The high incidence of bacterial pneumonia in winter and spring…

The high incidence of bacterial pneumonia in winter and spring…


Professor Huang Yi, chief physician of the Department of Respiratory and Critical Care Medicine at the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), said in an interview on the 5th that winter and spring are the periods of high incidence of bacterial pneumonia. In addition to causing pneumonia, severe pneumococcal infection can also cause patients to suffer from complications such as bacteremia, meningitis, and septic shock. She and He Qiuping, the chief physician of the preventive health department working at the Sanlin Community Health Service Center in Pudong New Area, Shanghai, both called on the public, especially susceptible people with related chronic underlying diseases, to get the pneumococcal vaccine in time.

The most common form of bacterial pneumonia is caused by pneumococci. “Pneumococcus is an opportunistic pathogen that often ‘lurks’ in the nasopharynx of normal people. It usually does not cause disease, but it can occur when the body’s immunity is reduced, respiratory virus infections such as influenza occur, malnutrition or the elderly When people are weak, they will take advantage of the situation.” Professor Huang Yi said that anyone of all ages may suffer from pneumococcal pneumonia, but among them, the elderly and people with underlying diseases such as chronic respiratory disease, chronic cardiovascular disease, and diabetes are more likely to suffer from pneumococcal pneumonia. People are susceptible to pneumococcal infection.

“Severe pneumonia can be complicated by bacteremia, septic shock, etc. Once these complications occur, they are very serious and may even endanger the patient’s life.” She explained that, especially for the elderly, severe infections may not necessarily have typical symptoms such as fever and cough. symptoms of pneumonia, but a sudden fall may occur. Family members may think that the old man is walking carelessly, but in fact it is pneumonia that causes weakness and even lowered blood pressure, causing him to become unstable and fall. Professor Huang Yi emphasized that this situation is very dangerous. If it is not discovered in time, the elderly will develop multi-system complications in the later stage, which will threaten the patient’s life.

Middle-aged and elderly people and patients with chronic respiratory diseases, chronic cardiovascular diseases and diabetes are all susceptible to pneumococcal infection. Studies have shown that patients with the above types of chronic diseases are 6 times, 6 times and 3 times more likely to develop invasive pneumococcal disease (IPD) than healthy people respectively. After being infected with IPD, the risk of death in patients with chronic obstructive pulmonary disease, diabetes, atherosclerotic heart disease, and congestive heart failure is approximately 3 to 5 times higher than in patients without underlying conditions.

Antibacterial treatment is the first priority when treating pneumococcal diseases. In China, the resistance rate of pneumococci to commonly used antibiotics has been increasing year by year, making treatment more difficult. When it comes to treatment, Professor Huang Yi said that early-stage Streptococcus pneumoniae is very sensitive to penicillin. In the 1940s and 1950s, doctors preferred penicillin to treat Streptococcus pneumoniae pneumonia. But by the mid-1980s, penicillin-resistant Streptococcus pneumoniae began to appear. She said that resistance to Streptococcus pneumoniae is very common at present, with the insensitivity rate to penicillin increasing year by year and the resistance rate to erythromycin to be over 95%. For penicillin-resistant Streptococcus pneumoniae, cephalosporins, tetracyclines and even quinolones need to be used.

“The treatment of bacterial pneumonia in the elderly requires not only the selection of antibacterial drugs, but also once serious complications occur, in addition to anti-infection, doctors must also pay attention to other aspects of treatment, such as anti-shock, anti-inflammation, Anticoagulation, etc.” Professor Huang Yi said that during the treatment of severe pneumonia, many details must be paid attention to, such as maintaining water, electricity, acid-base balance, microecological balance, nutritional support, etc.

China’s “Expert Consensus on Immunization and Prevention of Pneumococcal Diseases” points out that pneumococcal vaccination is the most effective way to prevent pneumococcal infection. “Once you suffer from pneumonia, especially severe pneumonia, the biggest problem is that the patient’s quality of life will be significantly reduced or even life-threatening.” Huang Yi said frankly that now, the aging of society is deepening, and once an elderly person in the family suffers from serious illness and needs to be hospitalized or even stay in the intensive care unit , although medical insurance can bear most of the financial burden, the pressure of caregiving does have a great impact on the patient’s family life. “In our daily work, we have encountered some elderly people in the intensive care unit who were able to take care of themselves before getting sick and had normal brain function. However, due to severe pneumonia causing hypoxia and ischemia, they survived despite treatment, but they were unable to take care of themselves and their brain function was impaired. Obviously, or unable to wean off the ventilator. This situation will cause a heavy care and financial burden on the family in the long run.”

The Chinese Society of Preventive Medicine recommends that the 23-valent pneumococcal vaccine (PPSV23) be used for vaccination of people aged 50 and above and patients with chronic diseases such as diabetes, cardiovascular disease, and lung disease. Several professional branches of the Chinese Medical Association have successively formulated guidelines or consensus, including the “Guidelines for the Diagnosis and Treatment of Community-Acquired Pneumonia in Adults in China (2016 Edition)” by the Respiratory Disease Branch, and “Influenza and Pneumococcal Vaccine in the Elderly” by the Respiratory Group of the Geriatrics Branch. “Vaccination Recommendations of Chinese Experts” and the General Medical Branch’s “Expert Consensus on the Application of Vaccines for Common Infectious Diseases in the Elderly in the Community” both recommend combined vaccination of pneumococcal vaccine and influenza vaccine, which can better benefit the people, especially can significantly reduce pneumonia in the elderly. morbidity and mortality. It is reported that currently, there are five PPSV23 models on the market for adult use in China (one imported and four domestically produced).

In an interview with Sanlin Community Health Service Center in Pudong New Area, Shanghai, He Qiuping, the physician in charge of the preventive health department, said that after the Spring Festival, many people came to the center’s outpatient clinics to inquire about influenza and pneumococcal vaccines to prevent respiratory diseases. . “For susceptible groups such as the elderly and other underlying diseases such as COPD in the community, we recommend that they receive pneumococcal vaccination during their stable condition.” The doctor at the community health service center said that pneumococcal vaccination is required for one year Vaccination can be done in all seasons. As a doctor, she recommends that it is necessary to get the flu vaccine before winter and spring, that is, before the high influenza season.



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