Pneumonia in myasthenia gravis: Microbial etiology and clinical management.
Pneumonia in myasthenia gravis: Microbial etiology and clinical management.
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DOI：
10.3389/fcimb.2022.1016728
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发表时间：
2022
影响因子：
5.7
通讯作者：
中科院分区：
文献类型：
--
作者：
重症肌无力（MG）患者由于长期接受免疫治疗和吸入倾向，容易发生肺炎。肺炎仍然是MG恶化的危险因素，也是MG患者死亡的最常见原因。对涉及的病原体进行分类并探索机械通气（MV）的危险因素有助于改善临床结局。在2013年1月至2022年10月期间，我们在一家专门研究神经肌肉疾病的三级研究中心对合并肺炎的MG患者进行了住院数据库审查。回顾性分析116例重症肌无力合并肺炎患者的临床及微生物学特点。在我们的队列中，90.32%（112/124）的微生物为细菌，42.86%（48/112）的病原菌对碳青霉烯类耐药。使用下一代测序（NGS）在12例患者中检测到高丰度的EB病毒（EBV），而在8例患者中检测到巨细胞病毒（CMV）。非发酵革兰阴性杆菌是最常见的微生物，其中氨苄西林、磺胺甲恶唑-甲氧苄啶（SMZ-TMP）、哌拉西林、头孢哌酮、头孢他啶和头孢吡肟可能具有抗感染作用。此外，外周淋巴细胞百分比[比值比（OR）0.88，95% CI 0.75-0.96，p = 0.02]和血清球蛋白（OR 1.16，95% CI 1.02-1.35，p = 0.03）与MV需求风险显著相关。我们对MG患者肺炎微生物病原学的鉴定可能为未来准确的抗生素选择提供前景，并在存在风险因素时进行早期干预。
Patients with myasthenia gravis (MG) are prone to the development of pneumonia due to the long-term immunotherapies they receive and a tendency for aspiration. Pneumonia remains a risk factor for MG worsening and is the most prevalent cause of mortality in MG patients. Classification of the pathogens involved and exploration of the risk factors for mechanical ventilation (MV) could aid in improving clinical outcomes. Between January 2013 and October 2022, we performed an inpatient database review for MG patients with pneumonia concurrence in a tertiary research center specializing in neuromuscular disorders. The clinical and microbiological characteristics of 116 MG patients with pneumonia were retrospectively analyzed. In our cohort, 90.32% (112/124) of organisms were bacteria and 42.86% (48/112) of pathogenic bacteria were carbapenem-resistant. A high abundance of Epstein–Barr virus (EBV) was detected using next-generation sequencing (NGS) in 12 patients, while cytomegalovirus (CMV) was detected in 8 patients. Non-fermentative Gram-negative bacilli were the most prevalent microorganisms, in which ampicillin, sulfamethoxazole-trimethoprim (SMZ-TMP), piperacillin, cefoperazone, ceftazidime, and cefepime may have an anti-infectious effect. Moreover, peripheral lymphocyte percentage [odds ratio (OR) 0.88, 95% CI 0.75–0.96, p = 0.02] and serum globulin (OR 1.16, 95% CI 1.02–1.35, p = 0.03) were significantly associated with the risk of MV demand. Our identification of the microbial etiology of pneumonia in MG patients may provide future perspectives on accurate antibiotic options and enable early interventions when risk factors are present.
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DOI：
10.1016/j.lanwpc.2020.100063
发表时间：
2020-12
期刊：
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影响因子：
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作者：
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影响因子：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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