Successful treatment of pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii with multi-route tigecycline: A case report

BACKGROUND Pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii(A.baumannii)is one of the most severe complications associated with craniotomy.However,limited therapeutic options exist for the treatment of A.baumannii ventriculitis due to the poor penetration rate of most antibiotics through the blood-brain barrier.CASE SUMMARY A 68-year-old male patient with severe traumatic brain injury developed pyogenic ventriculitis on postoperative day 24 caused by extensively drug-resistant A.baumannii susceptible to tigecycline only.Successful treatment was accomplished through multi-route administration of tigecycline,including intravenous combined with continuous ventricular irrigation plus intraventricular administration.The pus was cleared on the 3rd day post-irrigation,and cerebrospinal fluid cultures were negative after 12 d.CONCLUSION Our findings suggest that multi-route administration of tigecycline can be a therapeutic option against pyogenic ventriculitis caused by extensively drugresistant A.baumannii.

Risk factors and clinical responses of pneumonia patients with colistin-resistant Acinetobacter baumannii-calcoaceticus

BACKGROUND Nosocomial infections with carbapenem-resistant Acinetobacter baumanniicalcoaceticus complex(ABC)strains are great problem for intensive care units.ABC strains can develop resistance to all the antibiotics available.Carbapenem resistance is common and colistin resistance is rare in our country.Knowing the risk factors for colistin resistance is important since colistin seems to be the only remaining therapeutic option for the patients with pneumonia due to extensively drug resistant ABC for our country.AIM To investigate the comparison of clinical responses and outcomes between pneumonia patients with colistin-susceptible and-resistant Acinetobacter sp.Strains.METHODS During the study period,108 patients with pneumonia due to colistin-susceptible strains and 16 patients with colistin-resistant strains were included retrospectively.Continuous variables were compared with the Mann-Whitney U test,and categorical variables were compared using Pearson’s chi-square test or Fisher’s Exact chi-square test for two groups.A binary logistic regression model was developed to identify the potential independent factors associated with colistin resistance in patients with colistin-resistant strains.RESULTS High Acute Physiology and Chronic Health Evaluation II scores(OR=1.9,95%CI:1.4-2.7;P<0.001)and prior receipt of teicoplanin(OR=8.1,95%CI:1.0-63.3;P=0.045)were found to be independent risk factors for infection with colistin-resistant Acinetobacter sp.Different combinations of antibiotics including colistin,meropenem,ampicillin/sulbactam,amikacin and trimethoprim/sulfamethoxazole were used for the treatment of patients with colistin-resistant strains.Although the median duration of microbiological cure(P<0.001)was longer in the colistin-resistant group,clinical(P=0.703),laboratory(P=0.277),radiological(P=0.551),microbiological response(P=1.000)and infection related mortality rates(P=0.603)did not differ between the two groups.Among the patients with infections due to colistin-resistant strains,seven were treated with antibiotic combinations that included sulbactam.Clinical(6/7)and microbiological(5/7)response rates were quite high in these patients.CONCLUSION The optimal therapy regimen is unclear for colistin-resistant Acinetobacter sp.infections.Although combinations with sulbactam seems to be more effective in our study patients,data supporting the usefulness of combinations with sulbactam is very limited.

Anti-N-methyl-D-aspartate receptor encephalitis that aggravates after acinetobacter baumannii pneumonia:A case report

We report an atypical case of anti-N-methyl-D-aspartate receptor encephalitis(ANMDARE). A 27-year-old man diagnosed with ANMDARE received immunotherapy and had a good recovery. However, within one month, he developed severe status epilepticus and decreased level of conscience with new hyperpyrexia and dyspnea, and was admitted to the emergency intensive care unit. Acinetobacter baumanii were found in the sputum culture; and anti-NMDAR antibodies were positive(titer: 1/80) in the cerebrospinal fluid. Repeated immunotherapy was administered with antibacterial agents, and the patient recovered except for mild psychiatric sequelae. This is the first report of ANMDARE that aggravates after acinetobacter baumannii pneumonia. Awareness and knowledge of this disorder should be extended, especially in the emergency medicine community.

Risk factors and antibiotic resistance of pneumonia caused by multidrug resistant Acinetobacter baumannii in pediatric intensive care unit

With beta-lactam drugs and immunosuppressants widely used, the infection caused by Acinetobacter baumannfi （Ab） has become more and more serious with multidrug resistant Acinetobacter baumannfi （MDRAb） emerging and worsening rapidly. Compared with other patients, the incidence and multidrug resistance of MDRAb are higher in children in pediatric intensive care unit （PICU） because of immune deficiency, severe basic diseases, prolonged hospitalization and invasive operations. Hence it is significant to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence of MDRAb in children. A total 115 patients with MDRAb pneumonia and 45 patients with negative MDRAb （NMDRAb） pneumonia who had been treated from January 2009 to August 2011 were studied retrospectively at the PICU of Wuhan Children＇s Hospital. Clinical data were analyzed with univariate and multivariate Logistic regression. In 176 clinical strains of Acinetobacter baumannfi isolated, there were 128 strains of MDRAb, accounting for 72.73%. Drug susceptibility tests showed that the resistance rates of 13-1actam antibiotics were more than 70% except for cefoperazone sulbactam. The rates to carbapenems were higher than 90%. They were significantly higher than those of NMDRAb. Amikacin, levofloxacin, ciprofloxacin and minocycline had the lowest drug-resistance rates （〈20%）. Multivariate Logistic regression revealed that ICU stay, the time of mechanical ventilation, anemia, hypoproteinemia and the use of carbapenems were independent risk factors for MDRAb pneumonia. MDRAb is an important opportunistic pathogen to pneumonia in PICU, and its drug-resistance is severe. It increases significantly the mortality of patients. It is important to take the effective prevention measures for controlling it.

Molecular Detection of Carbapenemase Genes in Extensive Drug Resistant Acinetobacter baumannii Clinical Isolates from ICU Patients, Khartoum

Background: The emergence of carbapenemase producing Acinetobacter baumannii is increasingly reported nowadays and constitutes a major problem to the intensive care unit (ICU) patients with notable extensive-drug resistance ability. The study investigates carbapenemase producing A. baumannii strains exhibiting an extensively drug-resistant (XDR) phenotype, isolated from ICU patients in Khartoum. Methods: A total of 100 nonduplicate Gram-negative coccobacilli strains were obtained from microbiology laboratory of ICU patients’ clinical isolates. Molecular identification of A. baumannii was performed by targeting 16S rRNA gene using specifically designed primers. Then, XDR strains were determined by susceptibility testing (disc diffusion). For detection of carbapenemase genes Polymerase chain reaction (PCR) was carried out. Result: Of 100 ICU clinical isolates, 38 (38.0%) was confirmed A. baumannii strains, those strains showed 100% carbapenem resistance and 60.5% extensive drug resistance to the antibiotics tested. The frequency of carbapenemase producer was 57.9% (22/38) of carbapenem resistance A. baumannii (CRAB). The most common carbapenemase associated with resistance was blaOXA gene followed by blaNDM and blaGES A. baumannii isolates. The co-occurrence of blaOXA-48-like and blaNDM, blaOXA-23-like and blaOXA-51, and blaNDM-1 and blaOXA-51 was detected in 22.7%, 18.2% strains and 4.5% respectively. A unique characteristic of our findings was the coharbouring of the genes blaNDM-1, blaOXA-23-like, blaOXA-51 and blaOXA-143 in 9.1% strains (2/22), and this was the first report in the Khartoum city, Sudan. Conclusion: We have demonstrated for the first time a high prevalence of XDR-carbapenemase producing A. baumannii clinical isolates from ICU patients in Khartoum. Also an emergent blaOXA-143 was reported as High-Risk Clones. This highlights the routine mentoring of XDR-carbapenemase producing A. baumannii to avoid clone dissemination in our region hospitals.

Sources of multidrug-resistant Acinetobacter baumannii and its role in respiratory tract colonization and nosocomial pneumonia in intensive care unit patients

Background Multidrug-resistant Acinetobacter baumannii （MDRAB） is an important and emerging hospital-acquired pathogen worldwide. This study was conducted to identify the sources of MDRAB and its role in respiratory tract colonization and nosocomial pneumonia in intensive care unit （ICU） patients. Methods We conducted a prospective active surveillance study of MDRAB in three ICUs at a Chinese Hospital from April to August 2011, to identify the sources of MDRAB and its role in respiratory tract colonization and nosocomial pneumonia. Results One hundred and fourteen （13.0%） MDRAB isolates were detected from 876 specimens, with a sensitivity of 11.6% （55/474） in screening of the pharyngeal and tracheal swabs, and 14.7% （59/402） of the sputum/endotracheal aspirates. MDRAB colonization/infection was found in 34 （26.8%） of 127 patients, including 16 （12.6%） cases of pure colonization and 18 （14.2%） cases of pneumonia （two pre-ICU-acquired cases of pneumonia and 16 ICU-acquired cases of pneumonia）. Previous respiratory tract MDRAB colonization was found in 22 （17.3%） patients： eight （6.3%） were pre-ICU-acquired colonization and 14 （11.0%）ICU-acquired colonization. Of eight pre-ICU-colonized patients, five were transferred from other wards or hospitals with hospitalization 〉72 hours, and three came from the community with no previous hospitalization. Overall, 6/22 colonized patients presented with secondary pneumonia; only two （9.1%） colonized MDRAB strains were associated with secondary infections. Respiratory tract MDRAB colonization had no significant relationship with nosocomial pneumonia （P=0.725）. In addition, acute respiratory failure, mechanical ventilation, renal failure, and prior carbapenem use were risk factors for MDRAB colonization/infection. Conclusions A high proportion of cases of MDRAB colonization/infection in ICU patients were detected through screening cultures. About one-third were acquired from general wards and the community before ICU admission. The low incidence of MDRAB colonization-related pneumonia questions the appropriateness of targeted antibiotic therapy.

新型冠状病毒感染并广泛耐药鲍曼不动杆菌重症肺炎31例临床疗效与结局分析

目的为临床合理使用抗菌药物,进一步优化广泛耐药鲍曼不动杆菌(XDRAB)肺部感染诊疗策略提供参考。方法回顾性分析医院2022年12月至2023年2月收治的新型冠状病毒感染并XDRAB重症肺炎患者的病例资料、抗菌治疗方案、临床疗效、30 d死亡情况等信息。结果共纳入患者31例,按治疗方案的不同分为多黏菌素组(15例)、非多黏菌素组(12例)和未治疗组(4例),多黏菌素组治疗方案以注射用硫酸多黏菌素B或注射用硫酸黏菌素为主,同时联合其他药物治疗;非多黏菌素组治疗方案包括注射用替加环素、注射用头孢哌酮钠舒巴坦钠、注射用舒巴坦钠、注射用美罗培南、注射用亚胺培南西司他丁钠及注射用甲苯磺酸奥马环素任一药物或联合用药;疗程均不短于2 d。未治疗组治疗方案为不包括以上两组任一药物的其他药物。多黏菌素组有效率为26.67%,30 d死亡率为73.33%;非多黏菌素组分别为16.67%,83.33%;未治疗组分别为0,100.00%。临床药师参与多黏菌素组中6例患者的救治,其中2例(33.33%)有效。结论新型冠状病毒感染并XDRAB重症肺炎临床治愈率低,死亡率高,需要更准确地把握抗菌治疗时机和更规范地开展药物治疗,且临床药师参与治疗可能带来更多的临床获益。

不同抗生素联合替加环素治疗MDRAB相关VAP患者效果比较

目的探讨不同抗菌药物联合替加环素治疗多重耐药鲍曼不动杆菌(MDRAB)相关呼吸机相关性肺炎(ventilator associated pneumonia,VAP)患者的效果,旨在为临床上更好治疗该病提供方案选择。方法收集2016年1月—2023年8月青岛市市立医院收治的MDRAB相关VAP患者的临床资料,根据治疗方案不同分为替加环素组(A组)56例,头孢哌酮舒巴坦联合治疗组(B组)42例,碳青霉烯类联合治疗组(C组)24例,对三组患者住院期间感染情况及各项疗效指标进行比较。结果三组MDRAB相关VAP感染患者间感染病原体的种类、合并感染部位比较差异均无显著性(P>0.05),B组和C组细菌清除率高于A组(χ^(2)=5.38、4.48,P<0.05),三组患者住院病死率比较差异无显著性(P>0.05)。结论替加环素联合头孢哌酮舒巴坦或碳青酶烯类抗菌药物治疗MDRAB相关VAP的细菌清除率均显著高于单独使用替加环素,联合用药是一种比较好的治疗选择。

Drug-resistant gene based genotyping for Acinetobacter baumannii in tracing epidemiological events and for clinical treatment within nosocomial settings

Background Acinetobacter baumannfi has emerged as an important pathogen related to serious infections and nosocomial outbreaks around the world. However, of the frequently used methods, pulsed-field gel electrophoresis （PFGE） and amplified fragment length polymorphism （AFLP） in Acinetobacter baumannfi genotyping lack the direct molecular proof of drug resistance. This study was conducted to establish a typing method based on drug resistant gene identification in contrast to traditional PFGE and AFLP in the period of nosocomial epidemic or outbreak. Methods From January 2005 to October 2005, twenty-seven strains of Acinetobacter species from Intensive Care Units, the Second Affiliated Hospital in Ningbo were isolated, including both epidemic and sporadic events. Susceptibility test, PFGE, AFLP and drug resistance gene typing （DRGT） were carried out to confirm the drug resistance and analyze the genotyping, respectively. PFGE was used as a reference to evaluate the typeability of DRGT and AFLP. Results Twenty-seven strains of Acinetobacter displayed multiple antibiotic resistance and drug resistant genes, and β-1actamase genes were detected in 85.2% strains. The result of DRGT was comparable to PFGE in Acinetobacter strains with different drug resistance though a little difference existed, and even suggested a molecular evolution course of different drug-resistant strains. AFLP showed great polymorphism between strains and had weak ability in distinguishing the drug resistance. Conclusion Compared to AFLP and PFGE, DRGT is useful to analyze localized molecular epidemiology of nosocomial infections and outbreaks, which would benefit clinical diagnosis and therapy.

两种联合用药方案治疗耐碳青霉烯类鲍曼不动杆菌肺炎的效果及对炎症反应的影响

目的:探讨头孢哌酮舒巴坦分别联合莫西沙星、亚胺培南西司他丁治疗耐碳青霉烯类鲍曼不动杆菌(CRAB)肺炎的效果及对炎症反应的影响。方法:回顾性分析2022年1月至2023年6月于该院治疗的80例CRAB肺炎患者的资料,将2022年1—9月以方便抽样法抽取的40例患者设为A组,采用头孢哌酮舒巴坦联合莫西沙星治疗;将2022年10月至2023年6月以方便抽样法抽取的40例患者设为B组,采用头孢哌酮舒巴坦联合亚胺培南西司他丁治疗。比较两组患者的疗效、细菌清除效果、各项指标恢复时间、血清炎症指标及药品不良反应(ADR)发生情况。结果:B组患者的总有效率、细菌清除率分别为95.00%(38/40)、90.00%(36/40),明显高于A组的80.00%(32/40)、72.50%(29/40),差异均有统计学意义(P<0.05)。B组患者胸部CT恢复正常时间、退热时间和白细胞计数恢复正常时间短于A组,差异均有统计学意义(P<0.05)。治疗2周后,两组患者血清肿瘤坏死因子α(TNF-α)、降钙素原(PCT)及白细胞介素6(IL-6)水平低于治疗前,且B组患者TNF-α、PCT及IL-6水平低于A组,差异均有统计学意义(P<0.05)。B组患者ADR总发生率为12.50%(5/40),与A组的17.50%(7/40)比较,差异无统计学意义(P>0.05)。结论:头孢哌酮舒巴坦联合亚胺培南西司他丁治疗CRAB肺炎的效果优于头孢哌酮舒巴坦联合莫西沙星,可有效改善患者炎症状况,明显提高细菌清除效果,显著缩短体温、白细胞计数等指标恢复时间,且ADR较少。

西安某医院重症监护室常见细菌的分布特征及耐药性分析

目的 了解西安交通大学第二附属医院重症监护室(ICU)常见临床分离菌的分布特点及其耐药性。方法 回顾性分析该院 ICU 2020年1月1日-2022年12月31日临床分离菌的抗菌药物敏感性试验结果。结果 2020-2022年ICU临床分离菌3 649株,其中革兰阳性菌1 344株(36.8%)、革兰阴性菌2 305株(63.2%)。其中克雷伯菌属540株(14.8%)、肠球菌属522株(14.3%)、凝固酶阴性葡萄球菌448株(12.3%)、不动杆菌属438株(12.0%)、大肠埃希菌424株(11.6%)。甲氧西林耐药金黄色葡萄球菌(MRSA)、甲氧西林耐药表皮葡萄球菌(MRSE)和甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)的检出率分别为76.1%、82.4%和69.9%。除甲氧苄啶-磺胺甲噁唑外,MRSA、MRSE和MRCNS的耐药率均明显高于MSSA、MSSE和MSCNS。未检出葡萄球菌属对万古霉素、利奈唑胺耐药菌株。肠球菌属中屎肠球菌的耐药率高于粪肠球菌。未发现对万古霉素耐药的肠球菌属;发现2株对利奈唑胺耐药的粪肠球菌。肺炎克雷伯菌对亚胺培南和美罗培南的耐药率最高,分别为38.4%和40.2%。大肠埃希菌对亚胺培南和美罗培南的耐药率均<2.0%,而阴沟肠杆菌对该两药的耐药率>10.0%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为27.1%和19.6%;但鲍曼不动杆菌对该两药的耐药率高,分别为86.0%和86.7%。结论 该院ICU肺炎克雷伯菌和鲍曼不动杆菌对碳青霉烯类耐药率较高,但肠杆菌目中其他细菌对碳青霉烯类仍较敏感,细菌耐药率低。肠球菌属中已发现有对利奈唑胺的耐药菌株,未发现与万古霉素交叉耐药。因此,加强病原菌耐药性监测,合理使用抗菌药物,可以有效控制医院感染。

基于随机森林模型的耐碳青霉烯类鲍曼不动杆菌性呼吸机相关性肺炎风险预测模型的构建

目的:分析耐碳青霉烯类鲍曼不动杆菌(CRAB)性呼吸机相关性肺炎发生的风险因素,并采用随机森林模型和Logistic回归两种方法构建预测模型,为重症监护室降低CRAB性呼吸机相关性肺炎的发生风险提供理论依据。方法:选取2018年1月—2022年12月我院重症监护室收治的291例呼吸机相关性肺炎病人为研究对象,分析CRAB性呼吸机相关性肺炎的影响因素,基于随机森林模型和Logistic回归构建预测模型,计算受试者工作特征曲线(ROC)和曲线下面积(AUC),比较两种模型的差异。结果:多因素分析结果显示,氧合指数、气管切开、昏迷是CRAB性呼吸机相关性肺炎的独立影响因素。随机森林模型的AUC为0.78,Logistic回归模型AUC为0.61,随机森林模型的准确率(77.97%)、灵敏度(85.37%)、特异度(61.11%)均高于Logistic回归模型(66.10%、73.17%、50.00%)。结论:氧合指数、抗菌药物使用时间、气管切开、昏迷是CRAB性呼吸机相关性肺炎的高危风险因素,随机森林模型对CRAB性呼吸机相关性肺炎的预测性能优于Logistic回归模型。

老年COPD合并重症多重耐药鲍曼不动杆菌肺炎的短期死亡预警模型构建

目的构建一种基于LASSO(Least Absolute Shrinkage and Selection Operator)-logistic回归算法的模型,用于预测老年慢性阻塞性肺疾病(COPD)合并重症多重耐药鲍曼不动杆菌肺炎患者的短期死亡风险。方法将2022年1月至2023年12月西安高新医院呼吸与危重症医学科的74例老年COPD合并重症多重耐药鲍曼不动杆菌肺炎患者选为研究对象,其中男55例,女19例,年龄<70岁41例,≥70岁33例。通过LASSO-logistic回归算法筛选出与短期死亡风险显著相关的临床变量,利用这些变量构建风险预测模型,并采用10折交叉验证和Bootstrap方法对模型进行内部验证,从区分度[曲线下面积(AUC)]、校准度(校准曲线)方面评估模型的性能。采用χ^(2)检验、独立样本t检验。结果观察30 d内患者的生存情况,根据患者转归情况分为死亡组(21例)和生存组(53例),病死率为28.37%(21/74)。LASSO法通过交叉验证确定最优参数后,从一般资料、临床病理特征及既往治疗信息中筛选出5个与短期死亡密切相关的变量:行机械通气、行纤维支气管镜检查、使用镇静药物、合并脓毒症休克和使用抗真菌药物,这些变量被纳入logistic回归模型,回归分析显示它们是老年COPD合并重症多重耐药鲍曼不动杆菌肺炎患者死亡的独立影响因素(均P<0.05)。基于模型构建的用于预测老年COPD合并重症多重耐药鲍曼不动杆菌肺炎的短期死亡的森林图模型展示出良好的预测效能(AUC值为0.927),在训练集的分析中,Bootstrap法进行的1000次重抽样验证和校准曲线分析显示,模型预测结果与实际情况高度一致,验证曲线的平均绝对误差(MAE)为0.027,Hosmer-Lemeshow拟合优度检验也证实了模型的校准度良好。结论本研究构建的LASSO-logistic回归模型能够有效预测老年COPD合并重症多重耐药鲍曼不动杆菌肺炎患者的短期死亡风险。该模型有助于临床医生在治疗决策过程中更好地识别高风险患者,从而及时采取适当的治疗措施。

某三甲医院2017-2022年常见G^(-)菌的分布及耐药性分析

目的 分析2017-2019年和2020-2022年我院革兰阴性(G^(-))菌的病原菌分布、细菌耐药情况,为临床合理地应用抗菌药物提供参考依据。方法 采用回顾性分析2017-2019年和2020-2022年我院的各类送检标本,采用专业认可的鉴定系统或手工方法进行细菌鉴定和耐药性检测,应用Whonet5.6软件进行数据分析。结果 共检出革兰阴性菌14421株,痰液标本最常见。2017-2019年我院分离的G^(-)菌居前5位者为大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、阴沟肠杆菌。2020-2022年我院分离的G^(-)菌居前5位者为肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、阴沟肠杆菌。两组主要标本来源均为痰、尿液和分泌物。2020-2022年和2017-2019年相比,大肠埃希菌和肺炎克雷伯菌对多数抗生素的耐药率呈下降趋势(P<0.05);肺炎克雷伯菌对环丙沙星的耐药率呈上升趋势(χ^(2)=6.045,P<0.05);2020-2022年和2017-2019年相比,鲍曼不动杆菌对左氧氟沙星耐药率呈上升趋势(χ^(2)=18.328,P<0.05),对氨基糖苷类庆大霉素和妥布霉素耐药率呈下降趋势(χ^(2)=46.647,χ^(2)=31.780,P均<0.05);铜绿假单胞菌对头孢他啶、喹诺酮类环丙沙星和左氧氟沙星耐药率呈上升趋势(χ^(2)=8.201,χ^(2)=4.298,χ^(2)=15.032,P均<0.05),对β-内酰胺类亚胺培南和美罗培南耐药率呈下降趋势(χ^(2)=26.089,χ^(2)=24.966,P均<0.05);阴沟肠杆菌对头孢呋辛钠耐药率呈下降趋势(χ^(2)=121.541,P<0.05)。结论 2020-2022年和2017-2019年相比,我院部分G^(-)菌对一些抗菌药物的耐药率有所下降,但总体G^(-)菌的耐药形势仍然十分严峻,需定期进行细菌耐药性监测。

米诺环素联合头孢哌酮舒巴坦对MDR-AB感染重症肺炎患者肺功能及炎性因子的影响

目的 观察米诺环素联合头孢哌酮舒巴坦对多重耐药鲍曼不动杆菌(MDR-AB)感染重症肺炎患者肺功能及炎性因子的影响。方法 选取2020年1月—2023年6月武夷山市立医院收治的MDR-AB感染重症肺炎患者135例,根据随机数字表法分为联合组(68例)和对照组(67例)。在常规治疗基础上,对照组予头孢哌酮舒巴坦治疗,联合组在对照组基础上予米诺环素治疗,2组均治疗2周。比较2组疗效、细菌清除率,治疗前后肺功能[第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)/FVC]、炎性因子[白介素-8(IL-8)、C反应蛋白(CRP)、降钙素原(PCT)]及不良反应。结果 联合组总有效率为97.06%,高于对照组的86.57%(χ^(2)=4.964,P=0.026);联合组细菌总清除率为73.53%,高于对照组的56.72%(χ^(2)=4.204,P=0.040)。治疗2周后,2组FEV_(1)、FVC、FEV_(1)/FVC高于治疗前,且联合组高于对照组(P<0.05或P<0.01);2组IL-8、CRP、PCT水平低于治疗前,且联合组低于对照组(P<0.05或P<0.01)。联合组与对照组不良反应总发生率比较差异无统计学意义(14.71%vs.10.45%,χ^(2)=0.556,P=0.456)。结论 米诺环素联合头孢哌酮舒巴坦治疗MDR-AB感染重症肺炎疗效显著,可促进细菌清除,改善患者肺功能,减轻炎性反应,且安全性较高。

头孢哌酮/舒巴坦对耐碳青霉烯革兰阴性菌血流感染患者临床结局的影响

目的分析影响耐碳青霉烯类革兰阴性菌(carbapenem-resistant gram-negative bacteria,CRGNB)血流感染患者预后的因素,探讨头孢哌酮/舒巴坦对患者临床结局的影响。方法利用Whonet 5.6软件和山东第一医科大学第二附属医院电子病历系统检索我院2018年至2021年诊断为CRGNB血流感染患者的病历资料,应用SPSS 21.0软件进行统计学分析,应用单因素分析筛选影响患者预后的因素,应用logstic回归分析筛选影响患者预后的危险因素,并结合受试者工作特征(receiver operating characteristic,ROC)曲线行联合预测。结果共纳入56例CRGNB血流感染患者,单因素分析显示,死亡组和生存组在以下变量中差异均有统计学意义(P<0.05):抽取血培养时的急性生理与慢性健康评分(acute physiology and chronic health evaluation,APACHE Ⅱ)得分、快速Pitt菌血症(quick Pitt bacteremia score,qPitt)得分、快速序贯器官衰竭评分(quick sequential organ failure assessment,qSOFA)得分、血流感染后使用呼吸机天数、抽取血培养后72~96 h的早期临床失败评价标准(early clinical failure criteria,ECFC)得分、血流感染后未接受舒巴坦制剂治疗、接受替加环素治疗;logistic回归分析显示,抽取血培养后72~96 h的ECFC得分增高和血流感染后接受替加环素治疗、未接受舒巴坦制剂治疗是影响预后的独立危险因素;行联合预测分析结果显示,ROC曲线下面积为0.903(95%CI:0.824~0.982),敏感度81.82%(18/22),特异度85.29%(29/34),准确度83.93%(47/58)。以是否应用头孢哌酮/舒巴坦进行差异性对比分析发现,应用组的患者死亡率明显低于非应用组,但两组住院28 d存活率差异无统计学意义。结论对于CRGNB血流感染的患者应用头孢哌酮/舒巴坦可能与较低的死亡风险相关,而使用替加环素可能会增加患者死亡率,发生血流感染后接受含头孢哌酮/舒巴坦方案治疗可能降低患者住院死亡率。

多学科综合诊疗模式在肺移植受者多重耐药菌感染防控的应用

目的 探讨多学科综合诊疗(MDT)模式在肺移植受者术后多重耐药菌(MDRO)感染防控中的实践效果。方法 选择2019年至2022年的肺移植受者,从2020年1月开始成立MDT专家组,开展一系列防控措施,分析2020年至2022年MDRO防控措施落实率、环境物表MDRO检出率以及2019年至2022年肺移植受者MDRO检出率。结果 医护人员总体MDRO防控措施落实率由2020年的64.9%上升至2022年的91.6%,呈逐年升高趋势(P<0.05)。监测环境物表MDRO检出率从2020年的28%下降到2022年的9%,呈逐年下降趋势(P<0.05)。肺移植受者MDRO检出率从2019年的66.7%降低至2022年的44.3%,呈逐年降低趋势(P<0.001)。结论 通过MDT模式管理,提高了医务人员MDRO防控措施的执行力,有效降低了肺移植受者术后MDRO感染率和环境物表MDRO检出率,值得推广利用。

利奈唑胺联合多黏菌素B、亚胺培南治疗老年MDR-AB肺炎患者的效果

目的:观察利奈唑胺联合多黏菌素B、亚胺培南治疗老年多重耐药鲍氏不动杆菌(MDR-AB)肺炎患者的效果。方法:选取2022年1月至2023年1月该院收治的120例老年MDR-AB肺炎患者进行前瞻性研究,按照随机数字表法分为观察组与对照组各60例。对照组采用多黏菌素B联合亚胺培南治疗,观察组在对照组基础上加用利奈唑胺葡萄糖注射液治疗,比较两组治疗总有效率、血清炎性因子[白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF-α)]水平、外周血T细胞亚群指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平、肺功能指标[用力肺活量(FVC)、最大呼气中段流量(MMF)、呼气峰流速(PEF)]水平和不良反应发生率。结果:观察组治疗总有效率为95.00%,明显高于对照组的83.33%,差异有统计学意义(P<0.05);治疗后,观察组FVC、MMF、PEF、CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)水平高于对照组,IL-6、IL-8、TNF-α和CD8^(+)水平低于对照组,差异均有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:利奈唑胺联合多黏菌素B、亚胺培南治疗老年MDR-AB肺炎患者可提高治疗总有效率和肺功能指标水平,改善T细胞亚群指标水平,以及降低炎性因子水平,效果优于多黏菌素B联合亚胺培南治疗。

Role of immunodeficiency in Acinetobacter baumannii associated pneumonia in mice

Background:Acinetobacter baumannii(A.baumannii)has become one of the most important opportunistic pathogens inducing nosocomial pneumonia and increasing mortality in critically ill patients recently.The interaction between A.baumannii infection and immune response can influence the prognosis of A.baumannii related pneumonia.The target of the present study was to investigate the role of immunodeficiency in A.baumannii induced pneumonia.Methods:Male BALB/c mice were randomly divided into the normal immunity control(NIC)group,normal immunity infection(NIA)group,immune compromised control(CIC)group,and immune compromised infection(CIA)group(n=15 for each group).Intraperitoneal injection of cyclophosphamide and intranasal instillation of A.baumannii solution were used to induce compromised immunity and murine pneumonia,respectively.The mice were sacrificed at 6 and 24 h later and the specimens were collected for further tests.Seven-day mortality of mice was also assessed.Results:After A.baumannii stimulation,the recruitment of neutrophils in mice with normal immunity increased sharply(P=0.030 at 6 h),while there was no significant raise of neutrophil counts in mice with compromised immune condition(P=0.092 at 6 h,P=0.772 at 24 h).The Th cell polarization presented with pulmonary interleukin(IL)-4 and interferon(IFN)-γlevel in response to the A.baumannii in CIA group were significantly depressed in comparison with in NIA group(IFN-γ:P=0.003 at 6 h;P=0.001 at 24 h;IL-4:P<0.001 at 6 h;P<0.001 at 24 h).The pulmonary conventional dendritic cell accumulation was even found to be inhibited after A.baumannii infection in immunocompromised mice(P=0.033).Correspondingly,A.baumannii associated pneumonia in mice with compromised immunity caused more early stage death,more severe histopathological impairment in lung.Conclusion:A.baumannii could frustrate the immune response in immunocompromised conditions,and this reduced immune response is related to more severe lung injury and worse outcome in A.baumannii induced pneumonia.

CXCL5基因多态性对多重耐药鲍曼不动杆菌肺炎及碳青霉烯类药物敏感性的影响

目的探究CXC类趋化因子配体5(CXCL5)基因多态性对多重耐药鲍曼不动杆菌感染及碳青霉烯类药物敏感性的影响。方法将2020年7月至2022年7月于该院被明确诊断为多重耐药鲍曼不动杆菌肺炎的共121例患者纳入研究作为患者组。另外,将同期于该院体检的健康者121例纳入研究作为对照组。对纳入研究者进行单核苷酸基因多态性位点基因分型、药敏试验及炎症指标的检测。分析CXCL5基因rs352046、rs425535位点的基因型、等位基因分布与多重耐药鲍曼不动杆菌肺炎发生、炎症指标、严重程度、碳青霉烯类药物敏感性的关系。结果患者组和对照组CXCL5基因rs425535位点的等位基因和基因型分布比较,差异有统计学意义(P<0.05)。CXCL5基因rs352046、rs425535位点的等位基因和基因型分布与患者白细胞计数无关(P>0.05),而均与患者中性粒细胞、淋巴细胞、C反应蛋白与降钙素原水平有关(P<0.05)。rs425535位点基因型及等位基因分布情况与患者的多重耐药鲍曼不动杆菌肺炎的严重程度有关(P<0.05)。对耐碳青霉烯类药物的敏感性较高的患者和对这类药物不敏感的患者CXCL5基因rs425535位点的基因型及等位基因分布比较,差异有统计学意义(P<0.05)。结论CXCL5基因rs425535位点多态性与多重耐药鲍曼不动杆菌肺炎的发生、严重程度及碳青霉烯类药物敏感性有关,对CXCL5基因多态性进行检测有助于识别多重耐药鲍曼不动杆菌肺炎高危患者及合理使用抗菌药物。