Improving the rate of pathogen examination before antibiotic treatment is of great significance for clarifying pathogen diagnosis and curbing bacterial resistance, and is also one of the important goals for improving national medical quality and safety. In response to the current problem of low pathogen examination rates, Chengdu Women’s and Children’s Central Hospital adopts a FOCUS-PDCA model, has explored measures such as current situation investigation, root cause analysis, intervention plan formulation, countermeasure implementation, and effect evaluation to improve the rate of pathogen examination before antibiotic treatment in inpatients. This article mainly elaborates on the above model, which has practical significance for ensuring the rational use of antibiotics in inpatients.
Objectives To investigate the pathogenic characteristics and the possible relationship between pathogen and respiratory function in patients with acute exacerbations of COPD (AECOPD).Methods Sixty-four patients with AECOPD were investigated with lung function test，quantitative and qualitative sputum bacteria culture，drug sensitive test，and Mycoplasma pneumoniae and Chlamydia pneumoniae specific antibodies test.The patients were divided into three groups according to FEV1%pred，50%≤FEV1lt;80%pred for the Group One，30%pred≤FEV1lt;50%pred for the Group Two，and FEV1lt;30%pred for the Group Three.Meanwhile according to the result of sputum culture，infective bacteria were divided into four kinds： Gram-positive cocci for kind A，Gram-negtive germ except kind C for kind B，Acinetobacter，Enterobacter and Pseudomonas spp for kind C，and negative result for kind D.Results ⑴Of 64 patients who were conducted quantitative sputum culture，germs isolated were mostly Streptococcus pneumoniae，Enterobacter，Moraxella Catarrhalis，and Pseudomonas.Of 38 patients who were conducted qualitative sputum culture，most of them were found mixed infection，and germs isolated were mostly Streptococcus pneumoniae，Staphylococcus epidermidis，Acinetobacter and Enterobacter.⑵Both quantitative and qualitative sputum culture revealed that Most of Group One patients were not infected by bacteria，and the Group Three patients were mainly by resistant kind A and kind C bacteria (Plt;0.01 and 0.05 respectively).⑶The infection of Mycoplasma pneumoniae or Chlamydia pneumoniae was identified in 29.4% of the cases.Conclusions There is a close correlation between the degree of functional damage and the infected bacterial strains for patients with AECOPD，the more chance of bacteria infection such as S pneumoniae，Acinetobacter，Enterobacter and Pseudomonas，the more damage of lung function.
Organ transplantation is a critical treatment for end-stage organ diseases, yet postoperative infections significantly affect patient outcomes. Traditional diagnostic methods for infections often fall short in meeting the demands of precise prevention and treatment due to limitations in sensitivity, specificity, and speed. Targeted nanopore pathogen sequencing technology, characterized by its long-read capability, real-time detection, and adaptability, has shown unique potential in pathogen identification, structural variation analysis, and antimicrobial resistance gene profiling. This offers new insights into the prevention and management of postoperative infections. This expert consensus focuses on the standardized application of this technology in managing infections following organ transplantation, addressing its principles, clinical recommendations, and diagnostic workflows. By exploring its features and value in infectious disease diagnosis, the expert consensus provides standardized guidance on sample processing and result interpretation. The development of this consensus aims to promote the rational use of nanopore sequencing in diagnosing and treating post-transplant infections, enhance diagnostic accuracy and efficiency, improve patient outcomes, and facilitate the widespread adoption of this technology.
ObjectiveThe aim of this study was to assess the disease burden of non-COVID-19 lower respiratory infection (LRI) in China during the period 1990−2021, particularly during the period 2019−2021. MethodsData on the burden of disease for LRI in China were obtained from the GBD 2021 database. A Joinpoint regression model was used to describe the changes in disease burden trends of LRI in China from 1990 to 2021, and the results are presented in terms of average annual percentage change (AAPC). ResultsIn 2021, the age-standardized incidence rate of LRI in China was 2 853.31/100 000, the age-standardized rate of DALY was 347.67/100 000, and the age-standardized mortality rate was 14.03/100 000. Compared with 1990, the AAPC were −2.13%, −6.89% and −4.10% respectively. In contrast, during the COVID-19 pandemic, both showed a decreasing and then increasing trend, except for the age-standardized incidence rate, which showed a decreasing trend. Children under 5 years of age have experienced the greatest reduction in the burden of disease over the past decades, while the burden of disease has increased in absolute terms for the elderly over 70 years of age. Compared with 1990, the disease burden of LRI in China due to each pathogenic microorganism has decreased. And during 2019−2021, all pathogens showed an increasing trend, except for ASMR caused by influenza (APC=−55.21%) and respiratory syncytial virus (APC=−53.35%). In 2021, the primary attributable risk factors for LRI mortality in China shifted from household air pollution due to solid fuels, childhood underweight, and childhood stunting in 1990 to ambient particulate matter pollution, smoking, and secondhand smoke. ConclusionThe disease burden of LRIs in China showed an overall decreasing trend from 1990 to 2021, but with large variations between age groups and pathogens. During the two years following the outbreak of the COVID-19 pandemic, the incidence of LRI in China, along with the disease burden caused by influenza and respiratory syncytial virus, significantly declined. Over the past few decades, the attributable risk factors for mortality and DALYs have undergone substantial changes. To address this phenomenon, targeted measures should be implemented to reduce the burden of LRI on the population caused by air pollution and smoking.
Objective To analyze the etiology, risk factors, and prognosis of late-onset hospitalacquired pneumonia ( L-HAP) in respiratory ICU. Methods In this retrospective case control study, 30 L-HAP patients and 30 patients without HAP in respiratory ICU were enrolled to investigate the features and risk factors of L-HAP. Stratification was made according to the onset time of L-HAP. The etiology and pathogen distribution at each stage were described and analyzed. Results Univariate analysis revealed thatunconsciousness, aspiration, mechanical ventilation, hypoalbuminemia, and long-term use of proton pump inhibitor were significantly associated with L-HAP. Logistic regression analysis revealed that mechanical ventilation( OR = 8. 7) and hypoalbuminemia ( OR = 20. 4) were independent risk factors for L-HAP. The L-HAP patients had longer stay in hospital, long-termantibiotic use, and higher mortality compared with the patients without HAP. For the patients whose L-HAP onset time within 6-14 days, the dominated pathogens were Acinetobacter baumannii and Klebsiella pneumonia. For those within 15-28 days, the dominated pathogens were Pseudomonas aeruginosa, Acinetobacter baumanni, and Staphylococcus aureus. For those beyond 29 days, the dominated pathogens were Pseudomonas aeruginosa and Stenotrophomonas maltophilia. Conclusions Mechanical ventilation and hypoalbuminemia are independent risk factors for L-HAP. The pathogen features of L-HAP are quite different at different inhospital stage.
Community-acquired pneumonia (CAP) is still a common disease that seriously affects people’s health. It is of great clinical significance for proper anti-infective therapy to identify the characteristics and changes of the pathogens. Along with the accelerated process of aging population, increased use of immunosuppression agents, and increased morbidity of malignant tumor and underlying diseases, the pathogenic spectrum of patients with CAP varies as well. This article reviews the important pathogenic changes of CAP in recent years.
Objective To explore clinical effect of failure mode and effect analysis in improving the submission rate of pathogen examination in counterpart supported high-altitude county hospitals, and formulate practical measures and methods suitable for high-altitude county hospitals to improve the submission rate of pathogen examination. Methods Patients admitted to the People’s Hospital of Ganzi County between January and December 2024 were selected. The data of hospitalized patients between January and June 2024 were as the control group, and the data of hospitalized patients between July and December 2024 were as the intervention group. The study analyzed and compared the submission rate of pathogen testing and the pass rate of microbiological test specimens before antimicrobial treatment between the two groups. Results A total of 3 984 patients were included. Among them, there were 1 748 cases in the control group and 2 236 cases in the intervention group. A total of 10 risk factors and 2 high-risk points were identified. There were statistically significant differences in the submission rate of pathogen specimens before antibiotic treatment [36.21% (633/1 748) vs. 49.33% (1 103/2 236); χ2=68.646, P<0.001] and the qualified rate of microbiological test specimens [26.75% (122/456) vs. 36.45% (261/716); χ2=11.910, P=0.001] between the control group and the intervention group. Conclusions Failure mode and effect analysis can effectively find out the weak points in low pathogen examination submission rate in high-altitude county hospitals. According to the high-risk points to guide the formulation of relevant measures, the pathogen submission rate in the region can be effectively improved.
Objective To investigate the epidemical status of influenza in Mianyang during 2010-2011, so as to provide evidence for formulating prevention and control strategies. Methods Surveillance data, ILI etiological results, outbreak and epidemic situation of the influenza-like illnesses (ILI) in Mianyang during 2010-2011 were collected for analysis. Results There were 12 100 ILI cases reported in 2010, accounted for 2.72% of the total outpatients. While 8 364 ILI cases accounted for 1.83% of the total outpatients were reported in 2011, reduced by 32.47% compared with 2010. The temporal distribution of doctor-visiting ratio in those two years was in an increased bimodal pattern. Most cases were children aged 0-5 years, accounted for 46.24%. Most ILI cases were treated in the department of fever, accounted for 88.56%. A total of 788 ILI specimens were collected for the detection of Real time RT-PCR, of which 34 specimens showed positive strains (4.31%) including 5 influenza A/H1N1 (0.63%), 8 influenza A (1.02%), 1 seasonal influenza A/H3 (0.13%) and 20 influenza B (2.54%). No outbreak and epidemic situation in Mianyang during 2010-2011. Conclusion The influenza activity is relatively stable without large-scale outbreak in Mianyang during 2010-2011. The reporting quality of surveillance hospitals should be improved and the lab of flu surveillance network should actively prepare to do the isolation and identification of influenza virus. It is necessary to enhance flu surveillance so as to prevent and control influenza prevalence．
Objective To preliminarily understand the equipment configuration and information system function improvement of the microbiology laboratory for etiological submission before antibiotic treatment in Chinese medical institutions, and provide a scientific basis for further targeted action work on the rate of etiological submission before antibiotic treatment. Methods A network questionnaire was released in “Sentinel Hospital Information Reporting System of National Hospital Infection Management Professional Quality Control Center” between March 1 and June 21, 2022. The second-level and above hospitals were investigated. Results A total of 783 hospitals were included, of which 765 (97.7%) hospitals had been equipped with microbiology laboratory equipment to varying degrees, and the allocation rate of tertiary hospitals was higher than that of secondary hospitals (P<0.05). The top three items of common pathogenic test were aerobic (98.3%), bacterial smear (97.6%) and fungal smear (95.1%), and the last three items were streptococcus pneumoniae urine antigen (20.4%), silver hexamine staining (19.0%) and gene sequencing (8.9%). The comparison of relevant information system and function improvement among hospitals of different levels showed that tertiary hospitals were superior to secondary hospitals (P<0.05). In different regions, except for the allocation rate of nosocomial infection information monitoring system and rational drug use monitoring system (P>0.05), other relevant systems and functional improvement of hospitals in eastern, central and western regions, the differences were statistically significant (P<0.05). The number of hospitals that could obtain the indicators of “etiological submission rate of inpatients before antibiotic treatment”“etiological submission rate related to hospital infection diagnosis”“etiological submission rate before combined use of key drugs” were 698 (89.1%), 474 (60.5%) and 337 (43.0%), respectively. Among the factors affecting the implementation of special actions, 454 hospitals (58.0%) thought that the information system was not fully functional, 341 hospitals (43.6%) thought that the etiology testing project was not fully carried out, and 148 hospitals (18.9%) thought that the microbiology laboratory testing ability was insufficient. Conclusion All kinds of hospitals at all levels in China, especially specialized and secondary hospitals, need to further improve the configuration of equipment and information system functions in the microorganism laboratory related to aetiology inspection, strengthen the support for microbial inspection, and strengthen information management, monitoring and analysis.
Objective To investigate the distribution and antibiotic resistance of pathogens isolated fromlower respiratory tract in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) . Methods The patients with AECOPD, who were hospitalized in RICU from January 2008 to November 2009, were divided into a community infection group and a nosocomial infection group. Lower respiratory tract isolates were collected by bronchoscopic protected specimen brush for bacterial identification and susceptibility test. Results 134 cases were enrolled in the study, with 75 cases in thecommunity infection group and 59 cases in the nosocomial infection group. The positive detection rate in the nosocomial infection group was significantly higher than that in the community infection group [ 81. 4%( 48/59) vs. 54. 7% ( 41/75) ] . In the community infection group, 49 strains were isolated, in which gramnegativebacteria, gram-positive bacteria, and fungi accounted for 55. 1% , 28. 6% , and 16. 3% , respectively.In the nosocomial infection group, 55 strains were isolated, in which gram-negative bacteria, gram-positive bacteria, and fungi accounted for 61. 8% , 21. 8% , and 16. 4%, respectively. There was no significant difference in the microbial distribution between the two groups ( P gt; 0. 05) . The detection rate of ESBLs producing strains in the nosocomial infection group was significantly higher than that in the community infection group ( 58. 8% vs. 37% ) . The resistance rates in the nosocomial groups were higher than those in the community infection group. Conclusions Antibiotic resistance is serious in mechanically ventilated patients with AECOPD, especially in the nosocomial infection patients. The increased fungi infection and drug resistance warrant clinicians to pay more attention to rational use of antibiotics, and take effective control measures.