Community-Acquired Pneumonia

A randomized, double-blind, placebo-controlled, multicenter clinical trial for efficacy and safety of traditional Chinese medicine combined with antibiotics in the treatment of bacterial pneumonia in children

BACKGROUND

Pneumonia is the second leading cause of death in children worldwide after preterm birth and certification. Bacteria, viruses, mycoplasma, and other microorganisms are known to be the main causes of pneumonia, of which bacterial pathogenic factors account for 12.5% of cases. The invention and application of antibiotics have improved the prognosis of children with community-acquired bacterial pneumonia (CABP) to a certain extent, but with the emergence of antibiotic resistance worldwide, the mortality of children with CABP is still high. "Maxing Shigan Decoction" and "Qingfei Decoction" have significant efficacy in the treatment of CABP in children, but there is no standardized randomized controlled trial to systematically evaluate the outcomes.

METHODS

This study is a randomized, double-blind, placebo-controlled, multicenter clinical trial that will randomize 240 patients with CABP to group of Oral Maxing Shigan Decoction, group of Qingfei Decoction or group of placebos administered 3 times a day for 7 days. This study will observe a wide range of clinically relevant endpoints that have been used in clinical trials of pneumonia, including but not limited to clinical cure rate, antibiotic application days, complete antipyretic rate, complete antipyretic days, disease efficacy, traditional Chinese medicine syndrome effect, and antibiotic upgrade treatment rates. Safety will be assessed by monitoring for the incidence of adverse events during the study.

DISCUSSION

This clinical trial is the first to evaluate the efficacy and safety of "Maxing Shigan Decoction" and "Qingfei Decoction" in the treatment of children with CABP. The research results will provide a reference for future research design.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900025354. Registered on 14th October 2019-Retrospectively registered, http://www.chictr.org.cn/.

Comparison of clinical characteristics of patients with pandemic SARS-CoV-2-related and community-acquired pneumonias in Hungary - a pilot historical case-control study

The distinction between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related and community-acquired pneumonias poses significant difficulties, as both frequently involve the elderly. This study aimed to predict the risk of SARS-CoV-2-related pneumonia based on clinical characteristics at hospital presentation. Case-control study of all patients admitted for pneumonia at Semmelweis University Emergency Department. Cases (n = 30) were patients diagnosed with SARS-CoV-2-related pneumonia (based on polymerase chain reaction test) between 26 March 2020 and 30 April 2020; controls (n = 82) were historical pneumonia cases between 1 January 2019 and 30 April 2019. Logistic models were built with SARS-CoV-2 infection as outcome using clinical characteristics at presentation. Patients with SARS-CoV-2-related pneumonia were younger (mean difference, 95% CI: 9.3, 3.2-15.5 years) and had a higher lymphocyte count, lower C-reactive protein, presented more frequently with bilateral infiltrate, less frequently with abdominal pain, diarrhoea, and nausea in age- and sex-adjusted models. A logistic model using age, sex, abdominal pain, C-reactive protein, and the presence of bilateral infiltrate as predictors had an excellent discrimination (AUC 0.88, 95% CI: 0.81-0.96) and calibration (p = 0.27-Hosmer-Lemeshow test). The clinical use of our screening prediction model could improve the discrimination of SARS-CoV-2 related from other community-acquired pneumonias and thus help patient triage based on commonly used diagnostic approaches. However, external validation in independent datasets is required before its clinical use.

[CURB-65 as a predictor of 30-day mortality in patients hospitalized with COVID-19 in Ecuador: COVID-EC StudyAbstract]

Objetivo

Valorar la utilidad del CURB-65 para predecir la mortalidad a 30 días en pacientes adultos hospitalizados con COVID-19.

Métodos

Cohorte realizada entre el 1 de marzo y el 30 de abril de 2020 en Ecuador.

Resultados

Se incluyeron 247 pacientes (edad media 60 ± 14 años, 70% varones, mortalidad global 41,3%). Los pacientes con CURB-65 ≥ 2 presentaron mayor mortalidad (57 vs. 17%, p < 0,001), en asociación con otros marcadores de riesgo: edad avanzada, hipertensión arterial, sobrepeso/obesidad, fracaso renal, hipoxemia, requerimiento de ventilación mecánica o desarrollo de distrés respiratorio.

Conclusiones

En el análisis univariado (Kaplan-Meier) y multivariado (regresión de Cox) el CURB-65 ≥ 2 se relacionó con una mayor mortalidad a 30 días.

Community-acquired pneumonia: aetiology, antibiotic resistance and prospects of phage therapy

Bacteria are the most common aetiological agents of community-acquired pneumonia (CAP) and use a variety of mechanisms to evade the host immune system. With the emerging antibiotic resistance, CAP-causing bacteria have now become resistant to most antibiotics. Consequently, significant morbimortality is attributed to CAP despite their varying rates depending on the clinical setting in which the patients being treated. Therefore, there is a pressing need for a safe and effective alternative or supplement to conventional antibiotics. Bacteriophages could be a ray of hope as they are specific in killing their host bacteria. Several bacteriophages had been identified that can efficiently parasitize bacteria related to CAP infection and have shown a promising protective effect. Thus, bacteriophages have shown immense possibilities against CAP inflicted by multidrug-resistant bacteria. This review provides an overview of common antibiotic-resistant CAP bacteria with a comprehensive summarization of the promising bacteriophage candidates for prospective phage therapy.

[Update on respiratory infections in the emergency department]

Las infecciones respiratorias agudas (IRA) constituyen uno de los motivos de consulta más frecuentes en los Servicios de Urgencias (SU) y se encuentran entre las primeras causas de morbimortalidad en los países en vías de desarrollo, según la Organización Mundial de la Salud (OMS). De manera general, se pueden definir como un deterioro clínico agudo caracterizado por la presencia de tos, expectoración, disnea, fiebre, cambios en las características del esputo y alteraciones radiológicas; todas estas mani- festaciones pueden comprometer de manera significativa la salud de los pacientes. Realizar un buen diagnóstico y tratamiento de las IRA es primordial en la práctica diaria, tanto en Atención Primaria como a nivel hospitalario, para evitar complicaciones y mortalidad relacionadas con estas enfermedades. En esta actualización, hablaremos de las infecciones respiratorias más frecuentes en el SU, la bronquitis aguda, las agudizaciones de la EPOC o bronquiectasias y las neumonías.