{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T05:33:22Z","timestamp":1777354402245,"version":"3.51.4"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Pulmonary infections are common and challenging in older adults due to immune decline, comorbidities, and antimicrobial resistance. This study aimed to evaluate the effects of Chinese herbal medicine as an adjunct therapy to improve immune function and infection outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study was conducted at the Department of Geriatrics, the Second Hospital of Shandong University, China, and included 372 older adults who were admitted between 1 January 2024 and 30 June 2024. Patients were divided into two groups: those who received CHM treatment and those who received conventional treatment. Data were retrieved from the hospital\u2019s information system, including patient demographics, clinical status, laboratory results, and treatment outcomes. Outcomes included hospital stay time, febrile duration, symptom recovery, SpO\n                      <jats:sub>2<\/jats:sub>\n                      recovery, CPIS recovery, laboratory parameter recovery, MDR-related indicators and mortality. Propensity score matching and E-values were performed as a sensitivity analysis to address baseline confounding, with covariate balance assessed by standardized mean differences.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CHM treatment was associated with significantly reduced hospital stay and febrile period, as well as a higher fever resolution rate compared to conventional treatment. Inflammatory markers improved in the CHM group, suggesting a potential immunomodulatory effect. CHM-treated patients also exhibited greater reductions in MDR bacterial counts. These beneficial effects remained consistent in the PSM-matched cohort and were further validated by E-value analysis for robustness against unmeasured confounding. However, no significant differences were found in overall mortality or MDR bacterial reversal. Subgroup analysis showed greater benefits in frail, malnourished, immunocompromised, disabled, and patients with altered consciousness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CHM offers clinical benefits as an adjunct therapy for older adults with pulmonary infections, particularly in improving recovery time and managing MDR bacteria. Further research is required to confirm its efficacy and optimize treatment protocols.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1762339","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T04:32:18Z","timestamp":1777350738000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Chinese herbal medicine as adjunct therapy improves clinical recovery and reduces multidrug-resistant bacterial load in older adults with pulmonary infection: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Chunyan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Geriatrics, Integrated Traditional Chinese and Western Medicine Center, The Second Qilu Hospital of Shandong University, Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Qilu Hospital of Shandong University, Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fangxiao","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Integrated Traditional Chinese and Western Medicine Center, The Second Qilu Hospital of Shandong University, Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Integrated Traditional Chinese and Western Medicine Center, The Second Qilu Hospital of Shandong University, Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiao","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Integrated Traditional Chinese and Western Medicine Center, The Second Qilu Hospital of Shandong University, Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaojie","family":"Bi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Integrated Traditional Chinese and Western Medicine Center, The Second Qilu Hospital of Shandong University, Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ning","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Information Center, The Second Qilu Hospital of Shandong University, Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qingbo","family":"Zhou","sequence":"additional","affiliation":[{"name":"Geriatric Medicine Center, Affiliated Hospital of Shandong University of TCM","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2100","DOI":"10.1016\/s0140-6736(24)00367-2","article-title":"Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the global burden of disease study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"153800","DOI":"10.1016\/j.phymed.2021.153800","article-title":"Efficacy and safety of Lianhua Qingwen capsules, a repurposed Chinese herb, in patients with coronavirus disease 2019: a multicenter, prospective, randomized controlled trial [Phytomedicine 85 (2021) 153242]","volume":"94","author":"Hu","year":"2022","journal-title":"Phytomedicine"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1431706","DOI":"10.3389\/fphar.2024.1431706","article-title":"Efficacy and safety of traditional Chinese medicine combined with azithromycin sequential therapy for mycoplasma pneumonia among children: a meta-analysis of randomized controlled trials","volume":"15","author":"Lyu","year":"2024","journal-title":"Front Pharmacol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"117017","DOI":"10.1016\/j.jep.2023.117017","article-title":"The safety and efficacy of Chinese herbal medicine for pneumonia prevention in high-risk elder residents in the nursing home: a randomized, double-blind clinical trial","volume":"318","author":"Chen","year":"2024","journal-title":"J Ethnopharmacol"},{"key":"ref5","first-page":"289","article-title":"Integrated traditional Chinese and Western medicine for the treatment of multidrug-resistant bacterial pneumonia: a systematic review and meta-analysis","volume":"22","author":"Wang","year":"2024","journal-title":"J Integr Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"125","DOI":"10.2174\/1389557518666181017143141","article-title":"Antimicrobial effects of chemical compounds isolated from traditional Chinese herbal medicine (TCHM) against drug-resistant Bacteria: a review paper","volume":"19","author":"Zhao","year":"2019","journal-title":"Mini Rev Med Chem"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1021\/acscentsci.9b00452","article-title":"Tanshinones: first-in-class inhibitors of the biogenesis of the type 3 secretion system needle of Pseudomonas aeruginosa for antibiotic therapy","volume":"5","author":"Feng","year":"2019","journal-title":"ACS Cent Sci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"5553","DOI":"10.26355\/eurrev_202208_29426","article-title":"Antimicrobial mechanisms of traditional Chinese medicine and reversal of drug resistance: a narrative review","volume":"26","author":"Liu","year":"2022","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref9","first-page":"105","article-title":"Role of traditional Chinese medicine in antimicrobial stewardship: a perspective from clinical and basic research","volume":"12","author":"Zhong","year":"2023","journal-title":"Antimicrob Resist Infect Control"},{"key":"ref10","volume-title":"Guidelines for Integrating Older People into Primary Health Care for an Age-Friendly World","year":"2021"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America","volume":"200","author":"Metlay","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"ref12","first-page":"32","article-title":"Federation of Chinese Medicine Societies guidelines of integrated traditional Chinese and Western medicine for diagnosis and treatment of community-acquired pneumonia","volume":"25","year":"2025","journal-title":"Chin J Evid Based Med"},{"key":"ref13","volume-title":"Performance Standards for Antimicrobial Susceptibility Testing","year":"2025"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1097\/CCM.0000000000005303","article-title":"Extended lung ultrasound to differentiate between pneumonia and atelectasis in critically ill patients: a diagnostic accuracy study","volume":"50","author":"Haaksma","year":"2022","journal-title":"Crit Care Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1016\/j.ajem.2019.10.023","article-title":"Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: a meta-analysis","volume":"38","author":"Huang","year":"2020","journal-title":"Am J Emerg Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1080\/07853890.2023.2185673","article-title":"Clinical value of procalcitonin-to-albumin ratio for identifying sepsis in neonates with pneumonia","volume":"55","author":"Li","year":"2023","journal-title":"Ann Med"},{"key":"ref17","first-page":"1707","article-title":"Propensity score matching for causal inference in observational studies: an introduction and guide","volume":"32","author":"Austin","year":"2023","journal-title":"Stat Methods Med Res"},{"key":"ref18","first-page":"e000366","article-title":"Quantifying the impact of unmeasured confounding in observational studies with the E value","volume":"13","author":"Hansen","year":"2023","journal-title":"BMJ Open"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2590563","DOI":"10.1155\/2019\/2590563","article-title":"Impact of healthcare-associated infections on length of stay: a study in 68 hospitals in China","volume":"2019","author":"Jia","year":"2019","journal-title":"Biomed Res Int"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s13756-023-01234-y","article-title":"Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study","volume":"12","author":"Yi","year":"2023","journal-title":"Antimicrob Resist Infect Control"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"104352","DOI":"10.1016\/j.archger.2021.104352","article-title":"Length of hospital stay among oldest-old patients in acute geriatric ward","volume":"94","author":"Tal","year":"2021","journal-title":"Arch Gerontol Geriatr"},{"key":"ref22","first-page":"1123","article-title":"Inflammatory markers and prognosis in elderly patients with community-acquired pulmonary infection: a prospective cohort study","volume":"79","author":"Zhang","year":"2024","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1111\/andr.12821","article-title":"Low testosterone levels predict clinical adverse outcomes in SARS-CoV-2 pneumonia patients","volume":"9","author":"Rastrelli","year":"2021","journal-title":"Andrology"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1399335","DOI":"10.3389\/fmed.2024.1399335","article-title":"Combined coagulation and inflammation markers as predictors of venous thrombo-embolism and death in COVID-19","volume":"11","author":"Zhu","year":"2024","journal-title":"Front Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1093\/cid\/ciaa1227","article-title":"Reply to Pan","volume":"73","author":"Huang","year":"2021","journal-title":"Clin Infect Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"450","DOI":"10.12669\/pjms.39.2.6856","article-title":"Comparing the predictive values of procalcitonin\/albumin ratio and other inflammatory markers in determining COVID-19 severity","volume":"39","author":"\u00c7ak\u0131rca","year":"2023","journal-title":"Pak J Med Sci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1186\/s12906-020-03114-z","article-title":"Assessment of the anti-virulence potential of extracts from four plants used in traditional Chinese medicine against multidrug-resistant pathogens","volume":"20","author":"Pu","year":"2020","journal-title":"BMC Complement Med Ther"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"154514","DOI":"10.1016\/j.phymed.2022.154514","article-title":"Efficacy and safety of Reyanning mixture in patients infected with SARS-CoV-2 omicron variant: a prospective, open-label, randomized controlled trial","volume":"108","author":"Xu","year":"2023","journal-title":"Phytomedicine"},{"key":"ref29","first-page":"317","article-title":"Efficacy and safety of the Qiguiyin formula in severe pneumonia: study protocol for a randomized, double-blind, placebo-controlled clinical trial","volume":"40","author":"Huang","year":"2020","journal-title":"J Tradit Chin Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"116745","DOI":"10.1016\/j.jep.2023.116745","article-title":"Qingjin Huatan decoction protects mice against influenza a virus pneumonia via the chemokine signaling pathways","volume":"317","author":"Liu","year":"2023","journal-title":"J Ethnopharmacol"},{"key":"ref31","first-page":"154892","article-title":"Yinqiao san ameliorates pulmonary inflammation in aged mice via regulating NF-\u03baB\/IL-6 pathway","volume":"112","author":"Wang","year":"2024","journal-title":"Phytomedicine"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"154545","DOI":"10.1016\/j.phymed.2022.154545","article-title":"Xuanfei Baidu formula alleviates impaired mitochondrial dynamics and activated NLRP3 inflammasome by repressing NF-\u03baB and MAPK pathways in LPS-induced ALI and inflammation models","volume":"108","author":"Li","year":"2023","journal-title":"Phytomedicine"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"118521","DOI":"10.1016\/j.jep.2024.118521","article-title":"Sangju cold granule exerts anti-viral and anti-inflammatory activities against influenza a virus in vitro and in vivo","volume":"334","author":"Gao","year":"2024","journal-title":"J Ethnopharmacol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"79","DOI":"10.14715\/cmb\/2024.70.7.11","article-title":"Hypoxia-inducible factor-1\u03b1\/vascular endothelial growth factor signaling pathway-based ulcer-healing mechanism of Astragalus aqueous extract in diabetic foot rats","volume":"70","author":"Jia","year":"2024","journal-title":"Cell Mol Biol (Noisy-le-Grand)"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2481","DOI":"10.1007\/s00210-020-01814-4","article-title":"Flos lonicerae flavonoids attenuate experimental ulcerative colitis in rats via suppression of NF-\u03baB signaling pathway","volume":"393","author":"Liu","year":"2020","journal-title":"Naunyn Schmiedeberg's Arch Pharmacol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1016\/j.joim.2024.08.006","article-title":"Clinical efficacy of Xuebijing injection for the treatment of sepsis: a retrospective cohort study","volume":"22","author":"Gong","year":"2024","journal-title":"J Integr Med"},{"key":"ref37","first-page":"118965","article-title":"Qingjin huatan decoction reduces multidrug-resistant bacterial load by inhibiting biofilm formation in vitro","volume":"340","author":"Chen","year":"2023","journal-title":"J Ethnopharmacol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"104411","DOI":"10.1016\/j.micpath.2020.104411","article-title":"Antibacterial synergy between linezolid and baicalein against methicillin-resistant Staphylococcus aureus biofilm in vivo","volume":"147","author":"Liu","year":"2020","journal-title":"Microb Pathog"},{"key":"ref39","first-page":"2047","article-title":"Anti-inflammatory and antibacterial activities of P. Petiolosa (Christ) Ching ethyl acetate extract against S. aureus in mice","volume":"9","author":"Cheng","year":"2020","journal-title":"Pak J Pharm Sci"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"117488","DOI":"10.1016\/j.jep.2023.117488","article-title":"Revealing active constituents within traditional Chinese medicine used for treating bacterial pneumonia, with emphasis on the mechanism of baicalein against multi-drug resistant Klebsiella pneumoniae","volume":"321","author":"Qin","year":"2024","journal-title":"J Ethnopharmacol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"105056","DOI":"10.1016\/j.phrs.2020.105056","article-title":"Chinese herbal medicine for coronavirus disease 2019: a systematic review and meta-analysis","volume":"160","author":"Xiong","year":"2020","journal-title":"Pharmacol Res"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"6811","DOI":"10.3390\/molecules28196811","article-title":"Protective application of Chinese herbal compounds and formulae in intestinal inflammation in humans and animals","volume":"28","author":"Yang","year":"2023","journal-title":"Molecules"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1762339\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T04:32:29Z","timestamp":1777350749000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1762339\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":42,"alternative-id":["10.3389\/fmed.2026.1762339"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1762339","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]},"article-number":"1762339"}}