He Lujuan, Yang Hongzhong, Liu Shenggang, Liang Weijun, Zhou Zezhi, Long Jing, Wu Jinyang
The Affiliated Changsha Central Hospital, Department of Respiratory and Critical Care Medicine, Hengyang Medical School, University of South China, Changsha, China.
The Affiliated Changsha Central Hospital, Department of Internal Neurology, Hengyang Medical School, University of South China, Changsha, China.
Front Physiol. 2023 Feb 9;14:1132724. doi: 10.3389/fphys.2023.1132724. eCollection 2023.
To describe the clinical spectrum of severe pneumonia in order to understand the disease better. Retrospective analysis was made on 31 patients with severe pneumonia diagnosed in ICU by next-generation sequencing of metagenome Metagenomic next-generation sequencing(mNGS) from January 2019-November 2022, including clinical characteristics, laboratory examination results, imaging characteristics, treatment, and prognosis. We included 31 patients with severe pneumonia, 15 of whom had a history of virus exposure. There were 12 cases with multiple bacterial infections, and the common symptoms included fever (31/31,100%), dyspnea (31/31, 100%), cough (22/31, 71.0%), and myalgia (20/31, 64.5%). Laboratory data showed that white blood cells were average or slightly increased, but the levels of C-reactive protein and neutrophils were high. CT findings of the lung were consolidation (19/31, 61.3%) and pleural effusion (11/31, 35.5%). Only one lobe was involved in 11 patients (35.5%). Before diagnosis, 22 patients (71.0%) did not have atypical pathogens in their antimicrobial regimen. After diagnosis, 19 patients (61.3%) received single drug treatment, of which doxycycline or moxifloxacin were the most commonly used drugs. Among 31 patients, three died, nine improved, and nineteen were cured. The clinical manifestations of severe pneumonia are non-specific. The application of mNGS can improve the diagnostic accuracy of pneumonia, reduce the unnecessary use of antibiotics, and shorten the course of the disease. Doxycycline-based treatment is effective for severe pneumonia, but it is necessary to understand the secondary bacterial infection and other complications in the course of the disease.
为描述重症肺炎的临床谱，以便更好地了解该疾病。对2019年1月至2022年11月在重症监护病房（ICU）通过宏基因组二代测序（mNGS）诊断为重症肺炎的31例患者进行回顾性分析，内容包括临床特征、实验室检查结果、影像学特征、治疗及预后。我们纳入了31例重症肺炎患者，其中15例有病毒暴露史。有12例存在多重细菌感染，常见症状包括发热（31/31，100%）、呼吸困难（31/31，100%）、咳嗽（22/31，71.0%）和肌痛（20/31，64.5%）。实验室数据显示白细胞计数正常或略有升高，但C反应蛋白和中性粒细胞水平较高。肺部CT表现为实变（19/31，61.3%）和胸腔积液（11/31，35.5%）。11例患者（35.5%）仅一个肺叶受累。诊断前，22例患者（71.0%）的抗菌治疗方案中未包含非典型病原体。诊断后，19例患者（61.3%）接受单药治疗，其中多西环素或莫西沙星是最常用的药物。31例患者中，3例死亡，9例好转，19例治愈。重症肺炎的临床表现无特异性。mNGS的应用可提高肺炎的诊断准确性，减少抗生素的不必要使用，并缩短病程。基于多西环素的治疗对重症肺炎有效，但有必要了解疾病过程中的继发性细菌感染及其他并发症。
