/AN adults are needed.

Predicting the hotspots of age-adjusted mortality rates of lower respiratory infection across the continental United States: Integration of GIS, spatial statistics and machine learning algorithms

ObjectiveAlthough lower respiratory infections (LRI) are among the leading causes of mortality in the US, their association with underlying factors and geographic variation have not been adequately examined. MethodsIn this study, explanatory variables (n = 46) including climatic, topographic, socio-economic, and demographic factors were compiled at the county level across the continentalUS.Machine learning algorithms - logistic regression (LR), random forest (RF), gradient boosting decision trees (GBDT), k-nearest neighbors (KNN), and support vector machine (SVM) - were employed to predict the presence/absence of hotspots (P < 0.05) for elevated age-adjusted LRI mortality rates in a geographic information system framework. ResultsOverall, there was a historical shift in hotspots away from the western US into the southeastern parts of the country and they were highly localized in a few counties. The two decision tree methods (RF and GBDT) outperformed the other algorithms (accuracies: 0.92; F1-scores: 0.85 and 0.84; area under the precision-recall curve: 0.84 and 0.83, respectively). Moreover, the results of the RF and GBDT indicated that higher spring minimum temperature, increased winter precipitation, and higher annual median household income were among the most substantial factors in predicting the hotspots. ConclusionsThis study helps raise awareness of public health decision-makers to develop and target LRI prevention programs.

Consideration of Cough Reflex Development When Ordering Modified Barium Swallow Studies in Infants.

Infants <51weeks post-menstrual age (<51 PMA) are often referred for modified barium swallow (MBS) studies for suspectedsilent aspiration (SA) given a possible association between SA and aspiration pneumonia. Infants this young are unlikely to have developed a mature laryngeal cough reflex, most likely rendering SA an expected finding in those who aspirate. The aims of this retrospective review were to (1) determine if SA resolves in a significant proportion of infants around the expected emergence of the laryngeal cough reflex, (2) determine which factors or characteristics are associated with and without SA resolution in these infants, and (3) determine if SA, or any aspiration, is associated with increased rates of lower respiratory infection (including aspiration pneumonia) in these infants. Results from the chart review revealed that 79/148 (53.4%) infants had SA on MBS < 51 PMA. 16/48 (33.3%) infants assessed for SA by the time of the expected emergence of the cough reflex had resolution. SA resolution was less common in infants with obstructive sleep apnea (p = 0.037). A total of 50/70 (71.4%) infants with a follow-up MBS had eventual SA resolution. Aspiration was not significantly associated with LRI, including aspiration pneumonia. The results suggested that the laryngeal cough reflex might develop later than reported in the literature and there is no association between aspiration and LRI. These findings may indicate that age should be considered before ordering an MBS solely to assess for SA in this population. The study provides preliminary evidence for future prospective research regarding SA resolution.

Outcomes following feeding gastrostomy (FG) insertion in patients with learning disability: a retrospective cohort study using the health improvement network (THIN) database

ObjectivesTo measure the rates of lower respiratory tract infection (LRTI) and mortality following feeding gastrostomy (FG) placement in patients with learning disability (LD). Following this to compare these rates between...

The Etiology of Viral Lower Respiratory Tract Infections at a Tertiary Hospital in Jordan over Five Years

Background&#x0D; Lower respiratory tract infection (LRTI) is the most common condition treated in primary care and is considered the third leading cause of death worldwide. The objective of our study is to determine the etiological agents that cause viral LRTI in Jordan, aiming to help physicians to choose the appropriate treatment strategy.&#x0D; Materials and Methods &#x0D; We conducted a retrospective study on patients who were admitted with the diagnosis of LRTI between January, 2011 and January, 2016. We used Fast-track Diagnostics (FTD)® Respiratory 21 Kit (Fast-track Diagnostics, Luxembourg) real-time PCR to determine the viral etiology of LRTI, and we investigated pandemic H1N1 2009 swine flu virus using rapid test PCR.&#x0D; Results &#x0D; This study involved 495 patients with a mean age of 57.79 ± 18.43 years. The causative agents were identified in 157 patients out of 495 patients (31.7%). FTD real-time PCR was done for 170 patients, and the test was positive for seasonal Influenza A virus in 7.1% of patients, influenza B in 4.1%, RSV in 4.7%, metapneumovirus in 4.1%, adenovirus in 4.1%, corona 229E/NL63 in 4.1%, parainfluenza virus in 7.6%, and rhinovirus in 3.5%. The percent of cases who were positive for pandemic H1N1 2009 swine flu virus was 4.2%. The rate of ICU admission was 16.8%, and the mortality rate of LRTI was as low as 3.64%.&#x0D; Conclusions&#x0D; Viral LRTI is more common in winter season in Jordan, especially in January. Remarkably, Influenza A and Parainfluenza viruses were the main viral causative agents for LRTI in our study.

Deaths attributed to ambient air pollution in China between 2006 and 2016

Objective: To analyze the deaths attributed to ambient air pollution in China between 2006 and 2016. Methods: The data were collected from the project of Global Burden of Disease in 2016 (GBD2016). The Data Integration Model for Air Quality were used to estimate exposure to particulate matter smaller than 2.5 μm in aerodynamic diameter (PM(2.5)). The attributable death number was calculated based on the calculation of population attributable fraction (PAF), and the results were compared by gender, diseases and provinces. An average world population age structure was adopted to calculate age-standardized rates. Results: In 2016, a total of 1 075 000 deaths attributed to ambient air pollution occurred in China, accounting for 11.1% of the total deaths, and 57.6% of the deaths attributed to ambient air pollution were due to ischemic heart disease and stroke. The death number among men was 1.7 times higher than that in women, Compared with 2006, the proportion of ambient air pollution related deaths in total deaths decreased by 6.8%; the age- standardized death rate attributed to ambient air pollution decreased by 26.5% and the decrease rate of lower respiratory infections (37.6%) and chronic obstructive pulmonary disease (42.1%) were greater than ischemic heart disease (5.3%). The age-standardized rate of death attributed to ambient air pollution decreased both in men and in women, but the decrease rate was higher in women (34.8%) than that in men (20.4%). The PAFs varied among provinces, it was highest in Tianjin (13.9%), lowest in Tibet (6.1%), and it was relatively higher in Beijing, Hebei, Shandong, Henan and the three provinces in the northeast and relatively lower in Hong Kong, Macao, Fujian and Hainan etc.. The age-standardized rate of death attributed to ambient air pollution was highest in Xinjiang (120.1/100 000) and lowest in Hong Kong (30.9/100 000), and it was relatively higher in Qinghai, Guizhou, Henan and relatively lower in Macao, Shanghai and Fujian, etc.. Compared with 2006, the PAFs of 17 provinces decreased, the decrease rate ranged from 4.1% to 16.8%, whereas the PAF of Jilin (5.0%) and Heilongjiang (8.1%) increased, and the PAFs of other 14 provinces showed no significant change. The attributable age-standardized death rate decreased in all provinces with the decrease rate ranging from 11.9% (Heilongjiang) to 43.2% (Fujian), and the decrease rate was relatively higher in Guangdong, Zhejiang and Guizhou, and lower in the three provinces in the northeast, Hubei and Hebei etc. Conclusions: In 2016, the disease burden attributable to PM(2.5) in China was heavy, but mitigated compared with 2006. The gender and area specific distributions of deaths attributed to ambient air pollution were observed.

Leukopenia and lack of ribavirin predict poor outcomes in patients with haematological malignancies and respiratory syncytial virus infection.

Respiratory syncytial virus (RSV) infection causes morbidity and mortality in cancer patients. However, studies describing this infection in patients with haematological malignancies are scarce. We sought to evaluate the clinical impact of RSV infection on this patient population. We reviewed the records of patients with haematological malignancies and RSV infections cared for at our institution between January 2000 and March 2013. Of the 181 patients, 71 (39%) had AML, ALL or myelodysplastic syndrome, 12 (7%) had CML or CLL, 4 (2%) had Hodgkin lymphoma, 35 (19%) had non-Hodgkin lymphoma and 59 (33%) had multiple myeloma. Most patients [117 (65%)] presented with an upper respiratory tract infection (URTI) and 15 (13%) had a subsequent lower respiratory tract infection (LRTI). The overall LRTI rate was 44% and the 90 day mortality rate was 15%. Multivariable regression analysis showed that having both neutropenia and lymphocytopenia (adjusted OR = 7.17, 95% CI = 1.94-26.53, P < 0.01) and not receiving ribavirin-based therapy during RSV URTI (adjusted OR = 0.03; 95% CI = 0.01-0.11, P < 0.001) were independent risk factors for LRTI. Having both neutropenia and lymphocytopenia at RSV diagnosis was also a risk factor for death at 90 days after RSV diagnosis (adjusted OR = 4.32, 95% CI = 1.24-15.0, P = 0.021). Patients with haematological malignancies and RSV infections, especially those with immunodeficiency, may be at risk of LRTI and death; treatment with ribavirin during RSV URTI may prevent these outcomes.

Flu Vaccine Coupled to Vitamin D Decrease the Frequency of Lower Respiratory Tract Infections (Randomized Controlled Trial)

Introduction: Influenza disease is one of the major health concerns in pediatrics. One of the most recently suggested effects of vitamin D is preventing infectious diseases. The aim of our study was to compare flu vaccine effect to flu vaccine associated to vitamin D (100,000 UI per OS) in reducing respiratory tract infections in children. Patients and Methods: 347 healthy children aged 2 to 5 years randomly selected during fall 2012 and the following season fall 2013 were included; upper and lower respiratory tract infections following vaccination were noted. Our results were analyzed using SPSS program (Chi-square and T-test). Results: Out of a total of 347 children included, 150 received flu vaccine and 197 received flu vaccine plus vitamin D. 88 children from both groups manifested upper respiratory tract infections and 64 had lower respiratory tract infections. The statistical analysis revealed no significant difference between the two groups concerning the upper respiratory tract infection (p = 0.207) and a significant difference between groups for the lower respiratory tract infection (p = 0.001). Conclusion: Coupling vitamin D to flu vaccine provides no protection against upper respiratory infections but provides an effective strategy to decrease the rate of lower respiratory infections in children 2 - 5 years of age.

Respiratory Tract Infections Due to Human Metapneumovirus in Immunocompromised Children.

BackgroundThe clinical presentation and management of human metapneumovirus (hMPV) infections in immunocompromised children is not well understood.MethodsWe performed a retrospective evaluation of pediatric patients with laboratory-confirmed hMPV infections and underlying hematologic malignancy, solid tumors, solid organ transplant, rheumatologic disease, and/or receipt of chronic immunosuppressants. Data were analyzed using t tests and Fisher’s exact tests.ResultsOverall, 55 patients (median age: 5 years; range: 5 months–19 years) with hMPV infection documented between 2006 and 2010 were identified, including 24 (44%) with hematologic malignancy, 9 (16%) undergoing hematopoietic stem cell transplant, 9 (16%) with solid tumors, and 8 (15%) with solid organ transplants. Three (5%) presented with fever alone, 35 (64%) presented with upper respiratory tract infections, and 16 (29%) presented with lower respiratory tract infections (LRTI). Twelve (23%) patients required intensive care unit admission and/or supplemental oxygen ≥28% FiO2. Those with severe disease were more likely to be neutropenic (P = .02), but otherwise did not differ by age (P = .27), hematopoietic stem cell transplant recipient status (P = .19), or presence of lymphopenia (P = .09). Nine (16%) patients received treatment with ribavirin, intravenous immunoglobulin, or both. Three children (5%) died of hMPV pneumonia.ConclusionsImmunocompromised pediatric patients with hMPV infection have high rates of LRTI and mortality. The benefits of treatment with ribavirin and intravenous immunoglobulin in this patient population require further evaluation.

Bronchiolitis and pneumonia requiring hospitalization in young first nations children in Northern Ontario, Canada.

High rates of lower respiratory tract infection (LRTI), including bronchiolitis and pneumonia, have been reported in Inuit infants living in arctic Canada. We examined rates of LRTI in First Nations Canadian infants living in the Sioux Lookout Zone, in Northern Ontario. A retrospective review of hospital admissions for LRTI during a 5-year period, in patients <1 year of age was carried out at the Sioux Lookout Meno Ya Win Health Centre, an acute-care hospital that provides secondary care to 31 mainly isolated communities and the town of Sioux Lookout. Admission rates were compared with those in the province of Ontario, as a whole. One-hundred and seventeen subjects were identified. The annualized rate of admission for nonbacterial LRTI was 44 per 1000 infants <1 year of age per year. This rate was significantly higher than for the whole province (P = 0.011). Admission rates also varied significantly between communities (P < 0.001).Thirteen percent of subjects required transfer to a tertiary care center. A virus was identified in 55% (36/65) of subjects tested for respiratory viruses, and respiratory syncytial virus and parainfluenza virus were identified most often. Of patients who had a blood culture performed, bacteria were found in 10% (6/59) of subjects. Many patients had radiographic evidence of consolidation, consistent with pneumonia. Rates of LRTI are significantly elevated in First Nations infants living in the Sioux Lookout Zone. Varying rates between communities suggest that environmental factors may be contributing to rates of LRTI in this population.

Three-Year Study of Viral Etiology and Features of Febrile Respiratory Tract Infections in Japanese Pediatric Outpatients

For most febrile respiratory tract infections (RTIs) in children, the causative pathogen is never identified. We sought to identify the causative pathogen in individual cases of pediatric outpatient with RTIs and to determine whether particular clinical features of RTIs are associated with particular viruses. Over 3 years, we prospectively collected nasopharyngeal aspirate specimens from individual pediatric outpatients with an RTI accompanied by persistent fever (>3 days, ≥38.0°C) and peak temperature ≥39.0°C. Two methods-(1) viral culture for respiratory viruses and (2) real-time polymerase chain reaction (PCR) assays identifying 9 different respiratory viruses and 2 respiratory bacteria-were used to test specimens. For 495 specimens, viral culture and real-time PCR assays together identified at least 1 pathogen in 83.0% and ≥1 viruses alone in 79.4%. These 2 methods identified 138 children with respiratory syncytial virus, 66 with human metapneumovirus, 73 with parainfluenza viruses, 124 with adenovirus, 23 with rhinovirus, 38 with enterovirus, 11 with influenza type C virus, 15 with Mycoplasma pneumoniae and 3 with Chlamydophila pneumoniae; the coinfection rate was 19.7% among all infections. Among the patients with single-pathogen infections, the rate of lower RTI was 37.6% for respiratory syncytial virus, 40.7% for human metapneumovirus, 18.2% for parainfluenza viruses and 2.2% for adenovirus (P < 0.01). Viral culture and real-time PCR assays were used together to identify causative pathogens in 83% of febrile outpatient children with RTI; specific viruses were associated with particular clinical diagnoses.

The cost of lower respiratory tract infections hospital admissions in the Canadian Arctic

BackgroundInuit infants who reside in the Nunavut (NU) regions of Arctic Canada have extremely high rates of lower respiratory tract infections (LRTIs) associated with significant health expenditures, but the costs in other regions of Arctic Canada have not been documented.ObjectiveThis prospective surveillance compares, across most of Arctic Canada, the rates and costs associated with LRTI admissions in infants less than 1 year of age, and the days of hospitalization and costs adjusted per live birth.DesignThis was a hospital-based surveillance of LRTI admissions of infants less than 1 year of age, residing in Northwest Territories (NT), the 3 regions of Nunavut (NU); [Kitikmeot (KT), Kivalliq (KQ) and Qikiqtani (QI)] and Nunavik (NK) from 1 January 2009 to 30 June 2010. Costs were obtained from the territorial or regional governments and hospitals, and included transportation, hospital stay, physician fees and accommodation costs. The rates of LRTI hospitalizations, days of hospitalization and associated costs were calculated per live birth in each of the 5 regions.ResultsThere were 513 LRTI admissions during the study period. For NT, KT, KQ, QI and NK, the rates of LRTI hospitalization per 1000 live births were 38, 389, 230, 202 and 445, respectively. The total days of LRTI admission per live birth were 0.25, 3.3, 2.6, 1.7 and 3 for the above regions. The average cost per live birth for LRTI admission for these regions was $1,412, $22,375, $14,608, $8,254 and $10,333. The total cost for LRTI was $1,498,232 in NT, $15,662,968 in NU and $3,874,881 in NK. Medical transportation contributed to a significant proportion of the costs.ConclusionLRTI admission rates in NU and Nunavik are much higher than that in NT and remain among the highest rates globally. The costs of these admissions are exceptionally high due to the combination of very high rates of admission, very expensive medical evacuations and prolonged hospitalizations. Decreasing the rates of LRTI in this population could result in substantial health savings.

Attributable costs of ventilator-associated lower respiratory tract infection (LRTI) acquired on intensive care units: a retrospectively matched cohort study

BackgroundLower respiratory tract infections (LRTI) are the most common hospital-acquired infections on ICUs. They have not only an impact on each patient’s individual health but also result in a considerable financial burden for the healthcare system. Our aim was to determine the costs and the length of stay of patients with ICU-acquired LRTI.MethodsWe used a retrospectively matched cohort design, comparing patients with ICU-acquired LRTI and ICU patients without LRTI. LRTI was diagnosed using the definitions of the Centers for Disease Control and Prevention (CDC). Study period was from January to December 2010 analyzing patients from 10 different ICUs (medical, surgical, interdisciplinary). The device utilization ratio was defined as number of ventilator days divided by number of patient days and the device-associated LRTI rate was defined as number of ventilator associated LRTI divided by number of ventilator days. Patients were matched by age, sex, and prospectively obtained Simplified Acute Physiology Score II (SAPS II). The length of ICU stay of control patients needed to be at least as long as that of LRTI-patients before onset of LRTI. We used the Wilcoxon signed-rank test for continuous variables and the McNemar’s test for categorical variables.ResultsThe analyzed ICUs had 40,772 patient days in the study period with a median ventilation utilization ratio of 56 (IQR 42–65). The median device-associated LRTI rate was 3.35 (IQR 0.96-5.36) per 1,000 ventilation days. We analyzed 49 patients with ICU-acquired LRTI and 49 respective controls without LRTI. The median hospital costs for LRTI patients were significantly higher than for patients without LRTI (45,041 € vs. 26,467 €; p < .001). The attributable costs per LRTI patient were 17,015 € (p < .001). Patients with ICU acquired LRTI stayed longer in the hospital than patients without (36 days vs. 24 days; p = 0.011). An LRTI lead to an attributable increase in length of stay by 9 days (p = 0.011).ConclusionsICU-acquired LRTI is associated with increased hospital costs and prolonged hospital stay. Hospital management should therefore implement control measurements to keep the incidence of ICU-acquired LRTI as low as possible.

Nursing intervention on lower respiratory tract infection caused by multidrug-resistant bacteria

Objective To explore the correlated factors of respiratory tract infection resulted from multidrug-resistant (MDR) bacteria and provide the nursing interventions measures in order to reducing infection rates. Methods This study is a prospective study. The clinical data of 146 patients with lower respiratory tract infection in our hospital from January 2007 to December 2008 were collected and the high risk factors in nursing practices and environment were analyzed. Results The lower respiratory tract infection rate in patients with open airway and mechanical ventilation was highest(71.8%). A high volume bacterium in nurses' hands was the highest risk factor. The tendency of MDR bacteria were increasing. Conclusions Controlling the risk factors and treating the MDR bacteria is necessary to decrease the lower respiratory tract infection in ICU. Key words: ICU; Multidrug-resistant bacteria; Lower respiratory tractor; Nursing intervention

Surveillance of lower respiratory tract infections outbreaks in nursing homes in France

Lower respiratory tract infections (LRTI) are the leading cause of infectious deaths in nursing homes. An early reporting procedure of LRTI outbreaks to local public health authorities was set up in France in 2006 in order to reduce the morbidity and the mortality related to these events. Local public health authorities reported these outbreaks to the French institute for Public Health Surveillance through a web application allowing a real-time exchange of information. Between August 2006 and July 2007, 64 outbreaks were reported. In more than 30% of the episodes, influenza virus was detected. On average, attacks rates were 22% for the residents and 7% for the staff. Staff members were affected in at least 56% of outbreaks. Average influenza vaccine uptake was 91% for the residents and 38% for the staff. The time for control measures implementation was 6.7 days on average and control measures were implemented after reporting in 36% of outbreaks. When control measures were implemented more than 2 days after the onset of the first case, the duration of outbreaks was longer (16.4 days vs. 8.3 days, P < 0.005) and residents had an increased rate of LRTI (P < 0.001) than when these measures were implemented earlier. These data show that the influenza immunization coverage for staff working in nursing homes is limited. The implementation of control measures is often delayed, although recommendations stress that they should start upon diagnosis of the first case. Reporting creates a dialog between nursing homes and public health professionals which facilitates outbreak management.

Investigation of correlation factor in lower respiratory tract infection after tracheotomia in ICU

Objective To study the correlation factors in lower respiratory tract infections after tracheotomia in ICU. Methods 20 patients were accepted. We gathered the samples on skin of neck before tracheotomia, and gathered 12 samples on buccal cavity, professional jargon, pharyngeal portion secretion, sputum at lower respiratory tract, ward atmosphere, article surface, drainage tube, pipeline interface of breathing machine, humidification bottle, tracheostomy cannula and hands of nurse, respectively, at the first day, fifth day, tenth day and fifteenth day after tracheotomia. And then the relationship of kinds of factors and lower respiratory tract infection was analyzed by Chi-square criterion and Spearman rank correlation analysis of Stata 9.0 statistics software. Results The rate of lower respiratory tract infection was 95%, and the results were not same at indifferent times (P<0.01). Spearman rank correlation analysis showed that distribution of pathogenic bacteria in respiratory tract at different times had positive correlation with equipment pipeline, oral cavity, pharyngeal portion and incision of trachea, and had no obvious correlation with hands of nurse, ward atmosphere and article surface. Conclusions The patients after tracheotomia have an higher incidence rate on lower respiratory tract infection in ICU, especially within 10 days. lower respiratory tract infection after tracheotomia has close relationship with equipment pipeline, mainly such as ventilator, in addition to the patients' self-factors. Key words: Tracheotomy; lower respiratory tract infections; Intensive care unit; Correlation factors

Following-up of nosocomial lower respiratory infection in patients with hematological malignancy after chemotherapy

To observe and investigate the risk factors and pathogen diversification of nosocomial lower respiratory infections in patients with hematological malignancy after chemotherapy. Respiratory tract microbial population of fifty patients with different kinds of hematological malignancy and para-prepared to chemotherapy was quantitatively analyzed before and after chemotherapy at an arranged time from April, 2004 to December, 2005. Susceptibility test was determined for bacterium of nosocomial infection, and the homology of the same species of the bacteria was analyzed by a pulsed field gel electrophoresis (PFGE). Incidence rate of lower respiratory infections in patients with the hematological malignant after chemotherapy was 16%. The major nosocomial infectious pathogens were Acinetobacter spp; Escherichia coil and Fungus. Among them, Acinetobacter spp, were highly resistant to cephalosporins, quinolones, aminoglycosides, carbapenems and antibiotic with enzyme inhibitor, respectively but susceptible to Cefoperazone/Sulbactam belonging to antibiotic with enzyme inhibitor. And it was shown that there were two clones by the pulsed field gel electrophoresis (PFGE). Following-up of nosocomial lower respiratory infection in patients with hematological malignancy after chemotherapy might offer theoretical evidence for the rational use of antibiotics and the control of nosocomial infections.