Objective To explore the distribution of bacteria among community acquired lower respiratory tract infection (LRTI) inpatients with underlying chronic respiratory tract diseases.Methods The clinical data，sputum culture and drug susceptibility results of 212 community acquired LRTI patients who were hospitalized during the period 2001-2005 were retrospectively analyzed.All patients had various underlying chronic respiratory tract diseases.Results A total of 229 strains of pathogens were detected，with the majority being gram negative bacteria.In pathogens of acute exacerbation of chronic obstructive pulmonary disease，gram negative bacteria occupied 73.9%.And Pseudomonas aeruginosa and Klebsiella pneumoniae were the most common pathogens，with each occupying 18.2% and 13.6% respectively.Gram positive bacteria occupied 23.8%，mainly Staphylococcus aureus (10.2%) and Streptococcus pneumoniae (9.1%).In patients with bronchiectasis exacerbated by bacterial infection，86.2% were caused by gram negative bacteria，the top three being，in descending order，Pseudomonas aeruginosa (27.5%)，Haemophilus parainfluenzae (13.7%)，and Haemophilus influenzae (11.8%).Bronchiectasis was the major risk factor of getting Pseudomonas aeruginosa infection (OR=5.590，95%CI 2.792~11.192).The risk factors of getting Acinetobacter baumanii infection were antacid usage within 1 month (OR=9.652，95%CI 2.792~11.192) and hypoalbuminemia (OR=2.679，95%CI 1.108~6.476).For enterobacters infections，including Klebsiella pneumoniae，Enterobacter cloacae and Escherichia coli，the risk factors were antibiotic usage within 1 month (OR=4.236，95%CI 1.982~9.057)，having renal diseases (OR=4.305，95%CI 1.090~17.008) and diabetes mellitus (OR=2.836，95%CI 1.339~6.009).Conclusions Gram negative bacteria were the main pathogens of community acquired LRTI in hospitalized patients with underlying chronic respiratory tract diseases.The pathogens were influenced by underlying diseases，severity of diseases and drug usage history of patients.
Objective To improve the knowledge of kartagener syndrome and the understanding of primary ciliary dyskinesia ( PCD) . Methods Three cases of Kartagener syndrome were reported and analyzed on clinical manifestations, symptoms, imaging appearances of chest, and family history. Meanwhile the related literatures were reviewed. Results The three patients deserved special recognition because of recurrent upper and lower respiratory tract infection. Of them, the third case showed mainly the symptoms of nasosinusitis at an early age, and the distinct pulmonary symptoms appeared in his adulthood. Further examination showed that the triad of chronic sinusitis, bronchiectasis, and situs inversus is present in all cases. The parents of the two cases were consanguineous marriaged. Examination of the bronchial mucosal biopsy specimen of the first case under transmission electron microscopy showed cilia with the absence of inner dynein arms. The three cases got improvement after treatment of anti-infection and expectorant. Conclusion For patients with recurring infection in the upper and lower respiratory tract from infancy, the possibility of PCD should be considered no matter whether a situs inversus exists.
Objective To evaluate the efficacy of long-term inhaled salmeterol / fluticasone combined with low-dose oral erythromycin in patients with bronchiectasis. Methods Sixty-two patients with bronchiectasis after exacerbation and maintained stable were randomly divided into three groups. Group A was treated with low-dose oral erythromycin, group B inhaled salmeterol/fluticasone, and group C inhaled salmeterol/fluticasone plus low-dose oral erythromycin. The study duration lasted for 6 months. The clinical symptoms, dyspnea scale, exacerbation frequency, and pulmonary function parameters were measured and compared. Results Fifty-four patients completed the whole study and 8 cases withdrew. The results showed that 6 months of low-dose erythromycin therapy can improve the clinical symptoms, whille exacerbation frequency was also decreased. Inhaled salmeterol/fluticasone improved lung function, however, had no effect on cough, expectoration and exacerbation frequency. Inhaled salmeterol/fluticasone combined with erythromycin was more significantly effective in improving lung functions as well as symptoms. Conclusions Long-terminhaled salmeterol/fluticasone combined with low-dose oral erythromycin can improve the clinical symptoms and lung function, decrease the frequency of exacerbation in patients with bronchiectasis. It may be as an alternative to the maintenance treatment of bronchiectasis.
Abstract： Objective To compare clinical outcomes of complete video-assisted thoracoscopic surgery （cVATS） lobectomy with routine thoracotomy lobectomy for the treatment of bronchiectasis, and evaluate the feasibility, safety and specific considerations of cVATS lobectomy for the treatment of bronchiectasis. Methods We retrospectively analyzed the clinical data of 115 patients who underwent lobectomy for the treatment of bronchiectasis in Beijing Chaoyang Hospital from May 2009 to January 2012. According to the way of operation, these patients were divided into two groups （cVATS group and thoracotomy group）. In the thoracotomy group, there were 62 patients （28 males and 34 females with an age of 46.2±11.9 years） who underwent routine thoracotomy lobectomy. In the cVATS group, there were 53 patients （19 males and 34 females with an age of 45.7±12.2 years） who underwent cVATS lobectomy. Operation time, intra-operative blood loss, postoperative thoracic drainage, complications and hospitalization, and cost of hospitalization were compared between the two groups. Results There was no perioperative death in all patients. There was no statistical difference in operation time between the two groups. Intra-operative blood loss of thoracotomy group patients was significantly higher than that of cVATS group patients （228.8±121.7 ml vs. 157.1±123.8 ml, t=2.592, P=0.011）. Postoperative thoracic drainage （866.7±439.5 ml vs. 1 805.3±466.7 ml, t=9.003，P=0.000）, duration of chest tube drainage （6.6±3.3 d vs. 9.8±4.6 d,t=3.339，P=0.001）, and postoperative hospitalization （7.5±2.2 d vs. 11.2±5.4 d, t=3.424，P=0.001） of cVATS group were significantly lower than those of thoracotomy group. The cost of hospitalization of cVATS group was significantly higher than that of thoracotomy group （38 543.6±11 051.8 yuan vs. 30 523.4±10 028.5 yuan，t=3.423, P=0.001）. There was no statistical difference in postoperative complications between the two groups （P＞0.05）. Forty-five patients in cVATS group were followed up for 2 to 14 months. Among them, 42 patients completely had no sputum or haemoptysis and 3 patients still intermittently had some sputum. Conclusion cVATS lobectomy is safe and feasible for the treatment of bronchiectasis. Compared with routine thoracotomy lobectomy, cVATS lobectomy does not increase surgical risk, but can significantly reduce operation injury and length of hospital stay. During cVATS, the lung residual should be handled cautiously especially for patients with nonanatomic pulmonary resection, and the non-single-order operation is recommended.