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      Diagnosis and treatment of community‐acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association

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          Abstract

          Community‐acquired pneumonia (CAP) in adults is an infectious disease with high morbidity in China and the rest of the world. With the changing pattern in the etiological profile of CAP and advances in medical techniques in diagnosis and treatment over time, Chinese Thoracic Society of Chinese Medical Association updated its CAP guideline in 2016 to address the standard management of CAP in Chinese adults. Extensive and comprehensive literature search was made to collect the data and evidence for experts to review and evaluate the level of evidence. Corresponding recommendations are provided appropriately based on the level of evidence. This updated guideline covers comprehensive topics on CAP, including aetiology, antimicrobial resistance profile, diagnosis, empirical and targeted treatments, adjunctive and supportive therapies, as well as prophylaxis. The recommendations may help clinicians manage CAP patients more effectively and efficiently. CAP in pediatric patients and immunocompromised adults is beyond the scope of this guideline. This guideline is only applicable for the immunocompetent CAP patients aged 18 years and older. The recommendations on selection of antimicrobial agents and the dosing regimens are not mandatory. The clinicians are recommended to prescribe and adjust antimicrobial therapies primarily based on their local etiological profile and results of susceptibility testing, with reference to this guideline.

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          Human Infection with a Novel Avian-Origin Influenza A (H7N9) Virus

          New England Journal of Medicine, 368(20), 1888-1897
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            Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study

            Summary Background Middle East respiratory syndrome (MERS) is a new human disease caused by a novel coronavirus (CoV). Clinical data on MERS-CoV infections are scarce. We report epidemiological, demographic, clinical, and laboratory characteristics of 47 cases of MERS-CoV infections, identify knowledge gaps, and define research priorities. Methods We abstracted and analysed epidemiological, demographic, clinical, and laboratory data from confirmed cases of sporadic, household, community, and health-care-associated MERS-CoV infections reported from Saudi Arabia between Sept 1, 2012, and June 15, 2013. Cases were confirmed as having MERS-CoV by real-time RT-PCR. Findings 47 individuals (46 adults, one child) with laboratory-confirmed MERS-CoV disease were identified; 36 (77%) were male (male:female ratio 3·3:1). 28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age. Only two of the 47 cases were previously healthy; most patients (45 [96%]) had underlying comorbid medical disorders, including diabetes (32 [68%]), hypertension (16 [34%]), chronic cardiac disease (13 [28%]), and chronic renal disease (23 [49%]). Common symptoms at presentation were fever (46 [98%]), fever with chills or rigors (41 [87%]), cough (39 [83%]), shortness of breath (34 [72%]), and myalgia (15 [32%]). Gastrointestinal symptoms were also frequent, including diarrhoea (12 [26%]), vomiting (ten [21%]), and abdominal pain (eight [17%]). All patients had abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities. Laboratory analyses showed raised concentrations of lactate dehydrogenase (23 [49%]) and aspartate aminotransferase (seven [15%]) and thrombocytopenia (17 [36%]) and lymphopenia (16 [34%]). Interpretation Disease caused by MERS-CoV presents with a wide range of clinical manifestations and is associated with substantial mortality in admitted patients who have medical comorbidities. Major gaps in our knowledge of the epidemiology, community prevalence, and clinical spectrum of infection and disease need urgent definition. Funding None.
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              Extended-Spectrum β-Lactamases: a Clinical Update

              Extended-spectrum β-lactamases (ESBLs) are a rapidly evolving group of β-lactamases which share the ability to hydrolyze third-generation cephalosporins and aztreonam yet are inhibited by clavulanic acid. Typically, they derive from genes for TEM-1, TEM-2, or SHV-1 by mutations that alter the amino acid configuration around the active site of these β-lactamases. This extends the spectrum of β-lactam antibiotics susceptible to hydrolysis by these enzymes. An increasing number of ESBLs not of TEM or SHV lineage have recently been described. The presence of ESBLs carries tremendous clinical significance. The ESBLs are frequently plasmid encoded. Plasmids responsible for ESBL production frequently carry genes encoding resistance to other drug classes (for example, aminoglycosides). Therefore, antibiotic options in the treatment of ESBL-producing organisms are extremely limited. Carbapenems are the treatment of choice for serious infections due to ESBL-producing organisms, yet carbapenem-resistant isolates have recently been reported. ESBL-producing organisms may appear susceptible to some extended-spectrum cephalosporins. However, treatment with such antibiotics has been associated with high failure rates. There is substantial debate as to the optimal method to prevent this occurrence. It has been proposed that cephalosporin breakpoints for the Enterobacteriaceae should be altered so that the need for ESBL detection would be obviated. At present, however, organizations such as the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards) provide guidelines for the detection of ESBLs in klebsiellae and Escherichia coli . In common to all ESBL detection methods is the general principle that the activity of extended-spectrum cephalosporins against ESBL-producing organisms will be enhanced by the presence of clavulanic acid. ESBLs represent an impressive example of the ability of gram-negative bacteria to develop new antibiotic resistance mechanisms in the face of the introduction of new antimicrobial agents.
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                Author and article information

                Contributors
                caobin_ben@163.com
                jmqu0906@163.com
                Journal
                Clin Respir J
                Clin Respir J
                10.1111/(ISSN)1752-699X
                CRJ
                The Clinical Respiratory Journal
                John Wiley and Sons Inc. (Hoboken )
                1752-6981
                1752-699X
                26 September 2017
                April 2018
                : 12
                : 4 ( doiID: 10.1111/crj.2018.12.issue-4 )
                : 1320-1360
                Affiliations
                [ 1 ] National Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital Capital Medical University Beijing 100029 China
                [ 2 ] Department of Respiratory and Critical Care Medicine, Changhai Hospital the Second Military Medical University Shanghai 200433 China
                [ 3 ] Department of Respiratory and Critical Care Medicine Chinese PLA General Hospital Beijing 100853 China
                [ 4 ] Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine Shanghai Jiaotong University Shanghai 200025 China
                [ 5 ] Department of Respiratory and Critical Care Medicine, West China Hospital Sichuan University Sichuan 610041 China
                [ 6 ] Department of Pulmonary Medicine Peking Union Medical College Hospital Beijing 100730 China
                [ 7 ] Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital Tongji University School of Medicine Shanghai 200433 China
                [ 8 ] Department of Respiratory and Critical Care Medicine, Zhongshan Hospital Fudan University Shanghai 200032 China
                [ 9 ] Department of Respiratory and Critical Care Medicine, Shengjing Hospital China Medical University Shenyang 110004 China
                [ 10 ] Department of Respiratory Medicine Peking University Third Hospital Beijing 100191 China
                [ 11 ] Department of Laboratory Medicine Peking University People's Hospital Beijing 100044 China
                [ 12 ] State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases the First Affiliated Hospital of Guangzhou Medical University Guangzhou 510120 China
                [ 13 ] Department of Respiratory and Critical Care Medicine Guizhou Provincial People's Hospital Guizhou 550002 China
                [ 14 ] Department of Respiratory and Critical Care Medicine Jinling Hospital Nanjing 210002 China
                Author notes
                [*] [* ] Correspondence

                Jie‐Ming Qu, Ruijin Hospital, School of

                Medicine, Shanghai Jiaotong University,

                Shanghai 200025, China.

                Email: jmqu0906@ 123456163.com (or)

                Bin Cao, China‐Japan Friendship

                Hospital, Capital Medical University,

                Beijing 100029, China.

                Email: caobin_ben@ 123456163.com

                [†]

                Bin Cao and Yi Huang contributed equally to this study.

                Author information
                http://orcid.org/0000-0001-5305-6233
                Article
                CRJ12674
                10.1111/crj.12674
                7162259
                28756639
                6b7d77c7-032e-4fde-a224-c8d806e001f6
                © 2017 John Wiley & Sons Ltd

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 12 January 2017
                : 25 July 2017
                Page count
                Figures: 1, Tables: 8, Pages: 41, Words: 21794
                Categories
                Review Article
                Review Articles
                Custom metadata
                2.0
                April 2018
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:15.04.2020

                Respiratory medicine
                community‐acquired pneumonia,adult,antimicrobial therapy,aetiology,diagnosis,adjunctive therapy,prevention

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