Varicella-zoster virus, which is responsible for varicella(chickenpox) and herpes zoster(shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adul...Varicella-zoster virus, which is responsible for varicella(chickenpox) and herpes zoster(shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella(particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times:(1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection;(2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear(atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation;(3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and(4) when the baby is born and it is necessary to confirm a diagnosis of varicella(and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn.展开更多
AIM: To explore relationships between human carcinomas and mycoplasma infection. METHODS: Monoclonal antibody PD4, which specifically recognizes a distinct protein from mycoplasma hyorhinis, was used to detect mycopla...AIM: To explore relationships between human carcinomas and mycoplasma infection. METHODS: Monoclonal antibody PD4, which specifically recognizes a distinct protein from mycoplasma hyorhinis, was used to detect mycoplasma infection in different paraffin embedded carcinoma tissues with immunohistochemistry. PCR was applied to amplify the mycoplasma DNA from the positive samples for confirming immunohistochemistry. RESULTS: Fifty of 90 cases (56%) of gastric carcinoma were positive for mycoplasma hyorhinis. In other gastric diseases, the mycoplasma infection ratio was 28% (18/49) in chronic superficial gastritis, 30% (14/46) in gastric ulcer and 37% (18/49) in intestinal metaplasia. The difference is significant with gastric cancer (chi(2) = 12.06, P 【 0.05). In colon carcinoma, the mycoplasma infection ratio was 55.1% (32/58),but it was 20.9% (10/49)in adenomarous polyp (chi(2)=13.46, P 【 0.005). Gastric and colon cancers with high differentiation had a higher mycoplasma infection ratio than those with low differentiation (P 【 0.05). Mycoplasma infection in esophageal cancer, lung cancer, breast cancer and glioma was 50.9% (27/53), 52.6% (31/59), 39.7% (25/63) and 41% (38/91), respectively. The mycoplasma DNA was successfully amplified with the DNA extracted from the cancer tissues that were positive for mycoplasma infection (detected with antibody PD4). CONCLUSION: There was high correlation between mycoplasma infection and different cancers, which suggests the possibility of an association between the two. The mechanism involved in oncogenesis by mycoplasma remains unknown.展开更多
BACKGROUND:The diagnosis of aortitis is often delayed as symptoms are largely nonspecific.We report a case of Staphylococcal thoracic aortitis in a 73-year-old Chinese woman complicated by aortic dissection.METHODS:Th...BACKGROUND:The diagnosis of aortitis is often delayed as symptoms are largely nonspecific.We report a case of Staphylococcal thoracic aortitis in a 73-year-old Chinese woman complicated by aortic dissection.METHODS:The patient presented with pyrexia of unknown origin,and a contrast enhanced computed tomography aortogram revealed a large thrombus at the anterior aspect of the ascending aorta with two large ulcerations as a result of a chronic type A aortic dissection.A hemiarch replacement with a 28 mm Gleweave Vascutek graft was performed with resuspension of aortic valve commisures.Aortic thrombus cultures were positive for coagulase negative Staphylococcus aureaus,and histology showed chronic dissection of the aorta.RESULTS:The patient was treated with intravenous cefazolin for a 6-week duration and made good progress.CONCLUSIONS:This case highlights Staphylococcal infective aortitis complicated by dissection presenting as fever of unknown origin.Timely diagnosis is essential as progression to catastrophic rupture may occur.展开更多
BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidit...BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.展开更多
AIM To study the effect of Helicobacter pylori ( H. pylori ) infection on gastric epithelial proliferation in the progression from normal mucosa to gastric carcinoma. METHODS Gastric biopsy specimens from nor...AIM To study the effect of Helicobacter pylori ( H. pylori ) infection on gastric epithelial proliferation in the progression from normal mucosa to gastric carcinoma. METHODS Gastric biopsy specimens from normal controls ( n =11), superficial gastritis ( n =32), atrophic gastritis with intestinal metaplasia ( n =83), dysplasia ( n =25) and gastric carcinoma ( n =10) were studied by immunohistochemical staining of proliferating cell nuclear antigen (PCNA). RESULTS The gastric epithelial proliferation, expressed as PCNA labeling index (LI)%, was progressively increased in successive stages from normal mucosa to gastric carcinoma regardless of H. pylori status. There was significant difference in PCNA LI% among all groups ( P <0 01). The analysis pursuing the effect of H. pylori infection on gastric epithelial proliferation in the progression from normal mucosa to gastric carcinoma showed that in superficial gastritis and mild atrophic gastritis groups, PCNA LI% in H. pylori positive patients were 13 14±1 6 and 19 68±2 22 respectively, significantly higher than 6 95±0 78 and 11 34±1 89 in H. pylori negative patients ( P <0 01); but there was no such difference in other groups ( P >0 05). CONCLUSION H. pylori infection causes increased gastric epithelial proliferation in the stages of superficial and mild atrophic gastritis and may play a part in triggering gastric carcinogenesis.展开更多
Objective:To investigate the quality of indoor air of different wards and units of Olabisi Onabanjo University Teaching Hospital, Sagamu, to ascertain their contribution to infection rate in the hospital.Methods:The m...Objective:To investigate the quality of indoor air of different wards and units of Olabisi Onabanjo University Teaching Hospital, Sagamu, to ascertain their contribution to infection rate in the hospital.Methods:The microbial quality of indoor air of nine wards/units of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria was conducted. Sedimentation technique using open Petri-dishes containing different culture media was employed and samplings were done twice daily, one in the morning shortly after cleaning and before influx of people/patients into the wards/units and the other in the evening when a lot of activities would have taken place in these wards. Isolates were identified according to standard methods.Results:Results showed that there was a statistically significant difference(氈2= 6.0167) in the bacteria population of the different sampling time whereas it was not so for fungi population(氈2= 0.2857). Male medical ward(MMW) and male surgical general(MSG) recorded the highest bacterial and fungal growth while the operating theatre(OT) was almost free of microbial burden. The bacteria isolates were Staphylococcus aureus, Klebsiellasp., Bacillus cereus, Bacillus subtilis, Streptococcus pyogenes andSerratia marscenceswhile the fungi isolates includedAspergillus flavus, Penicilliumsp.,Fusariumsp.,Candida albicansandAlternariasp.Staphylococcus aureuswas the predominantly isolated bacterium whilePenicilliumsp. was the most isolated fungus.Conclusions:Though most of the microbial isolates were potential and or opportunistic pathogens, there was no correlation between the isolates in this study and the surveillance report of nosocomial infection during the period of study, hence the contribution of the indoor air cannot be established. From the reduction noticed in the morning samples, stringent measures such as proper disinfection and regular cleaning, restriction of patient relatives' movement in and out of the wards/units need to be enforced so as to improve the quality of indoor air of our hospital wards/units.展开更多
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 s...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.展开更多
BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutriti...BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone,and parenteral nutrition(PN) may be indicated.While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation,less is known about the risks,particularly infectious,associated with this therapy among this specific group of patients.AIM To describe the incidence,microbiology,and risk factors of central line-associated bloodstream infection(CLABSI) among children with BA listed for liver transplantation.METHODS Retrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children's Hospital from 2008 through2015(n = 96).Patients with a central line for administration of PN(n = 63) were identified and details of each CLABSI event were abstracted.We compared the group of patients who experienced CLABSI to the group who did not,to determine whether demographic,clinical,or laboratory factors correlated with development of CLABSI.RESULTS Nineteen of 63 patients(30%,95%CI:19,43) experienced 29 episodes of CLABSI during 4800 line days(6.04 CLABSI per 1000 line days).CLABSI was predominantly associated with Gram-negative organisms(14/29 episodes,48%)including Klebsiella spp.,Enterobacter spp.,and Escherichia coli.The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae.Grampositive organisms(all Staphylococcus spp.) and fungus(all Candida spp.)comprised 9/29(31%) and 6/29(21%) episodes,respectively.No demographic,clinical,or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysis CONCLUSION There is substantial risk for CLABSI among children with BA listed for liver transplantation.No clinical,demographic,or laboratory factor we tested emerged as an independent predictor of CLABSI.While our data did not show an impact of CLABSI on the short-term clinical outcome,it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization,unnecessary healthcare dollar expenditures,and may exact an opportunity cost,in terms of missed allograft offers.展开更多
Objective:To determine the pattern of antibiotic resistance among Staphylococcus aureus(S. aureus) isolates from clinical specimens and to identify community-acquired methicillin-resistant Staphylococcus aureus(CA-MRS...Objective:To determine the pattern of antibiotic resistance among Staphylococcus aureus(S. aureus) isolates from clinical specimens and to identify community-acquired methicillin-resistant Staphylococcus aureus(CA-MRSA) in specimens that have been collected from patients referring to one of the hospitals of Ahvaz.Methods:S.aureus isolates from a hospital in Ahvaz were screened for resistance to various antibiotics including methicillin.The susceptibility of the isolates was determined by Kirby-Bauer disc diffusion method.The MRSA was also treated with ethidium bromide to find the origin of resistance.Results:Among the bacterial isolates,all of 11 S.aureus were resistant to methicillin and cefixime,2 were resistant to ciprofloxacin,6 were resistant to tetracycline and the reminder were sensitive or intermediate to other antibiotics.The treated isolates were reminded resistant to methicillin and this suggested that the plasmid was not the origin of resistance in these isolates.Conclusions:These results showed that infection due to MRSA is widespread in Ahvaz and with respect to the spread of vancomycin resistance among MRSA and appearance of overwhelming infections.It is necessary to identify continuously the profile of antibiotic resistance among S.aureus isolates in other regions and finding appropriate antibiotic for infection control and eradication.展开更多
AIM: To follow the principles of evidence based medicine to reach the integrated results of these studies. METHODS: Twenty-one papers of case-control studies were selected, including 11 on gastric cancer,7 on precance...AIM: To follow the principles of evidence based medicine to reach the integrated results of these studies. METHODS: Twenty-one papers of case-control studies were selected, including 11 on gastric cancer,7 on precancerous lesion of stomach and 3 on lymphoma of stomach. Meta analysis was used to sum up the odds ratios (OR) of these studies. RESULTS: H. pylori vs gastric cancer (intestinal and diffuse type): the odds ratio from the fixed effect model is 3.0016 (95% CI: 2.4197-3.7234, P【0.001). H. pylori vs precancerous lesion of stomach: a random effect model was used to calculate the summary odds ratio and its value is 2.5635 (95% CI: 1.8477-3.5566, P【0.01). H. pylori vs lymphoma of stomach: though the quantity of literature is too small to make Meta analysis, the data of these 3 studies show that lymphoma of stomach is highly associated with H. pylori infections. CONCLUSION: Since it had been revealed that H. pylori infection pre-exists in gastric carcinoma and precancerous lesions, the results of Meta analysis present a strong evidence to support the conclusion that H. pylori infection is a risk factor for gastric carcinoma.展开更多
文摘Varicella-zoster virus, which is responsible for varicella(chickenpox) and herpes zoster(shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella(particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times:(1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection;(2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear(atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation;(3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and(4) when the baby is born and it is necessary to confirm a diagnosis of varicella(and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn.
基金Supported by National 863 Project (102-10-01-08)National Natural Science Foundation of China(39570405)+1 种基金Natural Science Foundation of Beijing(7941001)State Key Basic Research Program(G1998051203)
文摘AIM: To explore relationships between human carcinomas and mycoplasma infection. METHODS: Monoclonal antibody PD4, which specifically recognizes a distinct protein from mycoplasma hyorhinis, was used to detect mycoplasma infection in different paraffin embedded carcinoma tissues with immunohistochemistry. PCR was applied to amplify the mycoplasma DNA from the positive samples for confirming immunohistochemistry. RESULTS: Fifty of 90 cases (56%) of gastric carcinoma were positive for mycoplasma hyorhinis. In other gastric diseases, the mycoplasma infection ratio was 28% (18/49) in chronic superficial gastritis, 30% (14/46) in gastric ulcer and 37% (18/49) in intestinal metaplasia. The difference is significant with gastric cancer (chi(2) = 12.06, P 【 0.05). In colon carcinoma, the mycoplasma infection ratio was 55.1% (32/58),but it was 20.9% (10/49)in adenomarous polyp (chi(2)=13.46, P 【 0.005). Gastric and colon cancers with high differentiation had a higher mycoplasma infection ratio than those with low differentiation (P 【 0.05). Mycoplasma infection in esophageal cancer, lung cancer, breast cancer and glioma was 50.9% (27/53), 52.6% (31/59), 39.7% (25/63) and 41% (38/91), respectively. The mycoplasma DNA was successfully amplified with the DNA extracted from the cancer tissues that were positive for mycoplasma infection (detected with antibody PD4). CONCLUSION: There was high correlation between mycoplasma infection and different cancers, which suggests the possibility of an association between the two. The mechanism involved in oncogenesis by mycoplasma remains unknown.
文摘BACKGROUND:The diagnosis of aortitis is often delayed as symptoms are largely nonspecific.We report a case of Staphylococcal thoracic aortitis in a 73-year-old Chinese woman complicated by aortic dissection.METHODS:The patient presented with pyrexia of unknown origin,and a contrast enhanced computed tomography aortogram revealed a large thrombus at the anterior aspect of the ascending aorta with two large ulcerations as a result of a chronic type A aortic dissection.A hemiarch replacement with a 28 mm Gleweave Vascutek graft was performed with resuspension of aortic valve commisures.Aortic thrombus cultures were positive for coagulase negative Staphylococcus aureaus,and histology showed chronic dissection of the aorta.RESULTS:The patient was treated with intravenous cefazolin for a 6-week duration and made good progress.CONCLUSIONS:This case highlights Staphylococcal infective aortitis complicated by dissection presenting as fever of unknown origin.Timely diagnosis is essential as progression to catastrophic rupture may occur.
文摘BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.
文摘AIM To study the effect of Helicobacter pylori ( H. pylori ) infection on gastric epithelial proliferation in the progression from normal mucosa to gastric carcinoma. METHODS Gastric biopsy specimens from normal controls ( n =11), superficial gastritis ( n =32), atrophic gastritis with intestinal metaplasia ( n =83), dysplasia ( n =25) and gastric carcinoma ( n =10) were studied by immunohistochemical staining of proliferating cell nuclear antigen (PCNA). RESULTS The gastric epithelial proliferation, expressed as PCNA labeling index (LI)%, was progressively increased in successive stages from normal mucosa to gastric carcinoma regardless of H. pylori status. There was significant difference in PCNA LI% among all groups ( P <0 01). The analysis pursuing the effect of H. pylori infection on gastric epithelial proliferation in the progression from normal mucosa to gastric carcinoma showed that in superficial gastritis and mild atrophic gastritis groups, PCNA LI% in H. pylori positive patients were 13 14±1 6 and 19 68±2 22 respectively, significantly higher than 6 95±0 78 and 11 34±1 89 in H. pylori negative patients ( P <0 01); but there was no such difference in other groups ( P >0 05). CONCLUSION H. pylori infection causes increased gastric epithelial proliferation in the stages of superficial and mild atrophic gastritis and may play a part in triggering gastric carcinogenesis.
文摘Objective:To investigate the quality of indoor air of different wards and units of Olabisi Onabanjo University Teaching Hospital, Sagamu, to ascertain their contribution to infection rate in the hospital.Methods:The microbial quality of indoor air of nine wards/units of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria was conducted. Sedimentation technique using open Petri-dishes containing different culture media was employed and samplings were done twice daily, one in the morning shortly after cleaning and before influx of people/patients into the wards/units and the other in the evening when a lot of activities would have taken place in these wards. Isolates were identified according to standard methods.Results:Results showed that there was a statistically significant difference(氈2= 6.0167) in the bacteria population of the different sampling time whereas it was not so for fungi population(氈2= 0.2857). Male medical ward(MMW) and male surgical general(MSG) recorded the highest bacterial and fungal growth while the operating theatre(OT) was almost free of microbial burden. The bacteria isolates were Staphylococcus aureus, Klebsiellasp., Bacillus cereus, Bacillus subtilis, Streptococcus pyogenes andSerratia marscenceswhile the fungi isolates includedAspergillus flavus, Penicilliumsp.,Fusariumsp.,Candida albicansandAlternariasp.Staphylococcus aureuswas the predominantly isolated bacterium whilePenicilliumsp. was the most isolated fungus.Conclusions:Though most of the microbial isolates were potential and or opportunistic pathogens, there was no correlation between the isolates in this study and the surveillance report of nosocomial infection during the period of study, hence the contribution of the indoor air cannot be established. From the reduction noticed in the morning samples, stringent measures such as proper disinfection and regular cleaning, restriction of patient relatives' movement in and out of the wards/units need to be enforced so as to improve the quality of indoor air of our hospital wards/units.
基金supported by the Projects of Zhejiang Province Non-profit Technology Research(No.2013C33180),China
文摘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.
文摘BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone,and parenteral nutrition(PN) may be indicated.While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation,less is known about the risks,particularly infectious,associated with this therapy among this specific group of patients.AIM To describe the incidence,microbiology,and risk factors of central line-associated bloodstream infection(CLABSI) among children with BA listed for liver transplantation.METHODS Retrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children's Hospital from 2008 through2015(n = 96).Patients with a central line for administration of PN(n = 63) were identified and details of each CLABSI event were abstracted.We compared the group of patients who experienced CLABSI to the group who did not,to determine whether demographic,clinical,or laboratory factors correlated with development of CLABSI.RESULTS Nineteen of 63 patients(30%,95%CI:19,43) experienced 29 episodes of CLABSI during 4800 line days(6.04 CLABSI per 1000 line days).CLABSI was predominantly associated with Gram-negative organisms(14/29 episodes,48%)including Klebsiella spp.,Enterobacter spp.,and Escherichia coli.The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae.Grampositive organisms(all Staphylococcus spp.) and fungus(all Candida spp.)comprised 9/29(31%) and 6/29(21%) episodes,respectively.No demographic,clinical,or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysis CONCLUSION There is substantial risk for CLABSI among children with BA listed for liver transplantation.No clinical,demographic,or laboratory factor we tested emerged as an independent predictor of CLABSI.While our data did not show an impact of CLABSI on the short-term clinical outcome,it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization,unnecessary healthcare dollar expenditures,and may exact an opportunity cost,in terms of missed allograft offers.
基金Shahid Chamran University for providing the research grant
文摘Objective:To determine the pattern of antibiotic resistance among Staphylococcus aureus(S. aureus) isolates from clinical specimens and to identify community-acquired methicillin-resistant Staphylococcus aureus(CA-MRSA) in specimens that have been collected from patients referring to one of the hospitals of Ahvaz.Methods:S.aureus isolates from a hospital in Ahvaz were screened for resistance to various antibiotics including methicillin.The susceptibility of the isolates was determined by Kirby-Bauer disc diffusion method.The MRSA was also treated with ethidium bromide to find the origin of resistance.Results:Among the bacterial isolates,all of 11 S.aureus were resistant to methicillin and cefixime,2 were resistant to ciprofloxacin,6 were resistant to tetracycline and the reminder were sensitive or intermediate to other antibiotics.The treated isolates were reminded resistant to methicillin and this suggested that the plasmid was not the origin of resistance in these isolates.Conclusions:These results showed that infection due to MRSA is widespread in Ahvaz and with respect to the spread of vancomycin resistance among MRSA and appearance of overwhelming infections.It is necessary to identify continuously the profile of antibiotic resistance among S.aureus isolates in other regions and finding appropriate antibiotic for infection control and eradication.
基金Supported by Funds for University Key Teachers by the Ministry of Education,No.2000-65
文摘AIM: To follow the principles of evidence based medicine to reach the integrated results of these studies. METHODS: Twenty-one papers of case-control studies were selected, including 11 on gastric cancer,7 on precancerous lesion of stomach and 3 on lymphoma of stomach. Meta analysis was used to sum up the odds ratios (OR) of these studies. RESULTS: H. pylori vs gastric cancer (intestinal and diffuse type): the odds ratio from the fixed effect model is 3.0016 (95% CI: 2.4197-3.7234, P【0.001). H. pylori vs precancerous lesion of stomach: a random effect model was used to calculate the summary odds ratio and its value is 2.5635 (95% CI: 1.8477-3.5566, P【0.01). H. pylori vs lymphoma of stomach: though the quantity of literature is too small to make Meta analysis, the data of these 3 studies show that lymphoma of stomach is highly associated with H. pylori infections. CONCLUSION: Since it had been revealed that H. pylori infection pre-exists in gastric carcinoma and precancerous lesions, the results of Meta analysis present a strong evidence to support the conclusion that H. pylori infection is a risk factor for gastric carcinoma.
