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Objective To analyze the influence of delirium on the prognosis of elderly patients with severe pneumonia (SP) undergoing mechanical ventilation, and to construct a prediction model for the occurrence of delirium. Methods Three hundred and ninety-seven cases of SP patients undergoing mechanical ventilation were selected and were classified into the delirium group (80 cases) and non-delirium group (317 cases) according to the occurrence of delirium during the hospitalization period. The patients were followed up for 28 days starting from their admission to the intensive care unit (ICU). The 28-d cumulative survival rates of the two groups were compared, and the clinical data of the two groups were collected. Multivariate Logistic regression was used to analyze the risk factors for the occurrence of delirium during the hospitalization period in elderly SP patients undergoing mechanical ventilation and we constructed a risk prediction model. The value of the risk prediction model in predicting the occurrence of delirium in elderly SP patients was analyzed by the receiver operating characteristic (ROC) curve. Results The 28-day cumulative survival rate of the delirium group was 45. 00% (36/80), which was lower than that [14. 20% (45/317)] of the non-delirium group, with statistically significant difference (P<0. 05). Univariate analysis showed that the severity of disease, the proportion of diabetes mellitus, the proportion of cerebrovascular disease, blood lactate, C-reactive protein (CRP), and procalcitonin (PCT) levels were higher in the delirium group than in the non-delirium group, and the ICU time, mechanical ventilation time, and time to arousal after discontinuation of medication were longer than those in the non-delirium group, and the hemoglobin level was lower than that in the non-delirium group (all P<0. 05). Multifactorial Logistic regression analysis showed that high-risk condition, cerebrovascular disease, diabetes mellitus, prolonged mechanical ventilation, prolonged arousal time after discontinuation of medication, elevated blood lactate, elevated CRP, and elevated PCT were the independent risk factors for delirium in elderly patients with SP undergoing mechanical ventilation (all P<0. 05). The risk prediction model for the occurrence of delirium in elderly patients with SP undergoing mechanical ventilation: Ln (P/1-P) = -15. 475+1. 165×severity of illness + 1. 019×diabetes mellitus + 1. 476×cerebrovascular disease + 0. 008×duration of mechanical ventilation + 0. 103× time of arousal after discontinuation of medication + 0. 751×blood lactate + 0. 011×CRP + 0. 362×PCT (χ² =7. 996, P= 0. 434). The ROC curve showed that the area under the curve of the risk prediction model in predicting the occurrence of delirium in elderly SP patients undergoing mechanical ventilation was 0. 929 (95% CI：0. 899-0. 952), with a optimal cutoff value of 0. 217, a sensitivity of 83. 75%, a specificity of 86. 44%, and the maximum Youden index of 0. 702, respectively. Conclusions Delirium will increase the risk of death in elderly SP patients. A prediction model is successfully constructed based on the risk factors for delirium in elderly SP patients undergoing mechanical ventilation, and this model has a high predictive value. [ABSTRACT FROM AUTHOR]

Objective Severe pneumonia is a common pediatric disease, often complicated by respiratory failure (RF). The expression changes of long non-coding RNA zinc finger antisense 1 (ZFAS1) were examined in children with severe pneumonia, as well as their predictive value in the occurrence of RF and poor outcomes. Methods A total of 120 children with severe pneumonia were included, 60 of whom had RF. RT-qPCR was used to detect mRNA levels. Deaths during the follow-up period were recorded through a 28-day follow-up survey. Receiver operating characteristic (ROC) curve and Kaplan Meier (K-M) plot were drawn to display diagnostic and predictive values, with the help of multiple logistic and Cox regression analysis. Results A sharp rise of serum ZFAS1 was tested in severe pneumonia children, providing a area under the receiver operator characteristic curve (AUC-ROC) of 0.920, with a sensitivity of 81.67% and a specificity of 90.00%. Serum ZFAS1 (OR = 5.832, 95% CI = 2.283–14.899) was found to be associated with the occurrence of RF after adjusting other clinical indexes, with an AUC-ROC of 0.843. ZFAS1 (HR = 4.624, 95% CI = 1.318–16.217, P < 0.05) was an independent influence factor for the poor prognosis. Cases with high ZFAS1 levels had worse clinical outcomes. Conclusion Monitoring serum ZFAS1 levels is helpful in assessing severe pneumonia in children, especially for early identification of cases with RF. High serum ZFAS1 levels have a certain predictive value for poor prognosis in patients. [ABSTRACT FROM AUTHOR]

Patients with traumatic brain injury (TBI) frequently exhibit concomitant immunosuppression. In this study, we evaluated the predictive values of soluble programmed death-1 (sPD-1) and soluble programmed death ligand-1 (sPD-L1) in patients with severe TBI. Peripheral blood sPD-1 and sPD-L1 levels were measured within 48 h of patient admission. A total of 20 healthy volunteers and 82 patients were enrolled in this study. The levels of sPD-1 and sPD-L1 were upregulated in patients with severe TBI (P < 0.001). They were significantly increased in the post-TBI severe pneumonia group and among non-survivors (P < 0.001). The area under the curves (AUCs) for sPD-1 and sPD-L1 levels to predict severe pneumonia were 0.714 and 0.696, respectively, and the AUCs to predict mortality were 0.758 and 0.735. The levels of sPD-1 and sPD-L1 are correlated with the GCS scores at admission, APACHE II scores, length of MV, and time elapsed to mortality. The levels of sPD-1 and sPD-L1 emerged as independent predictive factors for severe pneumonia and mortality. This study demonstrates that upregulation of sPD-1 and sPD-L1 in severe TBI patients is significantly associated with severe pneumonia and mortality, suggesting their potential as predictive biomarkers for these outcomes. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the prognostic significance of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), creatinine, and lactic acid in patients diagnosed with severe pneumonia (SP). We conducted a retrospective analysis of patient data from our hospital who were diagnosed with severe pneumonia between June 2020 and June 2023. The patients were divided into two groups: survivors (363 cases) and non-survivors (346 cases). We collected demographic, clinical and laboratory data and used multifactorial logistic regression to identify prognostic risk factors. We also evaluated the predictive accuracy of each parameter using Receiver Operating Characteristic (ROC) curve analysis. Statistical analysis was performed using SPSS 26.0. In the study, it was found that patients who died had higher levels of certain markers in their blood, including NLR, PLR, procalcitonin (PCT), C-reactionprotein (CRP), Brain natriuretic peptide (BNP), blood creatinine, lactic acid and age Shock Index (SI) (p < 0.001). They also had lower levels of partial pressure of oxygen (PO2) and partial pressure carbon dioxide (PCO2) (p < 0.05). On the other hand, patients who survived had lower levels of these markers and higher levels of PO2 and PCO2. After analyzing the data, it was determined that NLR, PLR, creatinine and lactic acid were significant risk factors for poor prognosis in patients with SP. The Area Under ROC Curve (AUCs) for these factors ranged from 0.577 to 0.725, and they had sensitivities ranging from 67.9% to 77.7% and specificities ranging from 61.2% to 80.7%. When these factors were combined, they provided a more accurate evaluation of prognosis, with an AUC of 0.789 and a sensitivity of 67.1% and specificity of 77.4% at the optimal threshold. NLR, PLR, creatinine and lactic acid are significant prognostic indicators in SP patients. A combined assessment of these parameters enhances prognostic accuracy, aiding in better management. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the effects of enteral nutrition with different protein concentrations on muscle mass in severe pneumonia patients, providing insights for enteral nutrition practice in intensive care units (ICUs). Methods: A total of 120 severe pneumonia patients admitted to Dazhou Central Hospital's ICU between June 1, 2022, and February 1, 2023, meeting inclusion criteria, were randomly assigned to either a high-protein group (n = 60, 1.8 g/kg/d) or a standard-protein group (n = 60, 1.2 g/kg/d). Changes in relevant indicators were monitored on days 1, 5, and 10 of ICU admission, including quadriceps and diaphragm thickness, nutritional status (prealbumin and albumin), and adverse events such as diarrhea and constipation. Results: Autoregressive of order 1 model (AR(1)) analysis revealed a decrease in both quadriceps and diaphragm thickness over time in both groups. A significant group × time interaction was observed in quadriceps thickness. By day 10, compared to baseline, quadriceps thickness decreased in the high-protein (-0.315 cm [95% CI, -0.340 to -0.289]) and standard-protein (-0.429 cm [95% CI, -0.455 to -0.404]) groups. The high-protein group exhibited a lower quadriceps atrophy rate (13.97 ± 2.43%) compared to the standard-protein group (18.96 ± 2.61%), showing a significant difference (P < 0.001). No significant differences were found in diaphragmatic thickness between groups and over time. By day 10, both groups exhibited decreased diaphragmatic muscle thickness compared to baseline. The high-protein group (33.76 ± 5.09%) had a slightly lower phrenic atrophy rate compared to the standard-protein group (33.41 ± 4.53%). Both groups experienced enteral nutritional intolerance manifested as diarrhea, constipation, and other adverse events. Conclusion: High-protein enteral nutrition significantly improved quadriceps thickness and demonstrated good safety in severe pneumonia patients, suggesting its suitability for widespread clinical application. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the impact of body composition variables on hospital mortality compared to other predictive factors among patients with severe pneumonia. Additionally, we aimed to monitor the dynamic changes in body composition variables over the course on days 1, 3, and 8 after intensive care unit (ICU) admission for each patient. Methods: We conducted a prospective study, enrolling patients with severe pneumonia admitted to the medical intensive care unit at Kaohsiung Chang Gung Memorial Hospital from February 2020 to April 2022. We collected clinical data from all patients and assessed their body composition at 1, 3, and 8 days post-ICU admission. On day 1, we analyzed clinical and body composition variables to predict in-hospital mortality. Results: Multivariate analysis identified the Modified Nutrition Risk in the Critically Ill (mNUTRIC) score and the ratio of total body water to fat-free mass (TBW/FFM) as independent factors associated with in-hospital mortality in severe pneumonia patients. Receiver operating characteristic analysis determined that the TBW/FFM ratio was the most reliable predictive parameter of in-hospital mortality, with a cutoff value of 0.74. General linear regression with repeated measures analysis showed that hospital non-survivors displayed notable fluctuations in body water, fat, and muscle variables over the course of days 1, 3, and 8 after ICU admission. Conclusions: The mNUTRIC score and TBW/FFM ratio emerged as independent factors for predicting hospital mortality, with the TBW/FFM ratio demonstrating the highest reliability as a predictive parameter. [ABSTRACT FROM AUTHOR]

Objective To explore the application effect of risk management based on nursing quality sensitive indicators in elderly patients with severe pneumonia. Methods A total of 94 elderly patients with severe pneumonia admitted to the Respiratory Department of Zhengzhou Yihe Hospital from May 2021 to May 2023 were selected as the study subjects. The 94 elderly patients with severe pneumonia were divided into the control group and the observation group using a random number table method, with 47 cases in each group. The patients in the control group were given routine nursing care, while the patients in the observation group were given risk management based on sensitive indicators of nursing quality. Both groups continued to receive care until the patients were discharged. The nursing management effects of the two groups were compared. Results The indexes of blood gas analysis in the two groups after nursing were better than those before nursing, and the partial pressure of carbon dioxide in the observation group was lower than that in the control group, with statistical significances（P＜0. 05). The arterial oxygen partial pressure, oxygen and index in the observation group were higher than those in the control group after nursing, but the differences were not statistically significant（P＞0. 05). The duration of mechanical ventilation and hospitalization in the observation group were shorter than those in the control group, and the total incidence of nursing adverse events such as ventilator-associated pneumonia and falling off the bed was lower than that in the control group. The scores of SF-36 and the scores of nursing satisfaction were higher than those in the control group, with statistical significances（P＜0. 05). Conclusion After risk management intervention based on nursing quality sensitive indicators, elderly patients with severe pneumonia can improve their blood gas analysis indicators, further shorten their mechanical ventilation time, reduce hospital stay, reduce nursing adverse events such as ventilator-associated pneumonia and falls, promote the improvement of patient quality of life, and achieve satisfactory nursing outcomes. [ABSTRACT FROM AUTHOR]

Objective To investigate the molecular mechanism of polysaccharides from Atractylodes macrocephala koidz. (PAM) to treat severe pneumonia. Methods Sixty male SD rats were randomly divided into control group, model group (inoculation of Klebsiella pneumonia by tracheal puncture), positive control group (levofloxacin, 18 mg/kg), PAM low-dose group (50 mg/kg) and PAM high-dose group (200 mg/kg) with 12 in each. After occurrence of severe pneumonia, the rats were orally administered the medicine once daily for 7 day. The lung tissue underwent histopathological examination using HE staining microscopy to find the pathological alterations and evaluate the extent of injury. Wet/dry ratio of lung tissue was measured by weighing method. The leukocytes and neutrophils counts in peripheral blood were determined by hematology analyzer. The level of tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β) and IL-6 in serum and bronchoalveolar lavage fluid (BALF) was detected by enzyme-linked immunosorbent assay. The expression of proteins related to the Toll-like receptor 4 (TLR4) / myeloid differentiation factor 88 (MyD88)/nuclear factor-κB(NF-κB) signaling pathway in lung tissues was detected using Western blot analysis. Results Compared with the control group, lung injury score and wet/dry ratio, the number of leukocytes and neutrophils in peripheral blood, the level of TNF-α, IL-1β and IL-6 in serum and in BALF, protein expression of TLR4 and MyD88 and the phosphorylation level of NF-κB p56 in lung tissues from model group were all significantly increased(P＜0.05). The lung injury of rats in each levofloxacin treatment group exhibited significant improvement compared to the model group. Among them, the number of leukocytes and neutrophils in peripheral blood of rats in PAM high-dose group decreased significantly(P＜0.05); The level of TNF-α, IL-1β and IL-6 in serum and BALF, the protein expression of TLR4 and MyD88 and the phosphorylation level of NF-κB p56 in lung tissue were significantly decreased(P＜0.05). Conclusions The administration of PAM exerts a specific protective effect against Klebsiella pneumoniae-induced pneumonia in rats, potentially suppress inflammatory response through modulation of the TLR4/MyD88/NF-κB signaling pathway. [ABSTRACT FROM AUTHOR]

Jun Song,1 Ning Li,1 Ruihua Li,1 Yuanyuan Xu2 1Department of Pediatrics, Taihe County People’s Hospital, Fuyang, Anhui, 236000, People’s Republic of China; 2Pediatric Intensive Care Unit, Anhui Children’s Hospital, Hefei, Anhui, 230051, People’s Republic of ChinaCorrespondence: Yuanyuan Xu, Pediat Intens Care Unit, Anhui Children’s Hospital, 39 Wangjiang East Road, Baohe District, Hefei, Anhui, 230051, People’s Republic of China, Tel +86-551-62237451, Email Xuyuanyuan7451@163.comObjective: This study aimed to probe the changes in coagulation function-related indicators (prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (D-D), and fibrinogen degradation product (FDP)) in severe pneumonia and their clinical significance.Methods: The levels of coagulation function indicators of all the children were measured within 24 hours of admission. Pearson correlation analysis was utilized to analyze the correlation between PT, APTT, FIB, D-D, FDP and PCIS in children with severe pneumonia. The ROC curve was drawn to assess the power of PT, APTT, FIB, D-D and FDP in diagnosing severe pneumonia and predicting the prognosis of severe pneumonia. A logistic regression analysis was implemented to analyze the factors influencing the prognosis of children with severe pneumonia.Results: PT, APTT, FIB, FDP, and D-D in the critically severe pneumonia and the extremely severe pneumonia groups were higher versus the common pneumonia group (P < 0.05). FDP and D-D levels in children with severe pneumonia were negatively correlated with PCIS. PT, APTT, FIB, FDP, and D-D of children in the poor prognosis group were higher compared with those in the good prognosis group (P < 0.05). Further logistic regression analysis unveiled that FDP and APTT were influential factors impacting the prognosis of severe pneumonia.Conclusion: The levels of D-D, FDP, FIB, APTT, and PT in severe pneumonia are increased. Detecting the contents of coagulation function indicators can help clinical judgment of the changes in the condition of severe pneumonia and evaluate prognosis.Keywords: severe pneumonia, prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, fibrinogen degradation product, pediatric critical illness score

Abstract Patients with traumatic brain injury (TBI) frequently exhibit concomitant immunosuppression. In this study, we evaluated the predictive values of soluble programmed death-1 (sPD-1) and soluble programmed death ligand-1 (sPD-L1) in patients with severe TBI. Peripheral blood sPD-1 and sPD-L1 levels were measured within 48 h of patient admission. A total of 20 healthy volunteers and 82 patients were enrolled in this study. The levels of sPD-1 and sPD-L1 were upregulated in patients with severe TBI (P

ObjectiveTo investigate the etiology and epidemiological characteristics of pneumonia in children of different ages, to better characterize the co-infection patterns of pneumonia and their association with severe diseases.MethodsChildren aged 28 days to 13 years with pneumonia who were hospitalized in the Department of Pediatrics, Dongyang People's Hospital, Zhejiang Province from April 1 to December 28, 2023 were selected as the research subjects. Oropharynx swabs were collected from the patients within 24 hours of hospital admission, and PCR tests were conducted for 18 respiratory pathogens. Binary multivariate logistic regression analysis was used to analyze the status of viral and bacterial infection, patterns of co-infection in patients with different ages, and the risk factors for the outcome of severe pneumonia.ResultsA total of 2 191 hospitalized children with pneumonia were enrolled in the study. Severe cases were more common in children aged 5 years and older (53.3%) and in the second quarter of the year (46.5%). An average of (1.31±0.90) pathogens were detected in severe cases. Mycoplasma pneumoniae (44.4%, 973 cases) had the highest detection rate of pathogens. Streptococcus pneumoniae (21.7%, 476 cases) and rhinovirus (10.1%, 222 cases) were the most common bacteria and viruses, respectively, in hospitalized children with pneumonia in Dongyang City. Multivariate logistic regression analysis indicated positive interactions between different viral and bacterial pathogens. The adjusted OR (aOR) values for different respiratory pathogens in children with severe pneumonia varied significantly (all P

Abstract Purpose This study aimed to investigate the impact of body composition variables on hospital mortality compared to other predictive factors among patients with severe pneumonia. Additionally, we aimed to monitor the dynamic changes in body composition variables over the course on days 1, 3, and 8 after intensive care unit (ICU) admission for each patient. Methods We conducted a prospective study, enrolling patients with severe pneumonia admitted to the medical intensive care unit at Kaohsiung Chang Gung Memorial Hospital from February 2020 to April 2022. We collected clinical data from all patients and assessed their body composition at 1, 3, and 8 days post-ICU admission. On day 1, we analyzed clinical and body composition variables to predict in-hospital mortality. Results Multivariate analysis identified the Modified Nutrition Risk in the Critically Ill (mNUTRIC) score and the ratio of total body water to fat-free mass (TBW/FFM) as independent factors associated with in-hospital mortality in severe pneumonia patients. Receiver operating characteristic analysis determined that the TBW/FFM ratio was the most reliable predictive parameter of in-hospital mortality, with a cutoff value of 0.74. General linear regression with repeated measures analysis showed that hospital non-survivors displayed notable fluctuations in body water, fat, and muscle variables over the course of days 1, 3, and 8 after ICU admission. Conclusions The mNUTRIC score and TBW/FFM ratio emerged as independent factors for predicting hospital mortality, with the TBW/FFM ratio demonstrating the highest reliability as a predictive parameter.

Abstract Background This study aimed to assess the effects of enteral nutrition with different protein concentrations on muscle mass in severe pneumonia patients, providing insights for enteral nutrition practice in intensive care units (ICUs). Methods A total of 120 severe pneumonia patients admitted to Dazhou Central Hospital’s ICU between June 1, 2022, and February 1, 2023, meeting inclusion criteria, were randomly assigned to either a high-protein group (n = 60, 1.8 g/kg/d) or a standard-protein group (n = 60, 1.2 g/kg/d). Changes in relevant indicators were monitored on days 1, 5, and 10 of ICU admission, including quadriceps and diaphragm thickness, nutritional status (prealbumin and albumin), and adverse events such as diarrhea and constipation. Results Autoregressive of order 1 model (AR(1)) analysis revealed a decrease in both quadriceps and diaphragm thickness over time in both groups. A significant group × time interaction was observed in quadriceps thickness. By day 10, compared to baseline, quadriceps thickness decreased in the high-protein (-0.315 cm [95% CI, -0.340 to -0.289]) and standard-protein (-0.429 cm [95% CI, -0.455 to -0.404]) groups. The high-protein group exhibited a lower quadriceps atrophy rate (13.97 ± 2.43%) compared to the standard-protein group (18.96 ± 2.61%), showing a significant difference (P

Despite trials and programs for the prevention of childhood mortality due to pneumonia, Ethiopia is among the top five countries with the highest number of deaths due to pneumonia. Although the prevalence of pneumonia has increased in the above-mentioned trials, little is known about the recovery time from severe pneumonia and its predictors in the study area. Therefore, this study aimed to assess the time to recovery from severe pneumonia and its predictors among pediatric patients admitted to Mizan-Tepi University Teaching Hospital, Ethiopia, in 2022.

Objective To investigate the molecular mechanism of polysaccharides from Atractylodes macrocephala koidz.(PAM) to treat severe pneumonia. Methods Sixty male SD rats were randomly divided into control group, model group (inoculation of Klebsiella pneumonia by tracheal puncture), positive control group (levofloxacin, 18 mg/kg), PAM low-dose group (50 mg/kg) and PAM high-dose group (200 mg/kg) with 12 in each. After occurrence of severe pneumonia, the rats were orally administered the medicine once daily for 7 day. The lung tissue underwent histopathological examination using HE staining microscopy to find the pathological alterations and evaluate the extent of injury. Wet/dry ratio of lung tissue was measured by weighing method. The leukocytes and neutrophils counts in peripheral blood were determined by hematology analyzer. The level of tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β) and IL-6 in serum and bronchoalveolar lavage fluid (BALF) was detected by enzyme-linked immunosorbent assay. The expression of proteins related to the Toll-like receptor 4 (TLR4) / myeloid differentiation factor 88 (MyD88)/nuclear factor-κB(NF-κB) signaling pathway in lung tissues was detected using Western blot analysis. Results Compared with the control group, lung injury score and wet/dry ratio, the number of leukocytes and neutrophils in peripheral blood, the level of TNF-α, IL-1β and IL-6 in serum and in BALF,protein expression of TLR4 and MyD88 and the phosphorylation level of NF-κB p56 in lung tissues from model group were all significantly increased(P＜0.05). The lung injury of rats in each levofloxacin treatment group exhibited significant improvement compared to the model group. Among them, the number of leukocytes and neutrophils in peripheral blood of rats in PAM high-dose group decreased significantly(P＜0.05); The level of TNF-α, IL-1β and IL-6 in serum and BALF, the protein expression of TLR4 and MyD88 and the phosphorylation level of NF-κB p56 in lung tissue were significantly decreased(P＜0.05). Conclusions The administration of PAM exerts a specific protective effect against Klebsiella pneumoniae-induced pneumonia in rats, potentially suppress inflammatory response through modulation of the TLR4/MyD88/NF-κB signaling pathway.

Cytomegalovirus (CMV) is known to cause fatal pneumonia in human immunodeficiency virus (HIV) infected children. There is a paucity of literature on pediatric HIV and CMV coinfection in India. We describe six cases of severe pneumonia in infants infected with HIV. Four of these infants also had CMV coinfection, detected by urine polymerase chain reaction. There was a lack of antenatal and postnatal care in all cases. All four infants with CMV coinfection succumbed to severe acute respiratory distress syndrome, whereas the other two survived. In conclusion, a high index of suspicion for CMV should be kept in HIV-infected infants presenting with severe pneumonia, although CMV pneumonia is difficult to diagnose with certainty. The important role of antenatal care for mothers with HIV infection, as well as postnatal care for babies born to HIV-positive mothers, cannot be overstated.

Dan Ye,1,2 Yuanyuan Li,2 Kangkang Yan,1 Wenzhong Peng2 1Department of Pharmacy, Xi’an No.3 Hospital, the Affiliated Hospital of Northwest University, Xi’an, People’s Republic of China; 2Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Wenzhong Peng, Department of Respiratory Medicine, Xiangya Hospital, Central South University, Xiangya Road No. 87, Kaifu District, Changsha, Hunan, 410008, People’s Republic of China, Tel +86-0731-89753287, Fax +86-89753287, Email pengwenzhong@csu.edu.cnBackground: Chlamydia abortus is a zoonotic pathogen that causes miscarriage, stillbirth, and sepsis of pregnancy in pregnant women when it infects humans. However, it rarely causes pneumonia in humans.Case Presentation: This case reports a case of severe pneumonia characterized by high fever and cough, and the disease rapidly progressed to dyspnea. The patient was treated with moxifloxacin and doxycycline. Chlamydia abortus was detected in bronchoscopy examination and bronchoalveolar lavage fluid (BALF) through metagenomic next-generation sequencing (mNGS)-DNA. A weak positive for influenza A (H1N1) antigen was also found in the throat swab tested. Subsequently, we added mabaloxavir and replaced doxycycline with an intravenous infusion of omadacycline. After effective treatment, the patient developed a urinary tract infection, and the treatment plan was adjusted to meropenem combined with omadacycline. The patient’s condition improved, and she was discharged on the 14th day of admission.Conclusion: This is the first report of cases of non-pregnant female patients with Chlamydia abortus infection pneumonia. Consequently, infections with Chlamydia abortus can result in severe respiratory distress, disturbance of water and electrolyte balance, and abnormal liver function, which requires timely diagnosis and correct use of antibiotics by clinicians. Consequently, the mixed infection of H1N1 and Chlamydia abortus aggravated the complexity of the condition and treatment. Combining tetracycline and quinolone is effective for treating severe pneumonia with Chlamydia abortus infection.Keywords: chlamydia abortus, severe pneumonia, metagenomics next-generation sequencing, case report

Abstract Background Severe pneumonia has consistently been associated with high mortality. We sought to identify risk factors for the mortality of severe pneumonia to assist in reducing mortality for medical treatment. Methods Electronic databases including PubMed, Web of Science, EMBASE, Cochrane Library, and Scopus were systematically searched till June 1, 2023. All human research were incorporated into the analysis, regardless of language, publication date, or geographical location. To pool the estimate, a mixed-effect model was used. The Newcastle–Ottawa Scale (NOS) was employed for assessing the quality of included studies that were included in the analysis. Results In total, 22 studies with a total of 3655 severe pneumonia patients and 1107 cases (30.29%) of death were included in the current meta-analysis. Significant associations were found between age [5.76 years, 95% confidence interval [CI] (3.43, 8.09), P

Yi Shi, Yifan Ren Department of Pediatrics, Shaoxing Keqiao Women and Children’s Hospital, Shaoxing, Zhejiang Province, People’s Republic of ChinaCorrespondence: Yi Shi, Email shiyi111002@163.comBackground: Adenovirus pneumonia progresses rapidly, with a high rate of progression to severe pneumonia, but the early clinical manifestations lack specificity and are not easy to be recognized.Methods: Reviewing the relevant literatures, we studied and summarized the early recognition, clinical features and treatment outlook of severe adenovirus pneumonia Case Presentation: An 11-year-old child with community-acquired pneumonia, with influenza A antigen positive by colloidal gold, which further developed into acute respiratory distress syndrome after hospitalization. Three days later, adenovirus was detected positively by PCR of throat swab and diagnosed as severe adenovirus pneumonia. After aggressive treatment, her condition improved and was discharged from the hospital.Conclusion: Clinically, adenovirus combined with influenza virus infection is uncommon, and adenovirus infection is even rarer in adolescent children.Keywords: adenovirus, influenza virus, severe pneumonia, respiratory failure

Mycoplasma pneumoniae pneumonia （MPP） is a common cause of community-acquired pneumonia in children aged 5 and older in China. Although most affected children have favorable clinical prognosis， some cases can escalate into severe MPP due to risk factors such as pathogen resistance or co-infections， etc. These severe cases significantly jeopardize the lives of children and may lead to diverse long-term sequelae. In response to this challenge， the Children’s Medical Center of the Third Affiliated Hospital of Sun Yat-sen University， integrating current guidelines， expert consensus， and its extensive clinical experience， has devised the “412” cluster treatment strategy. This comprehensive approach encompasses treatments for anti-infection， anti-inflammatory storm， anticoagulation and antioxidant stress. Additionally， it seamlessly integrates traditional Chinese medicine with western therapies， featuring bundled respiratory management and follow-up care. This strategy provides a valuable reference for the diagnosis and treatment of severe MPP in children.

Abstract Background Pneumonia is one of the leading causes of infant mortality globally, particularly in sub-Saharan Africa. In Uganda, pneumonia was the fourth leading cause of death in children

Abstract Background Globally, pneumonia is one of the leading causes of morbidity and mortality as well as hospitalization burden for under-five children. Despite significant initiatives implemented to reduce morbidity and mortality from pneumonia in under-five children, little is known regarding the time to recovery and its predictors among under-five children admitted with severe pneumonia in Ethiopia. Hence, this study intended to estimate the median time to recovery and its predictors among under-five children admitted with severe pneumonia in East Wallaga zone public hospitals, western Ethiopia; 2023. Methods An institution-based retrospective cohort study was conducted among 383 under-five children who were admitted with severe pneumonia in East Wallaga zone public hospitals from January 2017 to December 2022. A systematic sampling method was used to select eligible medical records. EpiData Version 4.6 was used to enter the data and analyzed using STATA Version 17.0. Cox-proportional hazard assumption test and model fitness were checked. Variables with P-value ˂ 0.25 at bivariable Cox regression analysis were selected for the multivariable Cox proportional model. A multivariable Cox regression model with 95% CI and Adjusted Hazard Ratio (AHR) was used to identify a significant predictor of time to recovery from severe pneumonia at a P-value

The characteristics of severe human parainfluenza virus (HPIV)–associated pneumonia in adults have not been well evaluated. We investigated epidemiologic and clinical characteristics of 143 patients with severe HPIV-associated pneumonia during 2010–2019. HPIV was the most common cause (25.2%) of severe virus-associated hospital-acquired pneumonia and the third most common cause (15.7%) of severe virus-associated community-acquired pneumonia. Hematologic malignancy (35.0%), diabetes mellitus (23.8%), and structural lung disease (21.0%) were common underlying conditions. Co-infections occurred in 54.5% of patients admitted to an intensive care unit. The 90-day mortality rate for HPIV-associated pneumonia was comparable to that for severe influenza virus–associated pneumonia (55.2% vs. 48.4%; p = 0.22). Ribavirin treatment was not associated with lower mortality rates. Fungal co-infections were associated with 82.4% of deaths. Clinicians should consider the possibility of pathogenic co-infections in patients with HPIV-associated pneumonia. Contact precautions and environmental cleaning are crucial to prevent HPIV transmission in hospital settings.

Objective: This retrospective cohort study aimed to investigate the composition and diversity of lung microbiota in patients with severe pneumonia and explore its association with short-term prognosis. Methods: A total of 301 patients diagnosed with severe pneumonia underwent bronchoalveolar lavage fluid metagenomic next-generation sequencing (mNGS) testing from February 2022 to January 2024. After applying exclusion criteria, 236 patients were included in the study. Baseline demographic and clinical characteristics were compared between survival and non-survival groups. Microbial composition and diversity were analyzed using alpha and beta diversity metrics. Additionally, LEfSe analysis and machine learning methods were employed to identify key pathogenic microorganism associated with short-term mortality. Microbial interaction modes were assessed through network co-occurrence analysis. Results: The overall 28-day mortality rate was 37.7% in severe pneumonia. Nonsurvival patients had a higher prevalence of hypertension and exhibited higher APACHE II and SOFA scores, higher procalcitonin (PCT), and shorter hospitalization duration. Microbial α and β diversity analysis showed no significant differences between the two groups. However, distinct species diversity patterns were observed, with the non-survival group showing a higher abundance of Acinetobacter baumannii, Klebsiella pneumoniae, and Enterococcus faecium, while the survival group had a higher prevalence of Corynebacterium striatum and Enterobacter. LEfSe analysis identified 29 distinct terms, with 10 potential markers in the non-survival group, including Pseudomonas sp. and Enterococcus durans. Machine learning models selected 16 key pathogenic bacteria, such as Klebsiella pneumoniae, significantly contributing to predicting short-term mortality. Network co-occurrence analysis revealed greater complexity in the non-survival group compared to the survival group, with differences in central genera. Conclusion: Our study highlights the potential significance of lung microbiota composition in predicting short-term prognosis in severe pneumonia patients. Differences in microbial diversity and composition, along with distinct microbial interaction modes, may contribute to variations in short-term outcomes. Further research is warranted to elucidate the clinical implications and underlying mechanisms of these findings. [ABSTRACT FROM AUTHOR]

Polymyxin B (PMB) is often considered as the last line of defense for treating carbapenem‐resistant Klebsiella pneumoniae (CRKP). However, its efficacy is hindered by limited penetration across the blood‐air barrier in the lung due to its low lipid solubility. To simultaneously increase PMB in epithelial lining fluid while suppressing the excessive inflammatory response in the lung, a novel nano‐biomimetic system "Siv‐PMB@G4@MM" is designed and fabricated by encapsulating PMB‐ and anti‐inflammatory Sivelestat (Siv)‐loaded G4 PAMAM dendrimers with macrophage membranes (MM). The Siv‐PMB@G4@MM displayed a superior acidic pH‐responsive release property and can target inflamed lung tissues, greatly increasing the concentrations of PMB and Siv at the infection site. Compared with free drugs, Siv‐PMB@G4@MM demonstrated superior synergistic antibacterial and anti‐inflammatory activities. Moreover, due to the ability of MM to sequester lipopolysaccharide (LPS) and some pro‐inflammatory cytokines, Siv‐PMB@G4@MM further enhanced the anti‐inflammatory potential of Siv. In mouse models of LPS‐induced acute lung injury, pulmonary bacterial infection, and sepsis‐induced pneumonia, Siv‐PMB@G4@MM significantly reduced inflammatory responses and/or bacterial burdens, mitigated neutrophil infiltration and pulmonary edema, and decreased neutrophil extracellular trap (NET) secretion. The highly improved biocompatibility and efficiency of the multifunctional Siv‐PMB@G4@MM presents a promising strategy for the clinical treatment of antibiotic‐resistant bacterial pneumonia. [ABSTRACT FROM AUTHOR]

Background: The effect of combining prone ventilation with traditional Chinese medicine on severe pneumonia remains unclear. Objective: To evaluate the effect of Fu Zheng Jie Du Formula (FZJDF) combined with prone ventilation on clinical outcomes in patients with severe pneumonia. Methods: This single-center retrospective cohort study included 188 severe pneumonia patients admitted to the ICU from January 2022 to December 2023. Patients were divided into an FZJD group (receiving FZJDF for 7 days plus prone ventilation) and a non-FZJD group (prone ventilation only). Propensity score matching (PSM) was performed to balance baseline characteristics. The primary outcome was the change in PaO2/FiO2 ratio after treatment. Secondary outcomes included 28-day mortality, duration of mechanical ventilation, length of ICU stay, PaCO2, lactic acid levels, APACHE II score, SOFA score, Chinese Medicine Score, inflammatory markers, and time to symptom resolution. Results: After PSM, 32 patients were included in each group. Compared to the non-FZJD group, the FZJD group showed significantly higher PaO2/FiO2 ratios, lower PaCO2, and lower lactic acid levels after treatment (p < 0.05 for all). The FZJD group also had significantly lower APACHE II scores, SOFA scores, Chinese Medicine Scores, and levels of WBC, PCT, hs-CRP, and IL-6 (p < 0.05 for all). Time to symptom resolution, including duration of mechanical ventilation, length of ICU stay, time to fever resolution, time to cough resolution, and time to resolution of pulmonary rales, was significantly shorter in the FZJD group (p < 0.05 for all). There was no significant difference in 28-day mortality between the two groups. Conclusion: FZJDF as an adjuvant therapy to prone ventilation can improve oxygenation and other clinical outcomes in severe pneumonia patients. Prospective studies are warranted to validate these findings. [ABSTRACT FROM AUTHOR]

Background: Severe pneumonia has consistently been associated with high mortality. We sought to identify risk factors for the mortality of severe pneumonia to assist in reducing mortality for medical treatment. Methods: Electronic databases including PubMed, Web of Science, EMBASE, Cochrane Library, and Scopus were systematically searched till June 1, 2023. All human research were incorporated into the analysis, regardless of language, publication date, or geographical location. To pool the estimate, a mixed-effect model was used. The Newcastle–Ottawa Scale (NOS) was employed for assessing the quality of included studies that were included in the analysis. Results: In total, 22 studies with a total of 3655 severe pneumonia patients and 1107 cases (30.29%) of death were included in the current meta-analysis. Significant associations were found between age [5.76 years, 95% confidence interval [CI] (3.43, 8.09), P < 0.00001], male gender [odds ratio (OR) = 1.47, 95% CI (1.07, 2.02), P = 0.02], and risk of death from severe pneumonia. The comorbidity of neoplasm [OR = 3.37, 95% CI (1.07, 10.57), P = 0.04], besides the presence of complications such as diastolic hypotension [OR = 2.60, 95% CI (1.45, 4.67), P = 0.001], ALI/ARDS [OR = 3.63, 95% CI (1.78, 7.39), P = 0.0004], septic shock [OR = 9.43, 95% CI (4.39, 20.28), P < 0.00001], MOF [OR = 4.34, 95% CI (2.36, 7.95), P < 0.00001], acute kidney injury [OR = 2.45, 95% CI (1.14, 5.26), P = 0.02], and metabolic acidosis [OR = 5.88, 95% CI (1.51, 22.88), P = 0.01] were associated with significantly higher risk of death among patients with severe pneumonia. Those who died, compared with those who survived, differed on multiple biomarkers on admission including serum creatinine [Scr: + 67.77 mmol/L, 95% CI (47.21, 88.34), P < 0.00001], blood urea nitrogen [BUN: + 6.26 mmol/L, 95% CI (1.49, 11.03), P = 0.01], C-reactive protein [CRP: + 33.09 mg/L, 95% CI (3.01, 63.18), P = 0.03], leukopenia [OR = 2.63, 95% CI (1.34, 5.18), P = 0.005], sodium < 136 mEq/L [OR = 2.63, 95% CI (1.34, 5.18), P = 0.005], albumin [− 5.17 g/L, 95% CI (− 7.09, − 3.25), P < 0.00001], PaO2/FiO2 [− 55.05 mmHg, 95% CI (− 60.11, − 50.00), P < 0.00001], arterial blood PH [− 0.09, 95% CI (− 0.15, − 0.04), P = 0.0005], gram-negative microorganism [OR = 2.56, 95% CI (1.17, 5.62), P = 0.02], and multilobar or bilateral involvement [OR = 3.65, 95% CI (2.70, 4.93), P < 0.00001]. Conclusions: Older age and male gender might face a greater risk of death in severe pneumonia individuals. The mortality of severe pneumonia may also be significantly impacted by complications such diastolic hypotension, ALI/ARDS, septic shock, MOF, acute kidney injury, and metabolic acidosis, as well as the comorbidity of neoplasm, and laboratory indicators involving Scr, BUN, CRP, leukopenia, sodium, albumin, PaO2/FiO2, arterial blood PH, gram-negative microorganism, and multilobar or bilateral involvement. Systematic review registration: PROSPERO Protocol Number: CRD 42023430684. [ABSTRACT FROM AUTHOR]

Background: Pneumonia is an infectious disease with high mortality rates despite early diagnosis and adequate treatment. Therefore, the use of biological infection parameters is expected to improve patients' clinical outcome prognostic accuracy. In this study, we proposed a combination of decreased procalcitonin (PCT) and C-reactive protein (CRP) to predict the clinical outcome of severe pneumonia. Methods: This was a prospective cohort study of severe pneumonia patients treated in the single-center Intensive Care Unit (ICU) of Dr. Soetomo General Hospital from December 2023 to February 2024. Subjects who met the inclusion and exclusion criteria were examined for PCT and CRP within the first 24 hours of admission and repeated 96 hours later (day five). Clinical outcomes, including acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), septic shock, and 30-day mortality, were observed. Results: Thirty-five patients were enrolled for this study. Five subjects did not survive until the fifth day, and 30 subjects were eligible for analysis. A decrease of PCT >50% within five days was associated with a reduction of 30-day mortality (p=0.013) and septic shock incidence (p=0.005), whereas the decrease in CRP alone did not show any significant relationship towards any clinical outcome. The combination of a decreased PCT >50% and decreased CRP within five days could increase the prognostic specificity up to 88.9% in predicting 30-day mortality. Conclusion: Decreased PCT by more than 50% within 96 hours may predict the 30-day mortality rate and septic shock incidence in patients with severe pneumonia, while combining it with a decreased CRP expression would elevate prognostic specificity for severe pneumonia. [ABSTRACT FROM AUTHOR]

Background: Pneumonia is one of the leading causes of infant mortality globally, particularly in sub-Saharan Africa. In Uganda, pneumonia was the fourth leading cause of death in children <5 years in 2018. Analysis of 2013–2022 data for children <5 years from the District Health Information System indicated a high incidence of severe pneumonia in Kasese District, Uganda. We investigated to identify factors associated with severe pneumonia among children <5 years in Kasese District to inform prevention and control strategies. Methods: We conducted a 1:1 hospital-based case-control study among children aged 2–59 months presenting with pneumonia at five high-volume facilities in Kasese District from January to April 2023. A case was defined as pneumonia with ≥1 of the following danger signs: low oxygen saturation, central cyanosis, severe respiratory distress, feeding difficulties, altered consciousness, and convulsions. Controls were outpatient children aged 2–59 months with a diagnosis of non-severe pneumonia. We reviewed medical records at facilities and used an interviewer-administered questionnaire with caregivers to obtain information on socio-demographic and clinical characteristics. Logistic regression was used to identify factors associated with severe pneumonia. Results: We enrolled 199 cases and 174 controls. The odds of severe pneumonia were higher among children with diarrhoea only (adjusted odds ratio [aOR] = 2.9, 95%CI: 1.7–4.9), or malaria and diarrhoea (aOR = 3.4, 95%CI: 2.0-5.9), than those without a co-existing illness at the time of pneumonia diagnosis. Not being exclusively breastfed for ≥ 6 months (aOR = 2.0, 95%CI: 1.1–3.3) and exposure to indoor air pollution from cooking combustion sources (aOR = 2.9, 95%CI: 1.8–4.7) increased odds of severe pneumonia. Conclusion: The findings highlight the significance of comorbidities, lack of exclusive breastfeeding, and exposure to indoor air pollution in the development of severe pneumonia. Promoting exclusive breastfeeding for ≥ 6 months and advocating for the use of clean energy sources, could mitigate morbidity attributable to severe pneumonia in the region. [ABSTRACT FROM AUTHOR]

Systemic steroids are frequently used in critically ill patients for their anti-inflammatory properties. Potential benefits of these agents should be balanced against their known side effects. In this paper, we review trials assessing the use of systemic steroids in common conditions requiring admission to the intensive care unit. These include septic shock, the acute respiratory distress syndrome, severe pneumonia, COVID-19, and hypercapnic respiratory failure due to chronic obstructive pulmonary disease. We will mainly focus on well-conducted randomized controlled trials to determine whether steroids should be administered to critically ill patients presenting with these conditions. [ABSTRACT FROM AUTHOR]

Background: The precise identification of the underlying causes of infectious diseases, such as severe pneumonia, is essential, and the development of next-generation sequencing (NGS) has enhanced the effectiveness of pathogen detection. However, there is limited information on the systematic assessment of the clinical use of targeted next-generation sequencing (tNGS) in cases of severe pneumonia. Methods: A retrospective analysis was conducted on 130 patients with severe pneumonia treated in the ICU from June 2022 to June 2023. The consistency of the results of tNGS, metagenomics next-generation sequencing (mNGS), and culture with the clinical diagnosis was evaluated. Additionally, the results for pathogens detected by tNGS were compared with those of culture, mNGS, and quantitative reverse transcription PCR (RT-qPCR). To evaluate the efficacy of monitoring severe pneumonia, five patients with complicated infections were selected for tNGS microbiological surveillance. The tNGS and culture drug sensitisation results were then compared. Results: The tNGS results for the analysis of the 130 patients showed a concordance rate of over 70% with clinical diagnostic results. The detection of pathogenic microorganisms using tNGS was in agreement with the results of culture, mNGS, and RT-qPCR. Furthermore, the tNGS results for pathogens in the five patients monitored for complicated infections of severe pneumonia were consistent with the culture and imaging test results during treatment. The tNGS drug resistance results were in line with the drug sensitivity results in approximately 65% of the cases. Conclusions: The application of tNGS highlights its promise and significance in assessing the effectiveness of clinical interventions and providing guidance for anti-infection therapies for severe pneumonia. [ABSTRACT FROM AUTHOR]

Mycoplasma pneumoniae pneumonia (MPP) is a common cause of community-acquired pneumonia in children aged 5 and older in China. Although most affected children have favorable clinical prognosis, some cases can escalate into severe MPP due to risk factors such as pathogen resistance or co-infections, etc. These severe cases significantly jeopardize the lives of children and may lead to diverse long-term sequelae. In response to this challenge, the Children’s Medical Center of the Third Affiliated Hospital of Sun Yat-sen University, integrating current guidelines, expert consensus, and its extensive clinical experience, has devised the “412” cluster treatment strategy. This comprehensive approach encompasses treatments for anti-infection, anti-inflammatory storm, anticoagulation and antioxidant stress. Additionally, it seamlessly integrates traditional Chinese medicine with western therapies, featuring bundled respiratory management and follow-up care. This strategy provides a valuable reference for the diagnosis and treatment of severe MPP in children. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 has posed a significant threat to a subset of the patient population. The occurrence of hematological malignancies and tumor treatment can lead to immunosuppression in patients, which significantly increases the risk of serious complications, severe incidence and mortality after SARSCoV-2 infection. The treatment of a patient with follicular lymphoma infected with SARS-CoV-2 was described in detail. The patient remained positive for RT-PCR tests during the hospitalization for nearly 90 days. After undergoing 5 rounds of antiviral treatment, along with glucocorticoid anti-inflammatory therapy, low-molecular-weight heparin for anticoagulation, antibiotics for infection control, and respiratory support through the use of a ventilator, the patient eventually obtained negative result of the RT-PCR test. Subsequently, the patient was successfully weaned from mechanical ventilation and discharged. By summarizing the treatment process of this case, we hoped to provide reference and experience for future clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective To investigate disease characteristics and hospitalization costs of children with Mycoplasma Pneumoniae pneumonia (MPP) admitted to Shanghai municipal medical hospitals from 2019 to 2023. Methods Depending on the Shanghai Municipal Hospital Pediatric Alliance, we retrospectively investigated community acquired MPP pediatric patients hospitalized in 22 municipal hospitals with pediatric qualifications (including 4 children’s hospitals) in Shanghai from Jan 2019 to Dec 2023. We collected the patients' diagnosis codes, gender, age, length of hospital stay, hospitalization costs, and whether they progressed to severe Mycoplasma pneumoniae pneumonia (SMPP). Results From 2019 to 2023, a total of 29 045 hospitalized children with MPP were treated, with 6 035 cases (20.8%) identified as SMPP in the 22 hospitals. Trend analysis revealed a rising trend with years in the proportion of SMPP patients (χ² trend=365.498, P<0.001). Among the 4 children's hospitals, there were 18 710 cases with MPP, including 4 078 cases (21.8%) of SMPP. The proportion of SMPP patients also showed an increasing trend with years (χ² trend=14.548, P<0.001), and the proportion in 2023 (23.0%) was higher than that in previous years with statistical significance. There were statistical differences in the seasonal distribution of MPP cases between different years, with higher proportions in summer and autumn overall. The age distribution of hospitalized MPP children varied among different years, with school-age children accounting for the majority (56.8%) in 2023. There was no difference in the distribution of severe cases between different genders, but there were differences in the proportion of severe cases among different age groups in different years, with a gradual increase in severe cases among children aged 1 to 3 years (χ² trend= 191.567, P<0.001). The average length of hospital stay for MPP during the epidemic was higher than that during non-epidemic periods, and there were statistically significant differences in the average length of hospital stay between different years (P<0.001). The individual hospitalization costs during the epidemic were higher than in other years, and there were statistically significant differences in individual hospitalization costs between different years (P<0.001). The total hospitalization costs were still higher in 2019 and 2023. The individual hospitalization costs for SMPP were higher than for non-SMPP cases. Conclusion MPP outbreaks occurred in Shanghai in 2019 and 2023, with the higher proportions in summer and autumn overall. Compared to previous years, the number of hospitalized MPP children in Shanghai was higher in 2023, with a higher proportion of SMPP cases, especially among children under 3 years old. The individual per capita hospitalization expenses for SMPP cases were higher than for nonSMPP cases. [ABSTRACT FROM AUTHOR]

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Objective: Based on network meta-analysis, the efficacy of different Chinese herbal decoction in the treatment of adult severe pneumonia was evaluated. Methods: Computer search of CNKI, VIP, Wangfang, Cochrane Library, Embase, PubMed, Web of science databases. randomized controlled trials (RCT) on TCM decoction for severe pneumonia in adults were collected up to July 31, 2023. The Cochrane bias risk assessment tool was used to assess the quality of the included literature, and Stata17.0 software was used to perform a network meta-analysis based on the frequency framework. Results: Finally, 40 RCTs were included, involving 13 traditional Chinese medicines and 3 773 patients. The results of network meta-analysis showed that Maxingshigan Decoction combined with QianjinWeijian Decoction + Western medicine routine may be the most effective intervention in improving clinical efficacy, QingfeiTongfu Decoction + Western medicine routine may be the most effective in improving CRP, QingjinHuatan decoction + Western medicine routine may be the most effective in improving IL-6 and TNF-α. Maxingshigan Decoction + Western medicine routine may be the most effective in improving PCT, Xuanbai Chengqi decoction + Western medicine routine may be the most effective in improving APACHE II and CPIS. Conclusion: The curative effect of TCM decoction combined with conventional western medicine on adult severe pneumonia is better than that of conventional Western medicine and the adverse reaction is less. However, limited by the quality and number of included literatures, the above conclusions still need to be further verified. [ABSTRACT FROM AUTHOR]

Objective To explore the changes of traditional Chinese medicine(TCM) syndrome characteristics in patients with severe pneumonia (SP) before and after antibiotic application based on factor analysis method. Methods A total of 335 cases of SP admitted to the Department of Intensive Care Medicine, Department of Pulmonology, and Department of Cardiology of this hospital from January 2020 to June 2022 were included. At different time points (admission, 7 days of antibiotic use, the next day after antibiotic discontinuation), the "SP TCM Syndrome Collection Form" was filled out, and the information database of the four diagnosis of TCM was constructed, and the common factors were extracted by factor analysis method. Results The main characteristics of TCM syndromes in SP patients before and after the application ofantibiotics were all type of deficiency in origin and excess in superficiality, involving multiple organs such aslung, spleen, kidney. Overall, the characteristics of TCM syndromes changed from excess to deficiency after the application of antibiotics. A total of 11,14,and 15 common factors were extracted in turn at three different time points; admission. 7 days of antibiotic use, and the next day after antibiotic discontinuation. The key points of the syndromes at admission were concentrated on heat syndrome, phlegm syndrome. The key points of the syndromes at 7 days of antibiotic use were concentrated on heat syndrome and poison syndrome. The key points of the syndromes at the next day after antibiotic discontinuation were concentrated on Qi deficiency and Yin deficiency. Dampness and heat could be regarded as the a combination of SP. Conclusion The TCM syndrome types of SP show dynamic evolution characteristics before and after the application of antibiotics, and the distribution of each syndrome type at different time nodes has its own characteristics [ABSTRACT FROM AUTHOR]

Objective To investigate the factors influencing the development of severe pneumonia in patients with human immunodeficiency virus (HIV )/acquired immunodeficiency syndrome (AIDS). Methods This study retrospectively analyzed the clinical data of 139 patients with HIV/AIDS combined with pulmonary infections admitted to the Department of Infectious Diseases of General Hospital of Ningxia Medical University from January 2017 to August 2023, among which 48 cases were in the severe pneumonia group and 91 cases were in the non-severe pneumonia group. The influencing factors on the occurrence of severe pneumonia in patients with HIV/AIDS were analyzed by using logistic regression, and the predictive value of the indicators for severe pneumonia was analyzed by plotting the work characteristics of the subjects (ROC) curves. Results The incidence of severe pneumonia was 34. 5% (48/139) in 139 patients with HIV/AIDS coinfection of the lungs. Univariate analysis showed that cough, shortness of breath, percentage of neutrophils, percentage of lymphocytes, absolute value of lymphocytes, prothrombin activity (PTA), CD4+T and CD8+T lymphocyte counts, neutrophil/lymphocyte ratio (NLR), albumin, number of pathogens greater than or equal to two, and continuous strong antiretroviral therapy (ART) treatment (>three months) were significantly associated with severe pneumonia in HIV/AIDS patients (P <0. 05). Logistic stepwise regression analysis showed that previous pneumocystis pneumonia (PCP), number of pathogens greater than or equal to two, elevated NLR, elevated PTA, and shortness of breath were independent risk factors for severe pneumonia in HIV/AIDS patients, continuous ART treatment (>three months) and CD8+ T cell count were independent protective factors (P <0. 05). The area under the curve of multi-factor combined prediction is the largest (AUC=0. 917, 95%CI 0. 873-0. 961, P <0. 01). Conclusion The occurrence of severe pneumonia in HIV/ AIDS patients is closely related to previous PCP, number of pathogens greater than or equal to two, high NLR, high PTA, shortness of breath, continuous ART treatment (>three months), CD8+T cell count. Multifactor combined prediction have good predictive value [ABSTRACT FROM AUTHOR]

COVID-19 is associated with heterogeneous outcome. Early identification of a severe progression of the disease is essential to properly manage the patients and improve their outcome. Biomarkers reflecting an increased inflammatory response, as well as individual features including advanced age, male gender, and pre-existing comorbidities, are risk factors of severe COVID-19. Yet, these features show limited accuracy for outcome prediction. The aim was to evaluate the prognostic value of whole blood transcriptome at an early stage of the disease. Blood transcriptome of patients with mild pneumonia was profiled. Patients with subsequent severe COVID-19 were compared to those with favourable outcome, and a molecular predictor based on gene expression was built. Unsupervised classification discriminated patients who would later develop a COVID-19-related severe pneumonia. The corresponding gene expression signature reflected the immune response to the viral infection dominated by a prominent type I interferon, with IFI27 among the most over-expressed genes. A 48-genes transcriptome signature predicting the risk of severe COVID-19 was built on a training cohort, then validated on an external independent cohort, showing an accuracy of 81% for predicting severe outcome. These results identify an early transcriptome signature of severe COVID-19 pneumonia, with a possible relevance to improve COVID-19 patient management. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In this case report, we describe the successful management of severe scrub typhus with pneumonia, sepsis, and multiple organ dysfunction in a pregnant woman. Despite initial challenges, the patient responded favorably to fecal microbiota transplantation and oral fecal microbiota capsule therapy. Scrub typhus, caused by Orientia tsutsugamushi, can lead to severe multiorgan dysfunction and carries a mortality rate of up to 70% if not treated properly. In this report, we present the case of a 27‐year‐old pregnant woman at 18 + 6 weeks gestation whose symptoms worsened 15 days after onset and progressed to severe pneumonia with sepsis and multiple organ dysfunction syndrome. After the pathogen was confirmed by next‐generation sequencing analysis of bronchoalveolar‐lavage fluid and blood samples, the patient's treatment was switched to antiinfective chloramphenicol. The patient also underwent uterine evacuation due to a miscarriage. Extracorporeal membrane oxygenation was discontinued once the pulmonary infection significantly improved. Subsequently, the patient had recurrent diarrhea, abdominal distension, and difficulty eating. The antibiotic regimen was adjusted according to the drug sensitivity, but the diarrhea and abdominal distension still did not improve. Following a comprehensive multidisciplinary risk assessment, we initiated fecal microbiota transplantation and oral fecal microbiota capsule therapy. As a result, the patient's condition was effectively managed, and they were gradually discharged. Fecal microbiota transplantation may be a safe and effective treatment for severe pneumonia and shock in pregnant women. This has significant implications for maternal health. However, further clinical cases are required to observe its long‐term effectiveness. [ABSTRACT FROM AUTHOR]

Post-intubation hypotension (PIH) was one of the serious complications after Endotracheal intubation (ETI) in Severe pneumonia (SP) patients. The risk factors of PIH were investigated in SP patients to provide a theoretical basis of early intervention. This was a retrospective study wherein 420 SP patients undergone ETI from December 2019 to December 2022 were selected as the study subjects. Patients were divided into the hypotension and normal blood pressure groups based on the blood pressures recorded after intubation. Two groups were compared for the general data and various physicochemical indicators before the intubation. The independent risk factors of hypotension after tracheal intubation were explored in SP patients through univariate and multivariate logistic regression. PIH was developed in 170 (40.47%) SP patients. Univariate logistic regression analysis exhibited that age (Odd Ratio (OR) = 1.021, p = 0.001), weight (OR = 0.976, p = 0.015), inducer usage before intubation (OR = 1.221, p < 0.001), chronic obstructive pulmonary disease (OR = 1.768, p = 0.013), sepsis (OR = 1.870, p = 0.006), and hyperelastic acidemia (OR = 1.665, p = 0.012) were associated with PIH. Multivariate logistic regression analysis indicated that age (OR = 1.015, p = 0.033), weight (OR = 0.974, p = 0.012), inducer usage before intubation (OR = 1.228, p < 0.001), chronic obstructive pulmonary disease (OR = 1.660, p = 0.037), sepsis (OR = 1.733, p = 0.035), and hyperelastic acidemia (OR = 1.679, p = 0.018) were the independent risk factors of PIH. The study demonstrated that SP patients were prone to PIH with advanced age, low body weight, inducer usage before intubation, increased lactic acid levels before intubation, and high risk factors of chronic obstructive pulmonary disease (COPD) or sepsis. The findings had potential of advanced patient care, and refined medical practices, and could stimulate further investigations in the field. [ABSTRACT FROM AUTHOR]

Case 1: A 71-year-old man was admitted to our hospital with progressive fever and dyspnea, which had developed three days after the onset of COVID-19. Initial chest computed tomography (CT) revealed a pulmonary lesion consistent with a secondary bacterial infection. Streptococcus pyogenes was isolated from cultures of primary sputum collected from the endotracheal tube, and identified as the causative microorganism. Case 2: A 91-year-old man was transferred to our hospital with severe hypotension, which had developed nine days after the onset of COVID-19. A chest CT revealed pericardial effusion and pericardiocentesis yielded purulent fluid. S. pyogenes was isolated from the fluid specimens and was identified as the causative microorganism of the secondary bacterial pericarditis. Isolates from both patients were subsequently identified as M1UK-lineage S. pyogenes via genetic analysis. This report implicates COVID-19 as a potential risk factor for severe M1UK infection via the respiratory tract.

Pneumonia is a serious and common infectious disease in children. If not treated in time, it may develop into severe pneumonia. Severe pneumonia in children is mainly characterized by hypoxia and acidosis, often accompanied by various complications such as sepsis and multiple organ dysfunction. Severe pneumonia has a rapid onset and progression, and a high mortality rate. Biomarkers assist clinicians in the early diagnosis and treatment of patients by quickly and accurately identifying their conditions and prognostic risks. In this study, common clinical and novel biomarkers of severe pneumonia in children were reviewed, and the application value of biomarkers related to the severity and prognosis of severe pneumonia in children was evaluated to provide help for early identification and precise intervention by clinicians.

Severe pneumonia (SP) is a prevalent respiratory ailment characterized by high mortality and poor prognosis. Current scoring systems for pneumonia are not only time-consuming but also exhibit limitations in early SP prediction. To address this gap, this study aimed to develop a machine-learning model using inflammatory markers from peripheral blood for early prediction of SP. A total of 204 pneumonia patients from seven medical centers were studied, with 143 (68 SP cases) in the training cohort and 61 (32 SP cases) in the test cohort. Clinical characteristics and laboratory test results were collected at diagnosis. Various models including Logistic Regression, Random Forest, Naïve Bayes, XGBoost, Support Vector Machine, and Decision Tree were built and evaluated. Seven predictors—age, sex, WBC count, T-lymphocyte count, NLR, CRP, TNF-α, IL-4/IFN-γ ratio, IL-6/IL-10 ratio—were selected through LASSO regression and clinical insight. The XGBoost model, exhibiting best performance, achieved an AUC of 0.901 (95 % CI: 0.827 to 0.985) in the test cohort, with an accuracy of 0.803, sensitivity of 0.844, specificity of 0.759, and F1_score of 0.818. Indeed, SHAP analysis emphasized the significance of elevated WBC counts, older age, and elevated CRP as the top predictors. The use of inflammatory biomarkers in this concise predictive model shows significant potential for the rapid assessment of SP risk, thereby facilitating timely preventive interventions.

Background: The Ethiopian Federal Ministry of Health has been working by introducing vaccines, and integrating the management of newborn and child illnesses to prevent pneumonia, pneumonia-related hospitalization, and mortality. Despite these attempts, the prevalence of pneumonia and the proportion of hospitalizations have increased. Little is known about recovery time from severe pneumonia and its predictors in pediatric patients in the study area. Therefore, this study aimed to determine the time to recovery from severe pneumonia and its predictors in pediatric patients admitted to government hospitals in the southwest Region. Methods and Materials: A hospital-based prospective follow-up study was conducted among 791 pediatric patients admitted with severe pneumonia at a governmental hospital in the South West Region, of Ethiopia. A systematic sampling technique was used to recruit participants. Data were entered into Epi-data 4.4.2.1 and exported to STATA 14 for analysis. The assumptions of Cox proportional hazard models and goodness of fit were assessed using the Shoenfield residual and Cox-Snell, respectively. Bivariate and multivariable Cox regression models were used to identify the predictors of time to recovery. Variables with a p-value of

Abstract Background Early, rapid, and accurate pathogen diagnosis can help clinicians select targeted treatment options, thus improving prognosis and reducing mortality rates of severe pneumonia. Metagenomic next-generation sequencing (mNGS) has a higher sensitivity and broader pathogen spectrum than traditional microbiological tests. However, the effects of mNGS-based antimicrobial treatment procedures on clinical outcomes and cost-effectiveness in patients with severe pneumonia have not been evaluated. Methods This is a regional, multi-center, open, prospective, randomized controlled trial to evaluate that whether the combination of mNGS and traditional testing methods could decrease 28-day call-cause mortality with moderate cost-effectiveness. A total of 192 patients with severe pneumonia will be recruited from four large tertiary hospitals in China. Bronchoalveolar lavage fluid will be obtained in all patients and randomly assigned to the study group (mNGS combined with traditional microbiological tests) or the control group (traditional microbiological tests only) in a 1:1 ratio. Individualized antimicrobial treatment and strategy will be selected according to the analysis results. The primary outcome is 28-day all-cause mortality. The secondary outcomes are ICU and hospital length of stay (LOS), ventilator-free days and ICU-free days, consistency between mNGS and traditional microbiological tests, detective rate of mNGS and traditional microbiological tests, turn-out time, time from group allocation to start of treatment, duration of vasopressor support, types and duration of anti-infective regimens, source of drug-resistant bacteria or fungi, and ICU cost. Discussion The clinical benefits of mNGS are potentially significant, but its limitations should also be considered. Trial registration ChineseClinicalTrialRegistry.org, ChiCTR2300076853. Registered on 22 October 2023.

The aim of this study is to describe the novel epidemiological and clinical characteristics of influenza A-induced severe pneumonia occurring after the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to further assess its potential risk factors for mortality.

Abstract Background Antimicrobial resistance (AMR) is a major threat to children’s health, particularly in respiratory infections. Accurate identification of pathogens and AMR is crucial for targeted antibiotic treatment. Metagenomic next-generation sequencing (mNGS) shows promise in directly detecting microorganisms and resistance genes in clinical samples. However, the accuracy of AMR prediction through mNGS testing needs further investigation for practical clinical decision-making. Methods We aimed to evaluate the performance of mNGS in predicting AMR for severe pneumonia in pediatric patients. We conducted a retrospective analysis at a tertiary hospital from May 2022 to May 2023. Simultaneous mNGS and culture were performed on bronchoalveolar lavage fluid samples obtained from pediatric patients with severe pneumonia. By comparing the results of mNGS detection of microorganisms and antibiotic resistance genes with those of culture, sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results mNGS detected bacterial in 71.7% cases (86/120), significantly higher than culture (58/120, 48.3%). Compared to culture, mNGS demonstrated a sensitivity of 96.6% and a specificity of 51.6% in detecting pathogenic microorganisms. Phenotypic susceptibility testing (PST) of 19 antibiotics revealed significant variations in antibiotics resistance rates among different bacteria. Sensitivity prediction of mNGS for carbapenem resistance was higher than penicillins and cephalosporin (67.74% vs. 28.57%, 46.15%), while specificity showed no significant difference (85.71%, 75.00%, 75.00%). mNGS also showed a high sensitivity of 94.74% in predicting carbapenem resistance in Acinetobacter baumannii. Conclusions mNGS exhibits variable predictive performance among different pathogens and antibiotics, indicating its potential as a supplementary tool to conventional PST. However, mNGS currently cannot replace conventional PST.

Objective To evaluate the prognostic value of early blood inflammatory indicators in patients with respiratory failure caused by severe community-acquired pneumonia. Methods A total of 186 patients diagnosed with respiratory failure due to severe pneumonia on admission were recruited in this study. According to clinical prognosis， they were divided into the death group （n = 42） and improvement group （n = 144）. Twelve cytokines， ferritin， C-reactive protein， procalcitonin， blood routine examination and blood gas analysis results of the patients within two days after admission were analyzed. Pneumonia severity index （PSI） and APACHE Ⅱ scores of the patients were collected. The correlation between the above indicators and prognosis was explored. Results Compared with the improvement group， the levels of IFN-γ， IL-10， IL-6， IL-8， C-reactive protein （CRP）， procalcitonin and ferritin were significantly higher in the death group （all P < 0.05）. Upon admission， the hemoglobin level and platelet count in the death group were significantly lower than those in the improvement group （both P < 0.05）. The PSI and APACHE Ⅱ scores on admission in the death group were significantly higher compared with those in the improvement group （both P < 0.05）. Patients in the death group had higher lactic acid level and lower oxygenation index （OI） compared with their counterparts in the improvement group （both P < 0.05）. Multivariate Logistic regression analysis revealed that IL-6， ferritin， PSI and APACHE Ⅱ scores and lactic acid level were the risk factors for poor prognosis， whereas platelet count was the protective factor for poor prognosis （all P < 0.05）. The receiver operating characteristic （ROC） curve indicated that IL-6，procalcitonin and ferritin were favorable predictors for clinical prognosis of patients. When IL-6 and ferritin levels exceed 11.41 ng/L and 659 μg/L， and platelet count was less than 148.5×109/L， patients were at risk of death. Conclusions In patients with respiratory failure caused by severe community-acquired pneumonia， the increase of blood inflammatory indicators， such as IL-6， ferritin and procalcitonin， suggests high risk death in patients， especially for patients with IL-6 >11.41 ng/L， ferritin>659 μg/L， and platelet count9/L. Extensive attention should be paid to lowering the risk of death in these patients.

ABSTRACT: Objectives: Antimicrobial Stewardship 2018 (ASP 18) in China emphasizes the hierarchical control of antimicrobial drugs and the management of physicians’ prescribing authority, especially in children. The purpose of this study was to assess the effect of implementation of ASP 2018 on antibiotic consumption, resistance, and treatment outcomes in children with severe pneumonia from bacterial infections. Methods: A single center, retrospective study was conducted on 287 children with severe bacterial pneumonia, including 165 patients before intervention (May 2016–April 2018) and 122 patients after intervention (May 2018–April 2020). The antimicrobial resistance rates, antibiotic consumption, and clinical outcomes of the two periods were compared. Results: After the implementation of ASP 2018, Staphylococcus aureus (17.9%) became the predominant Gram-positive bacterium. The resistance of Streptococcus pneumoniae to clindamycin, erythromycin, and tetracycline was significantly reduced (P < 0.001), and Staphylococcus aureus to tetracycline also decreased (P = 0.034). In addition, Klebsiella pneumoniae (18.4%) replaced Pseudomonas aeruginosa (9.5%) as the most common Gram-negative bacterium. The resistance rates of Klebsiella pneumoniae to amoxicillin/clavulanic acid (AMC) and trimethoprim/sulfamethoxazole (SXT), and Acinetobacter baumannii to cefotaxime and SXT decreased significantly (P < 0.02). Total consumption (DDD/100 patient-days) of five antibiotics (cephalosporins, carbapenems, macrolides, antifungal agents, and linezolid) showed a decreasing trend, and the decrease in antifungal agents and linezolid was the most significant (27.4% and 25.6%, P < 0.001). The isolation rate of multidrug-resistant (MDR) strains decreased significantly from the highest, 16.8%, before intervention to 6.7% after intervention (P < 0.001). Conclusion: Our data indicate that the implementation of antimicrobial management strategies has significantly reduced the consumption of antibiotics and the occurrence of antimicrobial resistance in children with severe bacterial pneumonia in PICU.