无盆化擦浴模式预防ICU患者中心静脉导管相关血流感染的效果研究

目的分析ICU患者采用无盆化擦浴模式预防中心静脉导管相关血流感染(CLABSI)的效果。方法选取2022年6月—2023年6月在南昌大学第二附属医院ICU住院并应用中心静脉导管治疗的患者100例,采用抛硬币法分为传统组(n=50,传统盆式擦浴),新型组(n=50,无盆化擦浴)。比较两组干预效果。结果新型组导管感染率低于传统组,组间差异有统计学意义(P<0.05)。新型组患者皮肤均菌落数更少,治疗成本更低,擦浴时间更短,组间差异有统计学意义(P<0.05)。结论ICU患者采用无盆化擦浴模式预防CLABSI效果明显,同时还可降低皮肤菌落数量,缩短擦浴时间,节省治疗成本。

ICU内血流感染的病原菌及耐药性分析

目的探讨ICU内血流感染的病原菌分布及耐药性情况,为临床合理选用抗生素提供依据。方法回顾性分析2010年1月～2012年4月我院ICU内18 831份临床血流感染患者血培养标本,探讨常见病原菌的分布特点及耐药性。结果分离获得菌株560株,血培养标本分离率为10.81%,革兰阳性菌占61.1%,革兰阴性菌占31.1%,真菌占7.8%,居前五位的菌株依次为溶血葡萄球菌(20.0%),鲍氏不动杆菌(12.7%),表皮葡萄球菌(11.1%),肺炎克雷伯菌(6.4%),肠球菌属(8.0%)。MRSA和MRCNS的检出率分别为89.5%和97.2%,未发现万古霉素、替考拉宁耐药的金黄色葡萄球菌,肠杆菌科细菌及非发酵菌耐药现象普遍。结论革兰阳性菌是ICU内血流感染的主要病原菌,近年来真菌感染的发生率呈上升趋势,且血培养病原菌对常见抗菌药物的耐药现象普遍存在。

Diagnostic endoscopic ultrasonography:Assessment of safety and prevention of complications

Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients' specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% ofpatients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.

H pylori seroprevalence in patients with lung cancer

AIM: To assess H pylori seroprevalence in lung cancer and determine whether there is a potential association between lung cancer and H pylori infection. METHODS: The study was conducted on forty consecutive patients with lung cancer, confirmed by pathology (32 men, 8 women; mean age 55.50 ± 11.91 years, range 16-77 years). Forty healthy subjects (25 men, 15 women; mean age 43.08 ± 12.60 years, range 20-79 years) from the patients’ family members were matched to each case subject on the basis of age and socioeconomic status. H pylori infection was detected with a commercially available immunoglobulin G (IgG) enzyme-linked immunosorbent assay (Trinity kit, Biotech co., USA), previously validated in adults (86% sensitivity, 96% specificity) against a gold standard of culture and histology. RESULTS: H pylori seropositivity was present in 52.5% of patients with lung cancer in comparison to 45.0% of healthy control subjects. Although H pylori seropositivity was more frequent in lung cancer patients than in controls, the difference did not reach statistical significance (OR = 1.35, 95% CI = 0.56-3.25; P = 0.65). In addition, there was no significant difference between cases and controls in terms of gastrointestinal symptoms. CONCLUSION: The earlier described association between H pylori infection and lung cancer was not supported in this study. Further studies with larger sample sizes should be undertaken to assess the frequency of H pylori infection in patients with lung cancer and their potential association.

Study on the serum levels of soluble intercellular adhesion molecule-1 (sICAM-1) in patients with Helicobacter pylori Infection

Objective: To evaluate the interaction between serum levels of soluble intercellular adhesion molecule 1 (sICAM 1) and Helicobacter pylori (H. pylori) infection in patients with chronic gastritis and peptic ulcer. Methods: The serum levels of sICAM 1 in 205 patients with chronic gastric diseases were detected by ELISA method and the status of H. pylori was determined by histologic examination, RUT, 14 C UBT, and serology. The sera obtained from 18 healthy volunteers served as controls. Results: The serum levels of sICAM 1 were significantly higher in patients with H. pylori positive than those of H. pylori negative (889.43±32.52 ng/ml vs. 747.07±30.45 ng/ml, P <0.05). The serum levels of sICAM 1 in patients with mild, moderate and severe infection of H. pylori were 841.68±72.36 ng/ml, 905.43±37.59 ng/ml and 1012.54±49.34 ng/ml,respectively ( P <0.05). The serum levels of sICAM 1 proved to be significantly correlated with the density of H. pylori colonization in gastric mucosa ( r s =0.316, P < 0.001) . The serum levels of sICAM 1 in patients with chronic gastritis and peptic ulcer were significantly higher than those in healthy controls ( P <0.05). Conclusions: These results indicated that H. pylori infection up regulates the expression of sICAM 1.

Fusarium Vascular Infection of Oil Palm： Epidemiology, Molecular Diagnostic Tools and the Potential of Fusarium Suppressive Soil in Malaysia

Vascular wilt disease caused by Foe （Fusarium oxysporum f. sp. elaeidis） invades the host xylem and causes a devastating disease of oil palm in west and central Africa. This disease has not been reported in Southeast Asia, in spite of long term importation for breeding purposes of African seed and pollen, shown in this laboratory at the University of Bath to be contaminated with Foe disease epidemiology was recently studied in plantations in Ghana. Infection mainly occurred in clusters, implying root-root transmission rather than aerial spread by spores. Molecular diagnostic tools has being developed for： （1） rapid detection and quantification of Foe in plant tissue, soil, seed and pollen for quarantine purposes in order to prevent transcontinental spread of Foe; and （2） to test efficacy of putative disease resistant or tolerant palm genotypes. We have investigated the possibility of Foe-suppressive soils in Malaysia in order to explain the non-appearance of this vascular disease there and possibly to reveal other potential biocontrol agents. The explanation as to why Malaysia has not yet attained the disease is likely to revolve around the soil properties, in particular the microflora. This review reported that greater disease severity based on visual symptoms occurred in autoclaved soils and compost than in untreated soils when oil palm seedlings artificially infected with Foe.

Hemorrhagic Fever with Renal Syndrome Associated with Acute Pancreatitis

Hemorrhagic fever with renal syndrome (HFRS) is a systemic infectious disease caused by Hantaviruses and characterized by fevers, bleeding tendencies, gastrointestinal symptoms and renal failure. It encompasses a broad spectrum of clinical presentations, ranging from unapparent or mild illnesses to fulminant hemorrhagic processes. Among the various complications of HFRS, acute pancreatitis is a rare find. In this report, based on clinical data, laboratory and radiologic examination findings, we describe a clinical case, with HFRS from Dobrava virus, associated with acute pancreatitis. The patient was successfully treated by supportive management. Clinicians should be alert to the possibility of HFRS when examining patients with epidemiological data and symptoms of acute pancreatitis.

Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study

In many traditional Chinese medicine （TCM） hospitals, most patients are elderly with chronic diseases. Nosocomial bloodstream infections （nBSIs） are an important cause of morbidity and mortality. A retrospective sur- veillance study was performed to examine the epidemiology and microbiology of nBSIs in a TCM hospital from 2009 to 2011. A total of 482 patients with nBSIs were included in the study period. The incidence rate was 5.7/1000 admissions Escherichia coli （25.5%） was the most common Gram-negative and coagulase-negative staphylococcus （CONS） （14.1%） was the most common Gram-positive organism isolated. One-third of the E. coli and Klebsie/la pneumoniae isolated from the nBSIs were the third-generation cephalosporin-resistant. Half of the Acinetobacter species isolates were resistant to imipenem. Of all the CoNS isolates, 90.7% were resistant to methicillin. Carbapenems and glyco- peptide were the most frequently used for nBSI therapy. Only about one-third of patients （157/482） received appro- priate empirical therapy. Septic shock, hemodialysis, Pitt bacteremia score 〉4, urinary tract infection, and appropriate empirical therapy were most strongly associated with 28-d mortality. The incidence of nBSIs was low in the TCM hospital but the proportion of nBSIs due to antibiotic-resistant organisms was high. A high Pitt bacteremia score was one of the most important risk factors for mortality in nBSIs. Therefore, the implementation of appropriate empirical therapy is crucial to improve the clinical outcome of nBSIs.

Zika virus and Zika fever

An emerging mosquito-borne arbovirus named Zika virus(ZIKV), of the family Flaviviridae and genus Flavivirus, is becoming a global health threat. ZIKV infection was long neglected due to its sporadic nature and mild symptoms. However, recently, with its rapid spread from Asia to the Americas, affecting more than 30 countries, accumulating evidences have demonstrated a close association between infant microcephaly and Zika infection in pregnant women. Here, we reviewed the virological, epidemiological, and clinical essentials of ZIKV infection.