Professor Shubin Guo
Affiliated Beijing Chaoyang Hospital of Capital Medical University
Chief Physician, Professor, and Doctoral Supervisor
Director, Emergency Medicine Centre
Capital Medical University: Director, Emergency Medicine Department; Director, Teaching and Research Joint Office
Director, Beijing Key Laboratory of Cardiopulmonary-Cerebral Resuscitation
Director, Emergency Medicine Profession Committee for the Standardised Training of Beijing Resident Physicians
Director, Key Base for National Resident Physicians’ Standardised Training for Emergency Medicine
Chinese Medical Association: Former Chief Committee Member of the Popular Science Division, Standing Board Member of the Emergency Medicine Division, and Team Leader of the Acute Infections Medicine Study Group
Chinese Medical Doctor Association: Executive Director, Honorary President of the Popular Science Division, Vice President of the Emergency Physicians’ Division, and Team Leader of the Acute Infections Medicine Study Group
Chinese Research Hospital Association: Director/Chief Committee Member of the Emergency Medicine Profession Committee
Journals: Editorial board member of Chinese Medical Sciences Journal, acting editorial board member and editorial board member of Chinese Journal of Emergency Medicine, Chinese Journal of Critical Care Medicine, and Journal of Chinese Research Hospitals

Introduction: Achieving standardised diagnosis and treatment of infectious diseases successfully in the Emergency Medicine Department requires a deep understanding of the nature of acute infectious diseases.

Acute infection manifest when pathogenic microorganisms invade the body or displace existing pathogenic microorganisms in the body within a short timeframe (<72 hours), triggering interactions between the body and the microorganisms to elicit inflammatory responses in the body tissue and organs¹. Patients afflicted with such conditions often present with sudden onset and/or severe symptoms. Employing scientific and rational anti-infection strategies can significantly improve patient prognosis and minimize the strain on medical resources². In this issue, ‘Yixuejie’ is pleased to invite Professor Guo Shubin, Chief Physician at the Emergency Medicine Centre of Affiliated Beijing Chaoyang Hospital of Capital Medical University, to join us in exploring future directions for the standardised diagnosis and treatment of acute infectious diseases in China.

Demystifying three essential factors of acute infectious diseases
For acute infectious diseases in the Emergency Medicine Department, the onset characteristics differ significantly from those of other specialised departments. The differences are mainly reflected in diverse infection locations, a wide range of affected populations, and the complexity of pathogenic microorganisms. These characteristics significantly raise the difficulty level for clinicians in terms of diagnosis and treatment.

In light of this, Professor Guo advocates for the idea of ‘theory–technique integration’, wherein ‘theory’ refers to the pathophysiological study of acute infections medicine, or the understanding of the nature of the disease; and ‘technique’ refers to the method of diagnosis and treatment of acute infectious diseases. Building on this basis, he outlined three essential factors to guide the standardised diagnosis and treatment of infectious diseases.

First of all, understanding the mechanism of infections is crucial. Infection entails interactions between the body and pathogenic microorganisms, leading to damage and a series of pathological transformations. It includes two types of damage mechanisms: the direct impact of pathogenic microorganisms on the body, and the body’s immune response towards these pathogenic microorganisms, which collectively constitute the fundamental state of acute infectious disease.

Secondly, establishing an accurate diagnosis requires a thorough understanding of the extent of the damage caused by the pathogenic microorganisms to the body, and clearly distinguishing between mild and severe infection. Professor Guo noted that when pathogenic microorganisms lead to acute organ failure or cause new damage on top of existing organ damage, it can be classified as severe infection.

There are generally two categories of patients with severe infections. On one hand, some patients exhibit excessive immune response, wherein the body generates a large quantity of immune mediators following interaction with pathogenic microorganisms, which in turn leads to organ damage. This phenomenon is more prevalent in younger age groups. On the other hand, there are patients with immune deficiencies. Due to impaired organ function, the immune system is incapable of effectively controlling microorganisms, leading to widespread multiplication in the body, which can be fatal in severe cases. This phenomenon is more prevalent in elderly patients and those with poor baseline conditions. Therefore, in diagnosing infectious diseases, it is necessary for clinicians to conduct a comprehensive assessment, considering patient’s nutritional status, immune status, and baseline conditions.

Finally, clinicians must provide patients with treatment based on accurate diagnosis, focusing on controlling and eliminating the factors and causes of the disease. It is necessary to prioritise the order of treatment. If the patient already suffers from organ function damage prior to diagnosis and treatment, clinicians should quickly protect and restore the tissue and organ functions as much as possible while actively pursuing anti-infection treatment. For patients without organ function damage, clinicians should focus on the comprehensive clinical protection and support of organ functions, including the respiratory, circulatory, digestive, blood and endocrine systems, on top of eliminating the cause of disease. Ordered and alternating treatment of existing primary disease, nutritional support, and other comprehensive support treatments also constitute the foundation of clinical treatment.

Therefore, the key to the diagnosis and treatment of acute infectious disease lies in the correct understanding and assessment of the type of disease, followed by the formulation of an appropriate treatment plan. Additionally, it is essential to provide accurate evaluation of the patient’s physiological condition and offer comprehensive support.

Standardised diagnosis and treatment: Future goals for acute anti-infection treatment

Antimicrobial medicine plays an important role in combating infections. Clinicians must exercise caution in selecting antimicrobial medication, underscoring the importance of understanding the disease.

For instance, in cases where a patient is diagnosed with structural lung disease, Pseudomonas aeruginosa is well-known as the primary pathogen³. This bacterial strain harbours numerous variable virulence factors and antibiotic resistance determinants, resulting in a high mortality rate⁴. The appropriate antimicrobial medication should be selected for treatment based on this understanding.

Meanwhile, Professor Guo is also advocating for the development of a rapid health assessment platform, aiming to achieve rapid assessment and identification of pathogenic microorganisms in infectious disease patients. This initiative aims to streamline antimicrobial medication usage, transitioning directly from empirical treatment to precise and targeted treatment, thus curbing the present situation of misuse.

In addition, continuous screening of pathogenic microorganisms in the body of the patient during the treatment process is imperative. Taking COVID-19 as an example, Professor Guo pointed out that a key attribute of the COVID-19 virus is how it directly impacts the lymphocyte immune system upon entering the body, reducing lymphocyte count and leading to a poor prognosis. During this process, barriers in the body may suffer from damage, and various microbial ecosystems formed by bacteria in the upper respiratory tract, nasal cavity, and oral cavity of the human body, leading to bacterial infections alongside viral infection. While antiviral treatment is ongoing, it is necessary to support with antibacterial treatment to effectively alleviate the patient’s condition. Meanwhile, the use of antibacterial medication may result in continuous transformations of pathogenic microorganisms in the patient’s body.

Aside from the use of antibacterial medication, another important method of anti-infection treatment is the reactivation of immune functions, incorporating nutritional support and care measures (such as inhalation, coughing, muscle atrophy and osteoporosis prevention) into the treatment regimen. Professor Guo specially emphasised the importance of nutritional support to standardised treatment of infectious diseases in the Emergency Medicine Department, stating that it forms the foundation for treating acute infectious diseases and is key to future recovery.

However, standardised diagnosis and treatment in the Emergency Medicine Department face even more challenging situations during the outbreak of acute infectious diseases. During the COVID-19 pandemic, the Emergency Medicine Department served as the ‘guardian’. Professor Guo emphasized the department’s commitment to “holding a defibrillator at the door, even if there is only one person left”, ensuring it remains the last line of defence for the patients. This underscores the tremendous challenges faced by the Emergency Medicine Department.

Therefore, to better prepare for future infectious diseases outbreaks, it is necessary to promote standardised diagnosis and treatment systems widely. Professor Guo is currently committed to integrating cutting-edge technologies, such as digitalisation and artificial intelligence (AI), into the field of acute infections medicine. He is working towards constructing a standardised diagnosis and treatment model and knowledge database for acute infections medicine driven by big data and AI. The objective is to address the shortcomings in standardised diagnosis and treatment of acute infections by primary care physicians.

Conclusion

Drawing from his concept of ‘theory–technique integration’, Professor Guo analysed the treatment strategy for tackling acute infectious diseases, and explained the practical applications of ‘theory’ and ‘technique’ using structural lung inflammation as an example. Furthermore, to address the challenges posed by infectious diseases outbreak for emergency treatment, the integration of AI with modern medicine is poised to become a new weapon in the field of infectious diseases treatment in the future.

References:

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