MINISTRY OF EDUCATION AND TRAINING MINISTRY OF NATIONAL DEFENSE MILITARY MEDICAL UNIVERSITY LE THI DIEU HIEN STUDY ON CLINICAL, SUBCLINICAL CHARACTERISTICS, BACTERIAL PATHOGEN, SERUM CYTOKINE IN COMMU[.]
MINISTRY OF EDUCATION MINISTRY OF NATIONAL AND TRAINING DEFENSE MILITARY MEDICAL UNIVERSITY LE THI DIEU HIEN STUDY ON CLINICAL, SUBCLINICAL CHARACTERISTICS, BACTERIAL PATHOGEN, SERUM CYTOKINE IN COMMUNITY ACQUIRED PNEUMONIA PATIENTS ADMITTED AT HOSPITAL IN HAI PHONG Specialization: Internal medicine Number : 9720107 SUMMARY OF DOCTOR THESIS HA NOI - 2022 RESEARCH WAS COMPLETED IN MILITARY MEDICAL UNIVERSITY Academic supervisor: Assoc Prof TA BA THANG, MD, PhD Assoc Prof MAI XUAN KHAN Reviewer 1: Assoc Prof Phan Thu Phương, MD, PhD Reviewer 2: Assoc Prof Phạm Quốc Hoàn, MD, PhD Reviewer 3: Assoc Prof Nguyễn Viết Nhung, MD, PhD The thesis will defend the Committee of Military Medical University Time : Hour date month year Location for search the thesis: National Library Military Medical University Library ………………………… INTRODUCTION Community-acquired pneumonia (CAP) is one of the lower respiratory tract infections with high morbidity and mortality worldwide, especially in the elderly and with chronic comorbidities Currently, the common cause of CAP is still caused by bacteria, in which the leading cause is caused by typical bacteria (S pneumoniae and H Influenzae) However, there are changes in the distribution of bacteria as well as antibiotic susceptibility according to geography, the degree of pneumonia as well as the patient's location Viet TiepHai Phong Hospital is the central general hospital of the province and the last line of the northern coastal provinces There have been some studies on clinical, subclinical and etiology of CAP at some hospitals in Hai Phong, but there has not been any in-depth research on CAP caused by bacteria Cytokines such as Tumor necrosis factor-α (TNF-α), Interleukine-6 (IL-6), Interleukine-10 (IL-10) play a major role in the inflammatory mechanism in CAP Changes in these cytokines are associated with the severity of pneumonia as well as treatment outcomes However, the results on the changes of serum cytokines are still different in the studies, and there are no specific results on their changes in the group of patients with bacterial CAP For this reason, we carried out the study "Study on clinical, subclinical characteristics, bacterial pathogen and serum cytokine in community acquired pneumonia patients admitted at hospital in Hai Phong" This study aimed including: Clinical, subclinical characteristics and antibiotic resistance of bacteria in CAP patients at hospital in Hai Phong Evaluation of changes of levels TNF-α, IL-6, and IL-10 in serum and the relationship with clinical and subclinical characteristics in CAP patients at hospital in Hai Phong The summary of new main scientific contribution of the thesis The research results of the thesis have some contributions to the respiratory specialty as follows: - Characteristics of patients with community-acquired bacterial pneumonia hospitalized at Viet Tiep Friendship Hospital - Hai Phong: the age group ≥60 mainly encountered (74.3%); The proportion of male patients is higher than female The rate of comorbidities is high (60.2%) The severity of the disease was found in 44.8% On chest X-ray, diffuse lesions accounted for the majority (82.0%) The result of sputum culture was that Gram-negative bacteria accounted for the majority (84.6%), of which K.pneumoniae 30.7%, P.aeruginosa 24.3% The percentage of Gram-positive bacteria was 15.4% The rate of antibiotic-sensitive bacteria was 57.6%, antibiotic resistance 42.3% (resistance to antibiotic was 7.6%, resistance to multiple antibiotics was 34.5%) - Serum levels of TNF-α, IL-6 and IL-10 at the time of admission were all higher than those of healthy subjects Serum IL-6 concentration on day after treatment decreased significantly compared to the time of admission Increased levels of cytokines TNF-α, IL-6 were correlated with the average lesion area on chest Xray In the group of patients who isolated Gram-positive bacteria, the average serum IL-10 concentration on day was higher than that in the group of patients who isolated Gram-negative bacteria (p