Pub Date : 2020-08-07eCollection Date: 2020-12-01DOI: 10.1097/IM9.0000000000000035
Bo Tu, Yuening Zhang, Jingfeng Bi, Zhe Xu, Lei Shi, Xin Zhang, Peng Zhao, Dawei Zhang, Guang Yang, Enqiang Qin
Escherichia coli is a prevalent causative pathogen of spontaneous bacterial peritonitis (SBP). In this retrospective study, we investigated the microbiological characteristics and antibiotic susceptibility of E. coli clinical isolates obtained from liver cirrhosis patients suffering from nosocomial SBP. Our results showed that extended-spectrum β-lactamase (ESBL)-producing E. coli accounted for 47% of the cases, while 62% of the isolates were multi-drug resistant (MDR) pathogens. ESBL-producing and MDR isolates showed high incidences of resistance to third-generation cephalosporins, but they displayed susceptibility to carbapenems, β-lactamase inhibitors, and aminoglycosides. Importantly, liver cirrhosis patients with MDR E. coli SBP showed a significantly higher death rate than patients with non-MDR infections (P = 0.021). The 30-day mortality of nosocomial SBP was independently correlated with female gender [odds ratio (OR) = 5.200, 95% confidence interval (CI) = 1.194-22.642], liver failure (OR = 9.609, 95% CI = 1.914-48.225), hepatocellular carcinoma (OR = 8.176, 95% CI = 2.065-32.364), hepatic encephalopathy (OR = 8.176, 95% CI = 2.065-32.364), model of end-stage liver disease score (OR = 1.191, 95% CI = 1.053-1.346), white blood cell count (OR = 0.847, 95% CI = 0.737-0.973), and ascites polymorphonuclear (OR = 95.903, 95% CI = 3.410-2697.356). In conclusion, third-generation cephalosporins may be inappropriate for empiric treatment of nosocomial SBP caused by E. coli, due to the widespread presence of ESBLs and high incidence of MDR pathogens.
摘要大肠杆菌是自发性细菌性腹膜炎(SBP)的常见致病菌。在这项回顾性研究中，我们研究了从肝硬化院内性收缩压患者中获得的大肠杆菌临床分离株的微生物学特征和抗生素敏感性。结果显示，产广谱β-内酰胺酶(ESBL)的大肠杆菌占47%，而62%的分离株为耐多药(MDR)病原体。产esbl和MDR分离株对第三代头孢菌素耐药发生率高，但对碳青霉烯类、β-内酰胺酶抑制剂和氨基糖苷类敏感。重要的是，MDR型大肠杆菌SBP肝硬化患者的死亡率明显高于非MDR型感染患者(P = 0.021)。院内SBP的30天死亡率是独立与女性性别(比值比(或)= 5.200,95%可信区间(CI) = 1.194 - -22.642),肝功能衰竭(或= 9.609,95% CI -48.225 = 1.914),肝细胞癌(或= 8.176,95% CI -32.364 = 2.065),肝性脑病(或= 8.176,95% CI -32.364 = 2.065),终末期肝病评分模型(或= 1.191,95% CI -1.346 = 1.053),白细胞计数(或= 0.847,95% CI = 0.737 - -0.973),腹水多形核(OR = 95.903, 95% CI = 3.410 ~ 2697.356)。综上所述，由于ESBLs的广泛存在和耐多药病原菌的高发，第三代头孢菌素可能不适合经验性治疗大肠杆菌引起的医院性收缩压。
{"title":"Microbiological Characteristics and Antibiotic Sensitivity in Patients with Nosocomial Spontaneous Bacterial Peritonitis Caused by <i>Escherichia coli</i>: A Multicenter Study.","authors":"Bo Tu, Yuening Zhang, Jingfeng Bi, Zhe Xu, Lei Shi, Xin Zhang, Peng Zhao, Dawei Zhang, Guang Yang, Enqiang Qin","doi":"10.1097/IM9.0000000000000035","DOIUrl":"10.1097/IM9.0000000000000035","url":null,"abstract":"<p><p><i>Escherichia coli</i> is a prevalent causative pathogen of spontaneous bacterial peritonitis (SBP). In this retrospective study, we investigated the microbiological characteristics and antibiotic susceptibility of <i>E. coli</i> clinical isolates obtained from liver cirrhosis patients suffering from nosocomial SBP. Our results showed that extended-spectrum β-lactamase (ESBL)-producing <i>E. coli</i> accounted for 47% of the cases, while 62% of the isolates were multi-drug resistant (MDR) pathogens. ESBL-producing and MDR isolates showed high incidences of resistance to third-generation cephalosporins, but they displayed susceptibility to carbapenems, β-lactamase inhibitors, and aminoglycosides. Importantly, liver cirrhosis patients with MDR <i>E. coli</i> SBP showed a significantly higher death rate than patients with non-MDR infections (<i>P</i> = 0.021). The 30-day mortality of nosocomial SBP was independently correlated with female gender [odds ratio (OR) = 5.200, 95% confidence interval (CI) = 1.194-22.642], liver failure (OR = 9.609, 95% CI = 1.914-48.225), hepatocellular carcinoma (OR = 8.176, 95% CI = 2.065-32.364), hepatic encephalopathy (OR = 8.176, 95% CI = 2.065-32.364), model of end-stage liver disease score (OR = 1.191, 95% CI = 1.053-1.346), white blood cell count (OR = 0.847, 95% CI = 0.737-0.973), and ascites polymorphonuclear (OR = 95.903, 95% CI = 3.410-2697.356). In conclusion, third-generation cephalosporins may be inappropriate for empiric treatment of nosocomial SBP caused by <i>E. coli</i>, due to the widespread presence of ESBLs and high incidence of MDR pathogens.</p>","PeriodicalId":73374,"journal":{"name":"Infectious microbes & diseases","volume":"2 1","pages":"167-172"},"PeriodicalIF":0.0,"publicationDate":"2020-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48720831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-21eCollection Date: 2020-09-01DOI: 10.1097/IM9.0000000000000034
Prasanth Manohar, Belinda Loh, Sebastian Leptihn
{"title":"Will the Overuse of Antibiotics During the Coronavirus Pandemic Accelerate Antimicrobial Resistance of Bacteria?","authors":"Prasanth Manohar, Belinda Loh, Sebastian Leptihn","doi":"10.1097/IM9.0000000000000034","DOIUrl":"10.1097/IM9.0000000000000034","url":null,"abstract":"","PeriodicalId":73374,"journal":{"name":"Infectious microbes & diseases","volume":"2 1","pages":"87-88"},"PeriodicalIF":0.0,"publicationDate":"2020-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8529698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42603147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-16eCollection Date: 2020-09-01DOI: 10.1097/IM9.0000000000000033
Xiaoqin Zheng, Lanjuan Li
The recently emerged coronavirus disease 2019 (COVID-19) has rapidly evolved into a pandemic with over 10 million infections and over 500 thousand deaths. There are currently no effective therapies or vaccines available to protect against this coronavirus infection. In this review, we discuss potential therapeutic options for COVID-19 based on the available information from previous research on severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Substantial efforts are underway to discover new therapeutic agents for COVID-19, including the repurposing of existing agents and the development of novel agents that specifically target SARS-coronavirus 2 (SARS-CoV-2) or host factors. Through the screening of compound libraries, various classes of drugs, such as ribavirin, remdesivir, lopinavir/ritonavir, and hydroxychloroquine have been identified as potential therapeutic candidates against COVID-19. Novel antiviral drugs for SARS-coronavirus 2 are being developed to target viral enzymes or functional proteins, as well as host factors or cell signaling pathways.
{"title":"Potential Therapeutic Options for COVID-19.","authors":"Xiaoqin Zheng, Lanjuan Li","doi":"10.1097/IM9.0000000000000033","DOIUrl":"10.1097/IM9.0000000000000033","url":null,"abstract":"<p><p>The recently emerged coronavirus disease 2019 (COVID-19) has rapidly evolved into a pandemic with over 10 million infections and over 500 thousand deaths. There are currently no effective therapies or vaccines available to protect against this coronavirus infection. In this review, we discuss potential therapeutic options for COVID-19 based on the available information from previous research on severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Substantial efforts are underway to discover new therapeutic agents for COVID-19, including the repurposing of existing agents and the development of novel agents that specifically target SARS-coronavirus 2 (SARS-CoV-2) or host factors. Through the screening of compound libraries, various classes of drugs, such as ribavirin, remdesivir, lopinavir/ritonavir, and hydroxychloroquine have been identified as potential therapeutic candidates against COVID-19. Novel antiviral drugs for SARS-coronavirus 2 are being developed to target viral enzymes or functional proteins, as well as host factors or cell signaling pathways.</p>","PeriodicalId":73374,"journal":{"name":"Infectious microbes & diseases","volume":"2 1","pages":"89-95"},"PeriodicalIF":2.0,"publicationDate":"2020-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8529694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48056130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-24DOI: 10.1097/IM9.0000000000000030
Yichang Shao, Xun Zeng
Abstract Colorectal cancer (CRC) is the cancer occurring in colon and rectum, and is the fourth leading cause of tumor-associated deaths worldwide. As a multi-etiological cancer, CRC could be induced by genetic and environmental factors, including unhealthy diet, irregular lifestyle, inappropriate inflammatory, and the dysbiosis of gut microbiota. Since immunotherapy has been the most popular cancer therapy nowadays, the relationships among gut microbiota, host immune cells and CRC pathogenesis are widely investigated. Scientists constantly tried to figure out the underlying mechanisms involved to support the further therapeutic studies. In this review, we discuss the component shifts of gut microbiota in CRC patients compared with healthy people, summarize how immune cells participate in protecting host from pathogenic microbes, elaborate the molecular mechanisms involved in gut microbiota-associated carcinogenesis of colonic epithelial cells and look into how gut microbiota influence the CRC therapy.
{"title":"Molecular Mechanisms of Gut Microbiota-Associated Colorectal Carcinogenesis","authors":"Yichang Shao, Xun Zeng","doi":"10.1097/IM9.0000000000000030","DOIUrl":"https://doi.org/10.1097/IM9.0000000000000030","url":null,"abstract":"Abstract Colorectal cancer (CRC) is the cancer occurring in colon and rectum, and is the fourth leading cause of tumor-associated deaths worldwide. As a multi-etiological cancer, CRC could be induced by genetic and environmental factors, including unhealthy diet, irregular lifestyle, inappropriate inflammatory, and the dysbiosis of gut microbiota. Since immunotherapy has been the most popular cancer therapy nowadays, the relationships among gut microbiota, host immune cells and CRC pathogenesis are widely investigated. Scientists constantly tried to figure out the underlying mechanisms involved to support the further therapeutic studies. In this review, we discuss the component shifts of gut microbiota in CRC patients compared with healthy people, summarize how immune cells participate in protecting host from pathogenic microbes, elaborate the molecular mechanisms involved in gut microbiota-associated carcinogenesis of colonic epithelial cells and look into how gut microbiota influence the CRC therapy.","PeriodicalId":73374,"journal":{"name":"Infectious microbes & diseases","volume":"2 1","pages":"96 - 106"},"PeriodicalIF":0.0,"publicationDate":"2020-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/IM9.0000000000000030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42911534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-06eCollection Date: 2020-06-01DOI: 10.1097/IM9.0000000000000025
Kunkai Su, Xin Huang, Kaijin Xu, Weibo Du, Danhua Zhu, Meifang Yang, Wenji Yuan, Lanjuan Li
The pandemic of coronavirus disease 2019 (COVID-19), a respiratory disease caused by a novel severe acute respiratory syndrome coronavirus-2, is causing substantial morbidity and mortality. Along with the respiratory symptoms, underlying diseases in senior patients, such as diabetes, hypertension, and coronary heart disease, are the most common comorbidities, which cause more severe outcomes and even death. During cellular attachment and entry of severe acute respiratory syndrome coronavirus-2, the key protein involved is the angiotensin I converting enzyme 2 (ACE2), which is located on the membrane of host cells. Here, we aim to curate an expression profile of Ace2 and other COVID-19 related genes across the available diabetes murine strains. Based on strictly manual curation and bioinformatics analysis of the publicly deposited expression datasets, Ace2 and other potentially involved genes such as Furin, Tmprss2, Ang, and Ang2 were examined. We found that Ace2 expression is rather ubiquitous in three selected diabetes prone strains (db/db, ob/ob and diet-induced obese). With the most abundant datasets present, the liver shows a medium Ace2 expression level compared with the lungs, pancreatic islets, brain and even T cells. Age is a more critical factor for Ace2 expression in db/db compared with the other two strains. Besides Ace2, the other four host genes showed varied levels of correlation to each other. To accelerate research on the interaction between COVID-19 and underlying diseases, the Murine4Covid transcriptomics database (www.geneureka.org/Murine4Covid) will facilitate the design of research on COVID-19 and comorbidities.
{"title":"Transcriptomics Curation of SARS-CoV-2 Related Host Genes in Mice With COVID-19 Comorbidity: A Pilot Study.","authors":"Kunkai Su, Xin Huang, Kaijin Xu, Weibo Du, Danhua Zhu, Meifang Yang, Wenji Yuan, Lanjuan Li","doi":"10.1097/IM9.0000000000000025","DOIUrl":"10.1097/IM9.0000000000000025","url":null,"abstract":"<p><p>The pandemic of coronavirus disease 2019 (COVID-19), a respiratory disease caused by a novel severe acute respiratory syndrome coronavirus-2, is causing substantial morbidity and mortality. Along with the respiratory symptoms, underlying diseases in senior patients, such as diabetes, hypertension, and coronary heart disease, are the most common comorbidities, which cause more severe outcomes and even death. During cellular attachment and entry of severe acute respiratory syndrome coronavirus-2, the key protein involved is the angiotensin I converting enzyme 2 (ACE2), which is located on the membrane of host cells. Here, we aim to curate an expression profile of <i>Ace2</i> and other COVID-19 related genes across the available diabetes murine strains. Based on strictly manual curation and bioinformatics analysis of the publicly deposited expression datasets, <i>Ace2</i> and other potentially involved genes such as <i>Furin</i>, <i>Tmprss2</i>, <i>Ang</i>, and <i>Ang2</i> were examined. We found that <i>Ace2</i> expression is rather ubiquitous in three selected diabetes prone strains (db/db, ob/ob and diet-induced obese). With the most abundant datasets present, the liver shows a medium <i>Ace2</i> expression level compared with the lungs, pancreatic islets, brain and even T cells. Age is a more critical factor for <i>Ace2</i> expression in db/db compared with the other two strains. Besides <i>Ace2</i>, the other four host genes showed varied levels of correlation to each other. To accelerate research on the interaction between COVID-19 and underlying diseases, the Murine4Covid transcriptomics database (www.geneureka.org/Murine4Covid) will facilitate the design of research on COVID-19 and comorbidities.</p>","PeriodicalId":73374,"journal":{"name":"Infectious microbes & diseases","volume":"2 1","pages":"42-47"},"PeriodicalIF":0.0,"publicationDate":"2020-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8529699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46949773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-05DOI: 10.1097/IM9.0000000000000026
Sisi Huang, Anding Zhu, Yan Wang, Yancong Xu, Lu Li, Dexing Kong
Abstract Background: Regarding to the actual situation of the new coronavirus disease 2019 epidemic, social factors should be taken into account and the increasing growth trend of confirmed populations needs to be explained. A proper model needs to be established, not only to simulate the epidemic, but also to evaluate the future epidemic situation and find a pilot indicator for the outbreak. Methods: The original susceptible-infectious-recover model is modified into the susceptible-infectious-quarantine-confirm-recover combined with social factors (SIDCRL) model, which combines the natural transmission with social factors such as external interventions and isolation. The numerical simulation method is used to imitate the change curve of the cumulative number of the confirmed cases and the number of cured patients. Furthermore, we investigate the relationship between the suspected close contacts (SCC) and the final outcome of the growth trend of confirmed cases with a simulation approach. Results: This article selects four representative countries, that is, China, South Korea, Italy, and the United States, and gives separate numerical simulations. The simulation results of the model fit the actual situation of the epidemic development and reasonable predictions are made. In addition, it is analyzed that the increasing number of SCC contributes to the epidemic outbreak and the prediction of the United States based on the population of the SCC highlights the importance of external intervention and active prevention measures. Conclusions: The simulation of the model verifies its reliability and stresses that observable variable SCC can be taken as a pilot indicator of the coronavirus disease 2019 pandemic.
{"title":"Suspected Close Contacts as the Pilot Indicator of the Growth Trend of Confirmed Population During the COVID-19 Pandemic: A Simulation Approach","authors":"Sisi Huang, Anding Zhu, Yan Wang, Yancong Xu, Lu Li, Dexing Kong","doi":"10.1097/IM9.0000000000000026","DOIUrl":"https://doi.org/10.1097/IM9.0000000000000026","url":null,"abstract":"Abstract Background: Regarding to the actual situation of the new coronavirus disease 2019 epidemic, social factors should be taken into account and the increasing growth trend of confirmed populations needs to be explained. A proper model needs to be established, not only to simulate the epidemic, but also to evaluate the future epidemic situation and find a pilot indicator for the outbreak. Methods: The original susceptible-infectious-recover model is modified into the susceptible-infectious-quarantine-confirm-recover combined with social factors (SIDCRL) model, which combines the natural transmission with social factors such as external interventions and isolation. The numerical simulation method is used to imitate the change curve of the cumulative number of the confirmed cases and the number of cured patients. Furthermore, we investigate the relationship between the suspected close contacts (SCC) and the final outcome of the growth trend of confirmed cases with a simulation approach. Results: This article selects four representative countries, that is, China, South Korea, Italy, and the United States, and gives separate numerical simulations. The simulation results of the model fit the actual situation of the epidemic development and reasonable predictions are made. In addition, it is analyzed that the increasing number of SCC contributes to the epidemic outbreak and the prediction of the United States based on the population of the SCC highlights the importance of external intervention and active prevention measures. Conclusions: The simulation of the model verifies its reliability and stresses that observable variable SCC can be taken as a pilot indicator of the coronavirus disease 2019 pandemic.","PeriodicalId":73374,"journal":{"name":"Infectious microbes & diseases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/IM9.0000000000000026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41914273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-17DOI: 10.1097/im9.0000000000000021
Lanjuan Li
Abstract The prevention and treatment of COVID-19 nationwide has entered a tackling phase. Effective treatment of severe and critically ill patients is the key to reducing the fatality of the disease. The artificial liver blood purification system can remove inflammatory factors, alleviate the damage of the inflammatory response to the body, and has important value for the treatment of severe COVID-19. Led by Academician Lanjuan Li, based on the experience of treating patients across the country, integrating the opinions of experts from all over the country, the center summarized and formulated the consensus including the basic principles, treatment indications, relative contraindications, mode selection, monitoring indicators, and efficacy evaluation of artificial liver, which provides reference for treatment of severe COVID-19 patients.
{"title":"Translation: Expert Consensus on the Application of Artificial Liver Blood Purification System in the Treatment of Severe and Critical COVID-19","authors":"Lanjuan Li","doi":"10.1097/im9.0000000000000021","DOIUrl":"https://doi.org/10.1097/im9.0000000000000021","url":null,"abstract":"Abstract The prevention and treatment of COVID-19 nationwide has entered a tackling phase. Effective treatment of severe and critically ill patients is the key to reducing the fatality of the disease. The artificial liver blood purification system can remove inflammatory factors, alleviate the damage of the inflammatory response to the body, and has important value for the treatment of severe COVID-19. Led by Academician Lanjuan Li, based on the experience of treating patients across the country, integrating the opinions of experts from all over the country, the center summarized and formulated the consensus including the basic principles, treatment indications, relative contraindications, mode selection, monitoring indicators, and efficacy evaluation of artificial liver, which provides reference for treatment of severe COVID-19 patients.","PeriodicalId":73374,"journal":{"name":"Infectious microbes & diseases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46141884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-17DOI: 10.1097/IM9.0000000000000022
Yueyue He
Abstract The National Health Commission of the People's Republic of China has released the document: Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia to standardize the diagnosis and treatment of COVID-19
中华人民共和国国家卫生健康委员会发布《新型冠状病毒肺炎诊疗方案》，规范新型冠状病毒肺炎诊疗
{"title":"Translation: Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7)","authors":"Yueyue He","doi":"10.1097/IM9.0000000000000022","DOIUrl":"https://doi.org/10.1097/IM9.0000000000000022","url":null,"abstract":"Abstract The National Health Commission of the People's Republic of China has released the document: Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia to standardize the diagnosis and treatment of COVID-19","PeriodicalId":73374,"journal":{"name":"Infectious microbes & diseases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/IM9.0000000000000022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41926580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-17DOI: 10.1097/IM9.0000000000000023
Kaijin Xu, H. Cai, Yihong Shen, Qin Ni, Yu Chen, Shao-hua Hu, Jianping Li, Huafen Wang, Liang Yu, He Huang, Yunqing Qiu, G. Wei, Qiang Fang, Jianying Zhou, J. Sheng, T. Liang, Lanjuan Li
Abstract The current epidemic situation of coronavirus disease 2019 (COVID-19) still remains severe. As the National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital of the Zhejiang University School of Medicine is the primary medical care center for COVID-19 in Zhejiang Province. Based on the present expert consensus carried out by the National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on “Four-Anti and Two-Balance” for clinical practice. The “Four-Anti and Two-Balance” strategy includes antivirus, anti-shock, anti-hypoxemia, and anti-secondary infection, and maintaining of water, electrolyte and acid/base balance and microecological balance. Simultaneously, an integrated multidisciplinary personalized treatment is recommended to improve therapeutic effects. The importance of early viral detection, dynamic monitoring of inflammatory indexes, and chest radiographs has been emphasized in clinical decision-making. Sputum was observed with the highest positive rate by RT-PCR. Viral nucleic acids could be detected in 10% of the patients’ blood samples at the acute phase and 50% of patients had positive RT-PCR results in their feces. We also isolated live viral strains from feces, indicating potential infectiousness of feces. Dynamic cytokine detection was necessary to timely identify cytokine storms and for the application of the artificial liver blood purification system. The “Four-Anti and Two-Balance” strategy effectively increased cure rates and reduced mortality. Early antiviral treatment alleviated disease severity and prevented illness progression. We found that lopinavir/ritonavir combined with abidol showed antiviral effects against COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system was able to rapidly remove inflammatory mediators and block the cytokine storm. Moreover, it also contributed to the balance of fluids, electrolytes, and acids/bases and thus improved treatment efficacy during critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid administration was supported. Patients with an oxygenation index below 200 mm Hg were transferred to the intensive care unit. Conservative oxygen therapy was preferred and noninvasive ventilation (NIV) was not recommended. Patients with mechanical ventilation were strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis was prescribed rationally and was not recommended, except for patients with a long course of disease, repeated fever, and elevated procalcitonin, similarly secondary fungal infections were of concern. Some patients with COVID-19 showed intestinal microbial dysbiosis with decreased genus such as Lactobacillus and Bifidobacterium. Nutritional and gastrointestinal function should;
当前，新型冠状病毒病2019 (COVID-19)疫情形势依然严峻。浙江大学医学院第一附属医院是国家传染病临床研究中心，是浙江省新冠肺炎基层医疗服务中心。我们团队在国家卫健委、国家中医药管理局专家共识的基础上，总结并建立了以“四抗两平衡”为核心的有效治疗策略，用于临床实践。“四抗两平衡”策略包括抗病毒、抗休克、抗低氧血症、抗继发感染，以及维持水电解质酸碱平衡和微生态平衡。同时建议多学科综合个性化治疗，提高治疗效果。早期病毒检测、动态监测炎症指标和胸片在临床决策中的重要性已得到强调。痰液RT-PCR阳性率最高。10%的患者急性期血液样本中检测到病毒核酸，50%的患者粪便中RT-PCR结果阳性。我们还从粪便中分离出活的病毒株，表明粪便具有潜在的传染性。动态细胞因子检测对于及时识别细胞因子风暴和人工肝血液净化系统的应用是必要的。“四抗两平衡”战略有效提高治愈率，降低死亡率。早期抗病毒治疗减轻了疾病的严重程度，防止了疾病的发展。我们发现洛匹那韦/利托那韦联合阿比多尔对COVID-19具有抗病毒作用。休克和低氧血症通常由细胞因子风暴引起。人工肝血液净化系统能够快速清除炎症介质，阻断细胞因子风暴。此外，它还有助于平衡液体、电解质和酸/碱，从而提高危重疾病期间的治疗效果。对于病情严重的病例，支持早期和短时间的适度糖皮质激素治疗。氧合指数低于200 mm Hg的患者转至重症监护病房。首选保守氧疗，不推荐无创通气(NIV)。对机械通气患者进行严格的监督，并采取群集呼吸机相关肺炎预防策略。除病程长、反复发热、降钙素原升高的患者外，不建议合理使用抗菌药物预防，同样值得关注的是继发性真菌感染。部分患者出现肠道菌群失调，乳酸杆菌、双歧杆菌等菌群减少。营养和胃肠功能应;因此，对所有患者进行评估。建议营养支持和应用益生元或益生菌，以调节肠道菌群平衡，降低因细菌易位引起继发感染的风险。焦虑和恐惧在COVID-19患者中很常见。为此，建立了心理危机动态评估预警体系。我们还结合中医治疗，促进康复。优化重症患者护理流程，促进患者康复。由于严重急性呼吸综合征冠状病毒2型感染后的病毒清除模式尚不清楚，因此需要对出院患者进行2周的隔离，并定期随访。这些浙江的经验和建议在我中心得到了落实，取得了良好的效果。然而，由于新冠肺炎是一种新发疾病，需要进一步完善预防、诊断和治疗策略。
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Pub Date : 2020-04-16DOI: 10.1097/IM9.0000000000000029
Babak Javid, N. Balaban
COVID-19, caused by SARS-CoV2 is a rapidly spreading global pandemic. Although precise transmission routes and dynamics are unknown, SARS-CoV2 is thought primarily to spread via contagious respiratory droplets. Unlike with SARS-CoV, maximal viral shedding occurs in the early phase of illness, and this is supported by models that suggest 40-80% of transmission events occur from pre- and asymptomatic individuals. One widely-discussed strategy to limit transmission of SARS-CoV2, particularly from presymptomatic individuals, has been population-level wearing of masks. Modelling for pandemic influenza suggests some benefit in reducing total numbers infected with even 50% mask-use. COVID-19 has a higher hospitalization and mortality rate than influenza, and the impacts on these parameters, and critically, at what point in the pandemic trajectory mask-use might exert maximal benefit are completely unknown. We derived a simplified SIR model to investigate the effects of near-universal mask-use on COVID-19 assuming 8 or 16% mask efficacy. We decided to model, in particular, the impact of masks on numbers of critically-ill patients and cumulative mortality, since these are parameters that are likely to have the most severe consequences in the COVID-19 pandemic. Whereas mask use had a relatively minor benefit on critical-care and mortality rates when transmissibility (Reff) was high, the reduction on deaths was dramatic as the effective R approached 1, as might be expected after aggressive social-distancing measures such as wide-spread lockdowns. One major concern with COVID-19 is its potential to overwhelm healthcare infrastructures, even in resource-rich settings, with one third of hospitalized patients requiring critical-care. We incorporated this into our model, increasing death rates for when critical-care resources have been exhausted. Our simple model shows that modest efficacy of masks could avert substantial mortality in this scenario. Importantly, the effects on mortality became hyper-sensitive to mask-wearing as the effective R approaches 1, i.e. near the tipping point of when the infection trajectory is expected to revert to exponential growth, as would be expected after effective lockdown. Our model suggests that mask-wearing might exert maximal benefit as nations plan their post-lockdown strategies and suggests that mask-wearing should be included in further more sophisticated models of the current pandemic.
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