宏基因二代测序技术在重症肺炎病原体检测及治疗方案制定中的应用

目的观察宏基因二代测序技术(mNGS)在重症肺炎病原体检测及治疗方案制定中的应用效果。方法112例重症肺炎患者随机分为实验组和对照组,患者均行肺泡灌洗术;实验组灌洗液送mNGS检测,对照组灌洗液行一般细菌、真菌培养;两组均根据病原体检测结果调整抗感染方案。比较两组病原体检出率、抗生素使用时间、机械通气时间、住院日、住院费用、临床疗效、病死率。结果实验组病原体检出率高于对照组(χ;=23.59,P<0.05);实验组抗生素使用时间、机械通气时间、住院日、住院费用少于对照组(P均<0.05);实验组临床疗效高于对照组(χ;=3.895,P=0.048);实验组病死率低于对照组,但差异无统计学意义(χ;=1.037,P=0.308)。结论mNGS可提高重症肺炎病原体的检出率;对重症肺炎患者,根据mNGS的病原体检测结果调整制定治疗方案,可缩短抗生素使用时间、机械通气时间、住院时间,减少住院费用,提高治疗效果。

实时荧光定量PCR对几种常见引起重症肺炎病原体的检测

目的:对重症肺炎患者痰样本进行常见病毒类病原体和细菌类病原体检测。方法:采集某院128名重症肺炎患者的痰样本为实验组,正常人的痰样本为阴性对照组,利用RT-PCR的方法进行肺炎病原体的检测。结果:在128份痰样本中,检测出63份肺炎链球菌阳性标本、5份肺炎克雷伯菌阳性标本、17份流感病毒阳性标本、3份呼吸道合胞病毒阳性标本,阳性检测率高达68.8%,没有假阳性、假阴性,特异性非常强。结论:RT-PCR法能够对重症肺炎病原体进行准确、快速、特异的检测,为重症肺炎的预警和治疗提供科学依据。

传播新冠肺炎病原体行为的定性

对于行为人故意传播新冠肺炎病原体危害公共安全的行为,均应以以危险方法危害公共安全罪论处.行为人过失传播新冠肺炎病原体从而危害公共安全的,无论是否发生实害结果,也不论是否出现法条竟合,均应以妨害传染病防治罪论处.这一方案可以避免按过失以危险方法危害公共安全罪定罪时须有实害结果的要求,还可规避因果关系的证明难题.由于法定刑迥异,故应严格把握传播者的主观心态,既不可为了严惩而将过失拔高为故意,也不可觉得处罚过重而将故意降格评价为过失.

呼吸机相关性肺炎的病原体分析

目的探讨呼吸机相关性肺炎的有效治疗办法。方法对2012年6月~2015年5月收治的86例呼吸机相关性肺炎患者,随机分成对照组和观察组,对照组患者采取对症治疗,观察组患者在此基础上进一步采取针对性治疗,对比两组患者治疗效果。结果观察组患者通过及时积极的针对性治疗,肺炎症状改善情况明显优于对照组（P〈0.05）,差异具有统计学意义。结论长期使用呼吸机的患者发现肺炎,应及时明确肺炎病原体类型后进行针对性治疗,改善患者生存质量。

浙南地区呼吸道感染患儿非典型肺炎病原体感染的流行病学分析

目的研究浙南地区呼吸道感染儿童的流行病学情况。方法采用酶联免疫吸附法(ELISA)检测温州医科大学附属儿童医院上、下呼吸道感染的7 716例患儿,进行3种非典型呼吸道病原体的检测分析,具体为肺炎支原体(MP),肺炎衣原体(CP),嗜肺军团菌(LP)。结果 7 716例呼吸道感染患儿中存在的病原体抗体分别是肺炎支原体抗体3 545例(45.94%)、肺炎衣原体抗体1 545例(20.02%)、嗜肺军团菌抗体612例(7.93%)。肺炎三联总阳性率为73.89%,男性阳性率为74.57%(3 472/4 656),女性阳性率为72.88%(2 230/3 060),两者阳性比较差异有统计学意义(χ2=64.07,P<0.01)。结论肺炎支原体、肺炎衣原体、嗜肺军团菌是浙南地区儿童非典型病原体感染的主要病原体,其中混合感染以肺炎支原体和肺炎衣原体感染为主,其分布特点具有年龄差异,应高度重视、科学诊疗。

46例食管癌术后呼吸机相关性肺炎病原体及耐药性分析

目的：通过对46例手术后食管癌患者治疗资料回顾，分析患者采用呼吸机通气后所伴随的肺炎病原体种类及相关耐药性。方法：收集46例食管癌患者痰进行培养，这46例患者都进行了人工机械通气，将培养基分离得到81株致病菌后对致病菌进行分析。结果：革兰阳性菌占19．00％。阴性菌占74．00％，而位居前两位的是比例高达29．65％的铜绿假单孢菌，其次是不动杆菌属（25．90％）。耐药性研究发现：对抗菌药的耐药率有上升趋势的是全部的革兰阴性菌，而革兰阳性菌的耐药性主要是耐药金葡菌（40％）。结论：研究结果发现耐药菌时食管癌患者术后肺炎主要致病菌，临床为了减少耐药性和提高药物疗效，需要加强抗菌药物的合理使用。

成人传染性单核细胞增多症合并非典型病原体肺炎一例

传染性单核细胞增多症(infection mononucleosis,IM)是一种由EB病毒所致的感染性疾病,多发于青少年,血象常见淋巴细胞明显升高,其中可见10%以上非典型淋巴细胞。2017年11月本院消化科收治1例最终确诊为传染性单核细胞增多症合并非典型病原体肺炎的患者,其血象可见嗜酸性粒细胞明显增多,而淋巴细胞正常,非典型淋巴细胞检测为阴性。在IM患者中,此患者血常规变化特殊,临床上非常罕见。

水貂肺炎混合感染病原菌的分离鉴定

为了确定山东省临沂市某水貂养殖场水貂肺炎的病原体,试验从发病死亡水貂体内分离到2株细菌LY8301和LY8302,根据培养特征、生化试验、16S rRNA序列测定及药敏试验对2株细菌进行分析。结果表明:LY8301菌株为绿脓杆菌,LY8302菌株为鲍曼不动杆菌;2株细菌均对头孢噻吩、氨苄西林、青霉素G及四环素耐药,对阿米卡星、环丙沙星、庆大霉素和氧氟沙星较为敏感;2株细菌均对小鼠有较强的致病性,可以确定此次水貂肺炎由鲍曼不动杆菌与绿脓杆菌混合感染引起。

Relationship between Chlamydia pneumoniae infection and occurrence of bronchial asthma

Objective: To study the relationship between Chlamydia pneumoniae (C. pneumoniae) infection and asthma exacerbation. Methods: A prospective study of C. pneumoniae infection was conducted in 75 patients with asthma and 63 patients with respiratory tract infection, and 100 blood donors served as controls. The presence of infection was convinced by the polymerase chain reaction and direct immunofluorescence assay for C. pneumoniae DNA from throat swab specimens and micro-immunofluorescence testing for C. pneu-moniae-specific IgG, IgM and IgA antibodies. Results: Prevalence of specific IgG in asthma patients (81. 3%) was higher than that of the blood donors (68. 0%, P<0. 05) and was not significantly different from respiratory tract infection patients (68. 0%, P>0. 05). The acute C. pneumoniae infection rate of symptomatic asthma patients (59. 4%) was markedly higher than that of respiratory tract infection patients (34. 9% , P<0. 05). The average titer of C. pneumoniae IgG instead of IgA in asthma patients (48. 38±6. 94) was significantly higher than respiratory tract infection patients (24. 70±8. 77, P<0. 05). Other pathogens were identified in 12 of 21 (57. 1%) asthma patients with C. pneumoniae. The symptoms of 7 asthma patients with C. pneumoniae infection were improved through antibiotic treatment. Conclusion: The findings suggest a possible role of C. pneumoniae infection in asthma.

Molecular Detection, Culture and Isolation of Mycoplasma Pneumoniae From Reproductive Tract of STD Patients

Objective: To confirm whether Mycoplasma pneumoniae (MP) are present in reproductive tract of STD patients inChina. Methods: Application of nested PCR (nPCR) and DNAsequencing to test samples of urethral/vaginal swabs withMP culture confirmation of several nPCR positive patients. Results: 74 of 786 STD patients were positive for MP bynPCR, with a rate of 9.4%. of the 484 male patients, 10.5%were positive, and among the 302 female patients, 7.6%were positive. There was no significant difference betweenthem (P<0.05). of 12 cases of MP positive samples by nPCR,4 cases were first generation culture-positive, and one ofthem passed to the next generation successfully. DNAsequencing was performed on the nPCR product of oneswab sample and one MP culture isolation. The determinedsequence was identical to the typical MP strain. Conclusion: In China, MP are present in reproductivetract of both male and female STD patients.