Morbidity and mortality risk factors in emergency department patients with Acinetobacter baumannii bacteremia

BACKGROUND:Acinetobacter baumannii(AB)bacteremia is an increasingly common and often fatal nosocomial infection.Identification of morbidity and mortality risk factors for AB bacteremia in emergency department(ED)patients may provide ways to improve the clinical outcomes of these patients.METHODS:The records for 51 patients with AB bacteremia and 51 patients without AB infection were collected and matched in a retrospective case-control study between 2013 and 2015 in a singlecenter ED.Risk factors were analyzed by Chi-square and multivariate logistic regression statistical models.RESULTS:A significant risk factor for morbidity was the presence of a central venous catheter(CVC)(P<0.001).The mortality rate for the 51 patients with AB bacteremia was 68.6%.Risk factors for mortality were the presence of a CVC(P=0.021)and an ED stay longer than two weeks(P=0.015).CONCLUSION:AB infections lead to high morbidity and mortality.The presence of a CVC was associated with higher morbidity and mortality in patients with AB bacteremia.Avoiding CVC insertions may improve outcomes in ED patients with AB bacteremia.

Positive Rate of Different Hepatitis B Virus Serological Markers in Peking Union Medical College Hospital,a General Tertiary Hospital in Beijing

Objectives To investigate the positive rate of different hepatitis B virus （HBV） serological markers, and the demographic factors related to HBV infection. Methods We enrolled all patients tested for HBV serological markers, such as HBV surface antigen （HBsAg）, HBV surface antibody （HBsAb）, hepatitis B e antigen （HBeAg）, hepatitis B e antibody （HBeAb）, HBV core antibody （HBcAb）, and HBV-DNA from July 2008 to July 2009 in Peking Union Medical College Hospital. The positive rate of each HBV serological marker was calculated according to gender, age, and department, respectively. The positive rates of HBV-DNA among patients with positive HBsAg were also analyzed. Results Among 27 409 samples included, 2681 （9.8%） were HBsAg positive. When patients were divided into 9 age groups, the age-specific positive rate of HBsAg was 1.2%, 9.6%, 12.3%, 10.9%, 10.3%, 9.7%, 8.0%, 5.8%, and 4.3%, respectively. The positive rate of HBsAg in non-surgical department, surgical department, and health examination center was 16.2%, 5.8%, and 4.7%, respectively. The positive rate of HBsAg of males （13.3%） was higher than that of females （7.3%, P=0.000）. Among the 2681 HBsAg （＋） patients, 1230 （45.9%） had HBV-DNA test, of whom 564 （45.9%） were positive. Patients with HBsAg （＋）, HBeAg （＋）, and HBcAg （＋） result usually had high positive rate of HBV-DNA results （71.8%, P=0.000）. Conclusions Among this group of patients in our hospital, the positive rate of HBsAg was relatively high. Age group of 20-29, males, and patients in non-surgical departments were factors associated with high positive rate of HBsAg.

An unusual case report of Burkholderia cepacia endophthalmitis

Dear Editor,I am Huan Chen from the Department of Ophthalmology,Peking Union Medical College Hospital in Beijing,China.I am writing this letter to present an unusual case of Burkholderia cepacia endophthalmitis.Burkholderia cepacia[Burkholderia cepacian complex(Bcc)]is a group of genetically unique Gram-negative bacilli with similar phenotypes,belonging to the genus pseudomonas,which is widely found in water,soil and plants.

Investigation of Hepatitis C Virus Infection Rate of Patients in a General Hospital

Objective To investigate the infection rate of hepatitis C virus among the ambulatory patients and in-patients of a tertiary teaching hospital,and study the demographic factors related to the prevalence of hepatitis C virus infection.Methods All patients tested for hepatitis C virus antibody from July 2008 to July 2009 in Peking Union Medical College Hospital were enrolled in this cross-sectional analysis.The prevalence of hepatitis C virus infection was compared according to age,gender,and departments,respectively.Among patients with positive serology hepatitis C virus marker,the positivity of hepatitis C virus RNA was analysed.Results Among 29 896 subjects included,the hepatitis C virus antibody of 494 patients were positive(1.7%).When patients were divided into 9 age groups,the age specific prevalence of hepatitis C virus antibody were0.2%,1.7%,1.2%,1.1%,1.5%,1.9%,2.6%,2.4%and 2%,respectively.The prevalence of hepatitis C virus antibody in non-surgical department and surgical department was 3%and 1%,respectively.The prevalence of hepatitis C virus antibody of males was higher than that of the females.Total of 194 patients with positive hepatitis C virus antibody were tested for hepatitis C virus RNA,the RNA level of 113 patients(58.2%)were higher than the low detection limit.Conclusions The prevalence of hepatitis C virus antibody was relatively high among patients of general tertiary hospital.Age group of 60-69,males and patients in non-surgical departments were factors associated with high rate of hepatitis C virus infection.

mTOR Modulates Lymphocyte Differentiation through T-bet and Eomesodermin in Response to Invasive Pulmonary Aspergillosis in Rats

Background： Aspergillosis infection is common in the patients with insufficient immunity. The role of mammalian target of rapamycin （roTOR）, T-box expressed in T-cells （T-bet）, and eomesodermin （EOMES） in mediating T lymphocytes differentiation in response to Aspep,gilhls.fumigatus infection in immunocompromised rats was investigated in this study. Methods： lnvasive pulmonary aspergillosis （IPA） ofimmunosuppressive twenty male rats were established and sacrificed at 24 h （n = 5）, 48 h （n = 5）, 72 11 （n = 5）, and 96 h （n = 5） atter A.Jumigatus infection. In addition, control （n = 5）, cyclophospharnide （CTX） （n = 5）, and aspergillosis （n = 5） group were also established the tissues and pathology of lung tissue was examined by hematoxylin and eosin staining. CD8＋ T-cells was sorted by flow cytometry. Serum roTOR, S6K, T-bet, and EOMES were quantified by enzyme-linked immunosorbent assay. Results： Histology of lung tissue indicated severe lung tissue injury including infiltration of inflammatory cells, alveolar wall damage or degradation, blood congestion, and hemorrhage in the CTX, IPA, and CTX ＋ IPA rats. Hyphae were seen in the IPA, and CTX ＋ IPA groups. The proportion of CD8^＋ T-cells was significantly increased in the animals ofCTX ＋ IPA. Memory CD8＋ T-cells was significantly increased in early stage （24 h and 48 h, P 〈 0.001）, but decreased in the late phase of fungal infection （72 h and 96 h） in the animals of CTX ＋ IPA. In addition, at early stage of fungal infection （24 h and 48 h）, serum mTOR （P 〈 0.001 ）, S6K （P 〈 0.001 ）, and T-bet （P 〈 0.05） was significantly higher, while EOMES was significantly lower （P 〈 0.001 ）, in CTX ＋ IPA group than that in control, CTX alone or 1PA alone group. Conversely, serum roTOR, S6K, T-bet, and EOMES showed opposite changed in the late stage （72 h and 96 h）. Pearson＇s correlation analysis indicated that mTOR and S6K were significantly correlated with T-bet （r = 0.901 and 0.91, respectively, P 〈 0.001 ）, but negatively and significantly correlated with EOMES （r = -0.758 and -0.751, respectively, P 〈 0.001 ）. Conclusions： mTOR may regulate transcription factors of EOMES and T-bet, and by which mechanism, it may modulate lymphocytes differentiation in animals with immune suppression and fungal infection.

Clinical and Laboratory Characteristics of Patients with Nontuberculous Mycobacterium Bloodstream Infection in a Tertiary Referral Hospital in Beijing, China

Background： Nontuberculous Mycobacterium （NTM） bloodstream infection （BSI） is relatively rare. We aimed in this study to evaluate the clinical characteristics, laboratory evaluation, and outcomes of patients with NTM BSI. Methods： We retrospectively reviewed the clinical records of inpatients with NTM BSI at our institution between January 2008 and January 2015 and recorded clinical parameters including age, gender, underlying disease, clinical manifestation, organs involved with NTM disease, species of NTM, laboratory data, treatment and outcome of these patients. We also reviewed the reported cases and case series ofNTM BSI by searching PubMed, EMBASE, and Wanfang databases. Data of normal distribution were expressed by mean ~ standard deviation （SD）. Data of nonnormal distribution were expressed by median and interquartile range （IQR）. Results： Among the ten patients with NTM BSI, the median age was 51 years （IQR 29-57 years） and three patients were males. Eight patients were immunocompromised, with underlying diseases including human immunodeficiency virus （HIV） infection （one patient）, rheumatic diseases （two patients）, breast cancer （one patient）, myelodysplastic syndrome （two patients）, and aplastic anemia （two patients）. Other organ（s） involved were lung （two patients）, endocardium （two patients）, brain, spinal cord, and soft tissue （one each patient）. The median lymphocyte was 0.66 x 109/L （IQR 0.24-1 .93 × 10^9/L）. The median cluster of differentiation 4 （CD4） cell count was 179/ mm^3 （IQR 82-19/mm^3）. Five patients died （three with hematological diseases, one with breast cancer, and one with rheumatic disease）, three recovered, and two were lost to follow-up. Conclusions： We reported all cases in our hospital diagnosed with bloodstream NTM infection that was rarely reported. In this group of patients, patients usually had a high fever and could have multiple organ involvements. All patients with poor prognosis had underlying diseases.

Investigation of an enteritis outbreak caused by Salmonella enterica serovar Aberdeen in China

Salmonella Aberdeen is a ubiquitous pathogen that can cause severe gastroenteritis and plays an important role in food-borne illness and international food-trade dispute.[1]However,the molecular biological characteristics of this organism have been rarely studied.This study was conducted in accordance with the Declaration of Helsinki and aimed to assess the epidemiological and clinical characteristics of a food-borne outbreak caused by Salmonella Aberdeen.Furthermore,the molecular biological characteristics of the outbreak isolates were detected and analyzed.From June 10 to 12,2018,an enteritis outbreak affected 75 employees in the Fushan district of Yantai,Shandong province,China,including 33 males and 42 females.The mean age of the patients was 34.2±5.3 years.

Humoral response to inactivated SARS-CoV-2 vaccines in patients on sirolimus alone

Dear Editor,Sirolimus,a prototype of mammalian target of rapamycin(m TOR)inhibitor,was approved by the FDA as an immunosuppressant in combination with cyclosporine and corticosteroids for prophylaxis of organ rejection.Reduced immune response of SARS-Co V-2 vaccine has been observed in organ recipients on immunosuppressants containing sirolimus(Mazzola et al.,2022).