High mortality associated with gram-negative bacterial bloodstream infection in liver transplant recipients undergoing immunosuppression reduction

BACKGROUND Immunosuppression is an important factor in the incidence of infections in transplant recipient.Few studies are available on the management of immunosuppression(IS)treatment in the liver transplant(LT)recipients complicated with infection.The aim of this study is to describe our experience in the management of IS treatment during bacterial bloodstream infection(BSI)in LT recipients and assess the effect of temporary IS withdrawal on 30 d mortality of recipients presenting with severe infection.AIM To assess the effect of temporary IS withdrawal on 30 d mortality of LT recipients presenting with severe infection.METHODS A retrospective study was conducted with patients diagnosed with BSI after LT in the Department of Liver Surgery,Renji Hospital from January 1,2016 through December 31,2017.All recipients diagnosed with BSI after LT were included.Univariate and multivariate Cox regression analysis of risk factors for 30 d mortality was conducted in the LT recipients with Gram-negative bacterial(GNB)infection.RESULTS Seventy-four episodes of BSI were identified in 70 LT recipients,including 45 episodes of Gram-positive bacterial(GPB)infections in 42 patients and 29 episodes of GNB infections in 28 patients.Overall,IS reduction(at least 50%dose reduction or cessation of one or more immunosuppressive agent)was made in 28(41.2%)cases,specifically,in 5(11.9%)cases with GPB infections and 23(82.1%)cases with GNB infections.The 180 d all-cause mortality rate was 18.5%(13/70).The mortality rate in GNB group(39.3%,11/28)was significantly higher than that in GPB group(4.8%,2/42)(P=0.001).All the deaths in GNB group were attributed to worsening infection secondary to IS withdrawal,but the deaths in GPB group were all due to graft-versus-host disease.GNB group was associated with significantly higher incidence of intra-abdominal infection,IS reduction,and complete IS withdrawal than GPB group(P<0.05).Cox regression showed that rejection(adjusted hazard ratio 7.021,P=0.001)and complete IS withdrawal(adjusted hazard ratio 12.65,P=0.019)were independent risk factors for 30 d mortality in patients with GNB infections after LT.CONCLUSION IS reduction is more frequently associated with GNB infection than GPB infection in LT recipients.Complete IS withdrawal should be cautious due to increased risk of mortality in LT recipients complicated with BSI.

Differences in serum inflammatory mediators in early blood culture positive and negative patients with bacterial bloodstream infection

Objective: To study the differences in serum inflammatory mediators in early blood culture positive and negative patients with bacterial bloodstream infection. Methods: Patients who were hospitalized due to suspected bacterial bloodstream infection between December 2015 and September 2017 were divided into positive group and negative group according to the results of blood culture, and healthy volunteers who underwent medical examination during the same period were selected as control group. Peripheral blood specimens were collected from patients with suspected bacteremia on admission, the peripheral blood specimens were collected from the control group of volunteers during physical examination, and the levels of pro-inflammatory cytokines, anti-inflammatory cytokines, adhesion factors and chemokines were determined. Results: Serum PCT, CRP, IL-6, IL-17, IL-23, IL-4, IL-10, IL-13, sTM, ICAM-1, VCAM-1, EOTAXIN-3 and MCP-1 levels of positive group and negative group were significantly higher than those of control group, and serum PCT, CRP, IL-6, IL-17, IL-23, IL-4, IL-10, IL-13, sTM, ICAM-1, VCAM-1, EOTAXIN-3 and MCP-1 levels of positive group were significantly higher than those of negative group. Conclusions: Detection of serum inflammatory mediators can early predict the bacterial bloodstream infection.

Comparison of the serum contents of inflammatory mediators and oxidative stress mediators between patients with gram-positive bacteria and gram-negative bacteria infection

Objective: To compare the serum contents of inflammatory mediators and oxidative stress mediators between patients with gram-positive bacteria and gram-negative bacteria infection. Methods: Patients who were diagnosed with bloodstream bacterial infection in Zigong Third People's Hospital between March 2015 and April 2017 were selected as the research subjects and divided into gram-positive group and gram-negative group according to the results of blood culture and strain identification, and serum levels of inflammatory mediators PCT, IL-1β, IL-6, sTREM-1, TNF-α, NGAL, SAA, HPT and hs-CRP as well as oxidative stress mediators MDA, AOPP, TAC, CAT and SOD were determined. Results: Serum PCT, IL-1β, IL-6, sTREM-1, TNF-α, NGAL, SAA, HPT, hs-CRP, MDA and AOPP levels of gram-negative group were greatly higher than those of gram-positive group while TAC, CAT and SOD levels were greatly lower than those of gram-positive group. Conclusion: The changes of inflammatory mediators and oxidative stress mediators in the serum of patients with gram-negative bacteria infection are more significant than those of patients with gram-positive bacteria infection.

Selective intestinal decontamination for the prevention of early bacterial infections after liver transplantation

Bacterial infection in the first month after liver transplantation is a frequent complication that poses a serious risk for liver transplant recipients as contributes substantially to increased length of hospitalization and hospital costs being a leading cause of death in this period. Most of these infections are caused by gramnegative bacilli, although gram-positive infections, especially Enterococcus sp. constitute an emerging infectious problem. This high rate of early postoperative infections after liver transplant has generated interest in exploring various prophylactic approaches to surmount this problem. One of these approaches is selective intestinal decontamination(SID). SID is a prophylactic strategy that consists of the administration of antimicrobials with limited anaerobicidal activity in order to reduce the burden of aerobic gram-negative bacteria and/or yeast in the intestinal tract and so prevent infections caused by these organisms. The majority of studies carried out to date have found SID to be effective in the reduction of gram-negative infection, but the effect on overall infection is limited due to a higher number of infection episodes by pathogenic enterococci and coagulase-negative staphylococci. However, difficulties in general extrapolation of the favorable results obtained in specific studies together with the potential risk of selection of multirresistant microorganisms has conditioned controversy about the routinely application of these strategies in liver transplant recipients.

血培养阳性报警时间联合PCT、CRP在细菌性血流感染中的诊断价值研究

目的研究血培养阳性报警时间(TTP)联合降钙素原(PCT)、C反应蛋白(CRP)在细菌性血流感染(BSI)中的诊断价值。方法选取该院从2022年1月至2023年6月收治的700例细菌性BSI患者开展试验,作为感染组;另选取同期判定为血培养污染患者100例作为对照组。检测并对比分析2组患者TTP与PCT、CRP水平。对比不同检测方式诊断细菌性BSI的效能。此外,对比不同种类病原菌感染及不同感染程度患者TTP与PCT、CRP水平。结果感染组患者TTP为(12.66±3.43)h,短于对照组的(20.11±5.19)h,而血清PCT、CRP水平分别为(1.79±0.42)ng/mL、(41.73±7.55)mg/L,均高于对照组[(0.03±0.01)ng/mL、(3.55±1.01)mg/L],差异均有统计学意义(P<0.05)。将血培养结果作为“金标准”,TTP与PCT、CRP联合检测诊断细菌性BSI的灵敏度、特异度、准确度分别为91.00%、97.00%、91.75%,均高于上述三项指标单独诊断,差异均有统计学意义(P<0.05)。革兰阳性菌感染患者PCT水平低于革兰阴性菌感染患者,差异有统计学意义(P<0.05);不同种类病原菌感染患者TTP与CRP水平比较,差异均无统计学意义(P>0.05)。重度感染患者PCT、CRP水平均高于轻中度感染患者,差异均有统计学意义(P<0.05)。结论TTP联合PCT、CRP诊断细菌性BSI的效能较佳,且能有效鉴别病原菌类型,为患者感染严重程度的评估提供可靠依据。

碳青霉烯耐药肠杆菌目细菌(CRE)定植率及其引起血流感染的危险因素研究

目的分析碳青霉烯耐药肠杆菌目细菌(CRE)定植率及其引起血流感染的危险因素。方法选择2021年3月—2023年3月本院收治的384例感染高危接受CRE主动筛查患者,经CRE筛查显示阳性结果136例,CRE定植率为35.42%;以住院期间是否发生血流感染为依据,将136例CRE筛查阳性患者分为血流感染组(25例)与非血流感染组(111例)。分析CRE感染患者的科室分布、病原学检测情况,并采用单因素、多因素Logistic回归分析法分析CRE血流感染的危险因素。结果136例CRE阳性患者分布于14个科室,其中重症医学科63例,占比最高为46.32%,其次是血液病科27例,占比为19.85%;136例CRE阳性患者检出肺炎克雷伯菌115株,占比最高为84.56%,其次是大肠埃希菌10株,占比为7.35%;血流感染组中性粒细胞缺乏、放化疗、使用免疫抑制剂、使用糖皮质激素、抗生素使用≥2种、碳青霉烯类药物暴露史、中心静脉置管占比高于非血流感染组,气管切开率低于非血流感染组(P<0.05);多因素Logistic回归分析显示,中性粒细胞缺乏、使用糖皮质激素及碳青霉烯类抗生素暴露史是CRE血流感染发生的独立危险因素(P<0.05)。结论中性粒细胞缺乏、使用糖皮质激素及碳青霉烯类抗生素暴露史是CRE血流感染发生的独立危险因素,应早期识别以上危险因素,通过合理使用抗生素、糖皮质激素等,以降低CRE血流感染率。

细胞因子对血流感染的早期预测价值研究

目的探讨细胞因子12项对临床血流感染的早期应用价值。方法收集北京清华长庚医院从2023年5月至2024年1月所有血培养阳性的患者标本,通过基质辅助激光解吸电离的飞行时间质谱技术(matrix-assisted laser desorption/ionization time of flight mass spectrometry,MALDI-TOF MS)或细菌鉴定卡鉴别血流感染细菌菌种,通过纳入和排除标准进行筛选后,包括革兰氏阴性细菌(Gram-negative,G-)感染患者55例,革兰氏阳性细菌(Gram-positive,G+)感染患者46例。通过贝克曼流式细胞微球阵列法(cytometry bead array,CBA)检测G-与G+两组患者血流感染同期血浆中细胞因子12项水平,筛选出鉴别G-与G+细菌有显著性差异的细胞因子,并通过ROC曲线比较不同细胞因子及组合鉴别G-菌与G+菌的诊断效能,获取最佳临界值及其灵敏度和特异性。结果G-菌感染组IL-6、IL-8、IL-10、IL-17、TNF-α、IFN-α血浆水平显著高于G+菌感染组(P<0.05)。作6种细胞因子受试者工作曲线(receiver operator characteristic curve,ROC),IL-6鉴别G-/G+菌的ROC曲线下面积(area under curve,AUC)为0.796,最佳cut-off值为115.29pg/mL,诊断灵敏度为72.7%,特异性为82.6%;IL-8鉴别G-/G+菌的AUC为0.670,最佳cut-off值为55.75pg/mL,诊断灵敏度为85.5%,特异性为50.0%;IL-10鉴别G-/G+菌的AUC为0.715,最佳cut-off值33.62pg/mL,诊断灵敏度为52.7%,特异性为84.8%;IL-17鉴别G-/G+菌的AUC为0.561,最佳cut-off值2.41pg/mL,诊断灵敏度为70.9%,特异性为67.0%;TNF-α鉴别G-/G+菌的AUC为0.716,最佳cut-off值1.75pg/mL,诊断灵敏度为49.1%,特异性为78.3%;IFN-α鉴别G-/G+菌的AUC为0.641,cut-off值1.79pg/mL,诊断灵敏度为58.2%,特异性为83.6%;IL-6、IL-8、IL-10、IL-17、TNF-α、IFN-α6项联合鉴别G-与G+菌感染的AUC为0.817,灵敏度为63.6%,特异性为89.1%,诊断效能优于单个细胞因子。结论细胞因子联合模型辅助临床早期鉴别G-/G+菌血流感染,为临床早期抗生素选择提供依据。

急性白血病患者实验室证实的黏膜屏障损伤所致血流感染发生机制与研究进展

白血病已成为人类健康的重要威胁,感染并发症是临床白血病顺利治疗的主要障碍。白血病本身肿瘤特点和高强度化学治疗导致肠道屏障完整性损伤,肠道菌群易位是血流感染(BSI)的重要原因。实验室证实的黏膜屏障损伤所致血流感染(MBI-LCBI)是急性白血病患者BSI的重要组成,但相关研究非常有限。本文通过文献分析,综述黏膜屏障损伤、细菌易位,以及MBI-LCBI定义、诊断、流行情况,分析肠道微生态调节黏膜屏障完整性及MBI-LCBI的作用机制,以期为化学治疗介导黏膜炎及MBI-LCBI的防治及管理提供理论基础。

Acute suppurative terminal cholangitis:Clinical characteristics of a new subtype of acute cholangitis

Background:Acute suppurative terminal cholangitis(ASTC)is rarer than acute obstructive cholangitis and is not well studied.To explore this subtype of acute cholangitis,we described our clinical experience with ASTC.Methods:We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020.We analyzed their clinical characteristics,including etiology,clinical manifestations,imaging features,treatment and prognosis.Results:A total of 32 ASTC patients were included in the analysis.The majority of the patients had a history of biliary operations,and clinical manifestations were occult and atypical.The positive rate of bacterial culture was 46.9%.All the patients had typical imaging features on computed tomography and magnetic resonance imaging.Treatment with effective antibiotics was provided as soon as diagnosis was established.After treatment,most patients had a good outcome.Elevated levels of total bilirubin,aspartate aminotransferase,procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis.Conclusions:Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis,and that earlier diagnosis and more personalized treatments are needed.

基于MIMIC-IV数据库中发生血流感染的危重疾病患者相关数据构建革兰阴性菌血流感染风险预测模型

目的 基于重症医学信息数据库(MIMIC-IV)中发生血流感染的危重疾病患者相关数据构建预测危重疾病患者革兰阴性菌血流感染发生风险预测模型,以期为预测危重疾病患者发生革兰阴性菌血流感染风险提供新的方法。方法 收集MIMIC-IV中2 503例发生血流感染的危重疾病患者的临床资料及实验室检查指标[血常规(红细胞、白细胞、血小板等)、血生化(钾离子、钙离子、氯离子、碳酸氢根、阴离子间隙和尿素氮等)、凝血功能指标(INR、PT、PTT)]数据。将所有危重疾病患者以7∶3的比例分为训练集(1 752例)和验证集(751例)。在训练集中使用LASSO回归初步筛选出危重疾病患者发生革兰阴性菌血流感染的影响因素,并将筛选出来的影响因素行多因素Logistic回归分析,建立危重疾病患者革兰阴性菌血流感染风险预测模型(列线图模型)。在训练集和验证集中通过受试者工作特征曲线(ROC)、校准曲线和决策曲线(DCA)分别对列线图模型的区分度、一致性、临床适用性进行评价。结果 年龄、患有肿瘤、肝胆系统疾病、嗜酒史、钾离子、钙离子、碳酸氢根、阴离子间隙和尿素氮为危重疾病患者发生革兰阴性菌血流感染风险的影响因素,基于以上影响因素采用Logistic回归分析,构建列线图模型。训练集和验证集中,列线图模型预测危重疾病患者发生革兰阴性菌血流感染的ROC下面积分别为0.711(95%CI 0.667~0.756)、0.705(95%CI 0.678~0.733);校准曲线表明列线图模型预测革兰阴性菌血流感染发生的结果与实际结果之间具有良好的一致性(P=0.764);DCA显示列线图模型具有良好的临床适用性。结论 成功构建了预测危重疾病患者发生革兰阴性菌血流感染风险的列线图模型,该模型预测性能较好,能有效识别血流感染高风险危重疾病患者。

血清PCT、CRP和IL-6联合检测对细菌性血流感染的早期诊断价值

目的探讨血清PCT、CRP和IL-6联合检测对细菌性血流感染早期诊断的价值。方法选取2022年6月—2023年6月如皋市中医院收治的120例疑似细菌性血流感染者为研究对象,采血检测血清降钙素原(Procal⁃citonin,PCT)、C反应蛋白(C-reactive Protein,CRP)与白细胞介素-6(Interleukin,IL-6)水平,以血培养结果为金标准,评估3项指标联合检测的诊断效能。结果120例患者的细菌感染阳性率为43.33%,阴性率为56.67%。3项指标联合检测对细菌性血流感染的诊断准确率(95.83%)和灵敏度(96.15%)高于两两指标联合检测,差异有统计学意义(P均<0.05)。3项指标联合检测的特异度(95.59%)与两两指标联合检测相比,无显著差异(P>0.05)。结论细菌性血流感染患者的PCT、CRP、IL-6水平异常升高,联合检测可提高诊断效能。

16S rDNA文库构建技术辅助诊断长病程患者血流感染病原菌方面的应用

目的探讨16S rDNA文库构建技术在长病程患者细菌血流感染病原学诊断中的应用价值。方法随机收集2023年脓毒血症患者的血浆以及静脉血样本各20例。利用血培养、16S rDNA文库构建技术与16S rDNA高通量测序技术同时检测样本中的病原菌,比较三种方法检测结果的一致性和性能指标。进一步比较疑似混合感染组(SMIG)和单一感染组(SIG)患者的预后情况。结果通过一致性评价和临床性能指标分析后发现,16S rDNA文库构建技术的结果一致率为80.00%,灵敏度为88.24%,特异性为33.3%。16S rDNA高通量测序技术的结果一致率为70.00%,灵敏度为82.35%。通过K⁃M生存曲线分析显示,疑似混合感染组患者的住院时长以及PCT恢复正常时长明显高于单一感染组且差异有统计学意义(P<0.05)。结论疑似混合细菌血流感染患者的住院时长与病程长于单一细菌血流感染患者,且利用16S rDNA文库构建技术能够有效辅助血培养技术诊断长病程血流感染病原菌,辅助临床医生针对长病程血流感染患者制定更加精准的诊疗方案。

2019—2022年舟山地区血流感染监测及耐药变化

目的分析2019—2022年舟山地区血流感染病原菌分布情况及耐药趋势变化,为临床使用抗菌药物提供参考。方法选取2019年1月至2022年12月舟山市妇女儿童医院、舟山市中医院、舟山医院血液细菌培养分离得到的病原菌共4312株。参照美国临床实验室标准化协会2021年药敏执行标准,采用WHO推荐的细菌统计软件WHONET 5.6对病原菌分布及药敏结果进行分析。结果4312株中革兰阳性菌1814株(42.1%),革兰阴性菌2429株(56.3%),真菌69株(1.6%)。检出率最高的菌株分别是大肠埃希菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌、金黄色葡萄球菌、肠球菌。其中甲氧西林耐药金黄色葡萄球菌检出率45.2%,未检出青霉素耐药肺炎链球菌和万古霉素耐药粪肠/屎肠球菌。碳青霉烯类药物耐药肠杆菌检出率为3.1%,碳青霉烯类药物耐药铜绿假单胞菌和鲍曼不动杆菌检出率分别为21.6%和28.6%。结论舟山地区血流感染大多由大肠埃希菌、肺炎克雷伯菌和葡萄球菌引起,部分病原菌耐药形势严峻,应持续加强抗菌药物的临床管理,正确规范使用抗菌药物。

PCT、IL-6、CRP、SAA联合早期诊断细菌性血流感染的临床应用价值分析

目的:分析降钙素原(Procalcitonin,PCT)、白细胞介素-6(Interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)、血清淀粉样蛋白a(Serum amyloid a,SAA)联合早期诊断细菌性血流感染的临床应用价值。方法:回顾性分析2020年1月至2023年12月宁乡市中医医院的237例疑似为细菌性血流感染患者的临床资料,依照血培养病原菌检测结果分为细菌感染组和对照组。比较两组血清PCT、IL-6、CRP、SAA水平,分析血清PCT、IL-6、CRP、SAA及联合检查对细菌性血流感染的早期诊断价值。结果:237例疑似为细菌性血流感染患者中,血培养阳性患者占比为74.68%(177/237),血培养阴性患者占比为25.32%(60/237)。细菌感染组血清PCT、IL-6、CRP、SAA水平均高于对照组(P<0.05)。血清PCT、IL-6、CRP、SAA水平及联合检测曲线AUC大于参考线(AUC>0.5),血清PCT、IL-6、CRP、SAA、联合检测曲线AUC分别为0.731、0.703、0.590、0.686、0.839,95%CI分别为0.670~0.786、0.641~0.761、0.525~0.654、0.623~0.745、0.786~0.884,敏感度分别为0.418、0.593、0.260、0.565、0.729,特异度分别为0.967、0.767、0.950、0.917、0.850,cut-off值分别为4.77ng·mL^(-1)、126.51pg·mL^(-1)、144.18mg·L^(-1)、406.81mg·L^(-1)。结论:血清PCT、IL-6、CRP、SAA联合检测可早期诊断细菌性血流感染,且联合检测敏感度高于单项检测。

3889份住院患者血培养病原菌分布及耐药性分析

目的了解临床送检血培养标本的病原菌分布及耐药特点。方法回顾分析我院2016年1月—2017年12月临床送检的3889份血培养标本。结果 3889份血培养标本共检出病原菌438株,阳性率为11.26%。其中革兰阴性菌共检出273株,占62.33%,革兰阳性菌共138株,占31.51%,真菌15株,占3.42%,革兰阳性菌12株,占2.74%,无专性厌氧菌的检出;阳性率前3位的科室分别是肾内科、ICU和肝病科;分离率前3位的细菌是大肠埃希菌、金黄色葡萄球菌和肺炎克雷伯菌。结论定期对血培养病原菌的分布及耐药情况进行分析,为临床提供一手资料,以降低血流感染的病死率,提高治疗效果。

ICU内中心静脉导管相关性血流感染的调查及危险因素分析

目的了解ICU内中心静脉导管相关性血流感染(CRBSI)的发生率、病原菌的种类、分布情况,分析疾病危险因素对CRBSI预后的影响,为早期判断及干预创造时机。方法回顾性分析2012年1月至2013年6月ICU内CRBSI病例的临床及微生物学资料。结果本次调查患者共987例,发生CRBSI者共67例(6.8%),住院期间共死亡24例(35.8%)。67例CRBSI患者共检出81株病原菌,其中革兰阳性菌42株(51.9%),革兰阴性菌36株(44.4%),真菌3株(3.7%)。革兰阳性菌中以表皮葡萄球菌为主,革兰阴性菌中以鲍曼不动杆菌为主。Logistic多元回归分析显示:年龄大于或等于65岁、APACHEⅡ评分、复数菌性CRBSI是ICU内CRBSI患者住院期间死亡的独立危险因素。结论近年来ICU内CRBSI患者病死率仍然较高,病原菌以表皮葡萄球菌及鲍曼不动杆菌为主。老年、发病时病情程度、复数菌感染是ICU内CRBSI患者不良预后的独立危险因素。

血清PCT,CRP及NEU％联合检测对细菌性血流感染的早期诊断价值

目的 探讨联合检测血清降钙素原（procalcitonin,PCT）,C-反应蛋白（C-reactive protein,CRP）及中性粒细胞百分比（percentage ofneutrophils,NEU％）早期预测细菌性血流感染（bloodstream infection,BSI）的可行性.方法 回顾性分析2012年11月-2013年7月徐州医学院附属医院的住院患者376例,均为入院后首次送检血培养并同时检测血常规、PCT及CRP者.血液病患者排除在外.按血培养结果将患者分为血培养阳性组和血培养阴性组,比较两组中PCT,CRP和NEU％的水平变化,并绘制ROC曲线评价各指标的诊断价值.将系列联合检测与诊断价值较高指标的灵敏度和特异度进行比较.结果 103例患者的血培养为阳性,273例患者的血培养为阴性.血培养阳性组患者的PCT,CRP和NEU％水平显著高于血培养阴性组（9.95±21.40 ng/ml vs 3.94±20.03 ng/ml,Z=9.992,P=0.000;112.84±84.95 mg/mlvs 74.25±70.79 mg/ml,Z=4.503,P=0.000;85.61％±9.90％ vs 78.66％±13.22％,Z=5.302,P=0.000）,秩和检验得出差异具有统计学意义.PCT的AUC为0.818,经Z检验,大于CRP（AUC=0.651,Z=4.175,P=0.000）和NEU％ （AUC=0.677,Z=3.597,P=0.000）,差异具有统计学意义.PCT,CRP和NEU％诊断细菌性BSI的灵敏度和特异度分别为75.2％和78.8％,99.0％和6.6％,92.4％和21.2％,三者系列联合检测灵敏度为70.5％,特异度为81.3％.联合检测较PCT单项检测灵敏度有所下降,经χ^2检验差异无统计学意义（χ^2=2.25,P=0.134）,但特异度升高,差异具有统计学意义（χ^2=4.2,P=0.041）.当三项指标均阴性时,排除细菌性BSI的特异度高达100％.结论 联合检测PCT,CRP及NEU％可为临床早期预测细菌性BSI提供更便捷、可靠的诊断方法.

老年血流感染患者107例病原菌分布和药敏分析

目的探讨老年患者血流感染(BSI)的病原微生物学特征。方法回顾性分析2015年1—12月铜陵市人民医院所有年龄≥65岁且确诊为BSI住院患者的临床及血培养资料。结果 107例患者中分离病原菌107株(剔除重复菌株)。其中社区获得性感染患者占57.9%(62/107),医院获得性感染患者占42.1%(45/107);社区获得性BSI分离细菌中革兰阴性菌占67.7%,医院获得性BSI中革兰阳性菌占55.5%。老年男性继发于呼吸系统感染者多于老年女性(P<0.001),老年女性继发于泌尿系统感染者多于老年男性(P<0.001)。分离的病原菌中,革兰阴性菌59株,占55.1%,革兰阳性菌45株,占42.1%,真菌3株,占2.8%。检出率居前6位的依次为大肠埃希菌(30.9%)、凝固酶阴性葡萄球菌(20.6%)、金黄色葡萄球菌(金葡菌)(10.3%)、肺炎克雷伯菌(6.5%)、肠球菌属(6.5%)、不动杆菌属(4.7%)。大肠埃希菌和肺炎克雷伯菌中产超广谱β内酰胺酶(ESBL)株分别占51.5%和28.6%;大肠埃希菌对阿米卡星、头孢西丁及哌拉西林-他唑巴坦耐药率在10%以下,对碳青霉烯类无耐药;肺炎克雷伯菌仅对替加环素尚无耐药,对碳青霉烯类耐药率达14.3%~28.6%。甲氧西林耐药金葡菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)检出率分别为各自菌种的36.4%和72.7%。未发现耐万古霉素、替考拉宁和利奈唑胺葡萄球菌;检出1株耐万古霉素屎肠球菌。结论老年患者BSI病原菌以革兰阴性菌为主,大肠埃希菌和凝固酶阴性葡萄球菌是最常见的病原菌。应重视性别、原发感染部位等因素对老年患者BSI的影响。

Etiological analysis on bacterial ocular disease in northern China (1989-1998)

OBJECTIVE: To review the distribution and trends of bacterial culture specimens in Beijing Institute of Ophthalmology. METHODS: A retrospective analysis of the bacterial culture-positive rate, the distribution of gram' s stain, and the distribution and change of isolates was performed on 4705 specimens during a 10-year period (1989- 1998). RESULTS: Positive cultures numbered 1339 of the 4705 specimens, with a positive rate of 28.6%. Gram-positive cocci constituted 55.6% of the total isolates, followed by gram-positive bacilli 13.1% . Gram-negative cocci accounted for 2.8%, and gram-negative bacilli 28.5% . In the positive bacteria cultures, coagulase-negative Staphylococcus (mainly Staphylococcous epidermidis) was the most common isolate (25.3%), and followed by Pseudomonas 18.8%, Micrococcus 11.7%, Cotynbaccterium 10.1%, and Staphylococcus aureus 8.2% . During the 10-year period, the overall frequency of gram-positive cocci appeared to increase with time while the frequency of gram-negative bacilli decreased. CONCLUSIONS: Gram-positive cocci and gram-negative bacilli are still the predominant pathogens of ocular infection in northern China. The frequency of the former increases annually whereas that of the latter decreases. It is important to comprehend the distribution and trends of ocular pathogenic bacteria for the diagnosis, prevention and treatment of bacterial infectious ocular disease.

自贡3家三级综合医院血流感染病原菌的临床分布及耐药性分析

目的:了解自贡地区血流感染病原菌的临床分布及耐药情况,为本地区血流感染的诊断与治疗提供参考。方法:收集2017年1-12月自贡地区3家三级综合医院血培养阳性菌株及药敏结果,以大肠埃希菌ATCC25922、金黄色葡萄球菌ATCC25923、铜绿假单胞菌ATCC27853、肺炎链球菌ATCC49619为质控菌,采用WHONET 5.6及SPSS 19.0软件对血流感染病原菌的临床分布和耐药性进行分析。结果:共分离细菌879株,其中革兰氏阳性菌212株(24.1%),革兰氏阴性菌667株(75.9%);临床分布前5位的细菌分别为大肠埃希菌(50.7%)、肺炎克雷伯菌(10.2%)、金黄色葡萄球菌(6.5%)、表皮葡萄球菌(3.2%)和肺炎链球菌(2.6%)。携带病原菌患者的年龄及性别分布特点为40岁以上人群占88.5%,男女比例为1.15∶1。常见革兰氏阳性菌的耐药情况显示,未分离出耐万古霉素或利奈唑胺的金黄色葡萄球菌、凝固酶阴性葡萄球菌、粪肠球菌、屎肠球菌和肺炎链球菌,耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCN)的检出率分别为15.8%和64.2%;屎肠球菌较粪肠球菌对常见抗菌药物的耐药率更高,其中粪肠球菌对青霉素及氨苄西林耐药率为0,未检出耐青霉素的肺炎链球菌。常见革兰氏阴性菌的耐药情况显示,未分离出耐厄他培南的大肠埃希菌和肺炎克雷伯菌,并且这两种细菌对阿米卡星、头孢替坦、头孢吡肟、哌拉西林/他唑巴坦及亚胺培南的耐药率均较低(<10%),这两种细菌中产超广谱β-内酰胺酶(ESBLs)菌株的检出率分别为42.2%和24.4%,产ESBLs菌株比不产ESBLs菌株对常见抗菌药物耐药率更高。非发酵菌中鲍曼不动杆菌较铜绿假单胞菌对常见抗菌药物耐药率更高,两者对亚胺培南的耐药率分别为68.8%和13.6%;未分离出耐阿米卡星及妥布霉素的铜绿假单胞菌。结论:自贡地区血流感染以肠杆菌科细菌为主,鲍曼不动杆菌的耐药性严重,应加强医院感控管理。