Objective To study the distribution and drug resistance of pathogens causing hospital-acquired pneumonia (HAP) and explore the related risk factors, so as to provide valuable clinical reference for prevention and treatment of HAP. Methods A case-control study was conducted in a 3700-bed tertiary hospital. Nosocomial infections reported from January 2014 to December 2014 were investigated. A total of 419 inpatients with HAP were enrolled in as a study group, and 419 inpatients without nosocomial infection in the same period and department, with same gender, underlying diseases, and same age, were chosen as a control group. Risk factors of HAP, distribution and drug resistance of pathogens of HAP were analyzed. Results The incidence rate of HAP was 0.62% and the mortality rate was 19.81%. Multivariate analysis identified chronic lung diseases, admission in ICU, two or more kinds of antibiotics used, hospitalization time≥5 days, cerebrovascular disease, and mechanical ventilation were significant risk factors. Totally 492 strains of pathogens were isolated, including 319 strains of gram-negative bacteria, 61 strains of gram-positive bacteria, 112 strains of fungi.Acinetobacter baumannii,Klebsiella pneumonia,Candida albicans,Pseudomonas aeruginosa,Candida glabrata ranked the top five predominant pathogens. Drug resistance rates ofAcinetobacter baumannii to commonly used antibiotics were higher than 75%. Drug resistance rates ofKlebsiella pneumoniae to piperacillin and third-generation cephalosporin were higher than 50%. Conclusions HAP prevails in patients with hospitalization time≥5 days, admission in ICU, cerebrovascular diseases, two or more antibiotics combined used, chronic lung diseases, and mechanicalventilation. It is associated with increased length of hospital stay, decreased quality of life, and elevated morbidity and mortality. The main pathogens of HAP are Gram-negatives.Acinetobacter baumannii andKlebsiella pneumoniae are resistant to the common antibiotics in different degree.
ObjectiveTo explore the pathogenesis of cervical spondylosis combined with cervicogenic vertigo, and to investigate the clinical results of anterior discectomy and fusion in treating the disease. MethodsA retrospective study was performed on 83 patients with cervical spondylosis myelopathy (n=60, 72%) or radiculopathy (n=23, 37.3%) accompanied by sympathetic symptoms such as dizziness between March 2008 and November 2012. The disease involved single segment in 29 cases, double segment in 50 cases, and triple in 4 cases. All the segments involved were treated with anterior discectomy and fusion. Vertigo alleviation was observed before surgery, 3 days after surgery, and during the final follow-up. Neurological status was evaluated by Japanese Orthopedic Association (JOA) score system and sympathetic symptoms were evaluated with vertigo symptom and function scoring system. ResultsThe average follow-up was 21 months (ranging from 12 to 30 months). Significant difference was observed between sympathetic symptom scores and JOA scores before surgery and 3 days after surgery or at the final follow-up (P<0.05), but no significant difference was found between the scores 3 days after surgery and during the final follow-up (P>0.05). ConclusionThe surgical effect for cervicogenic vertigo is often accompanied by the relief of spinal cord and nerve roots symptoms. Surgery is effective for cervical spondylosis combined with cervicogenic vertigo.
Objective To analyze the clinical and etiological characteristics and bacterial susceptibility in patients with ventilator-associated pneumonia (VAP) in Guangzhou area.Methods A retrospective study was conducted on VAP patients in four hospital of Guangzhou from Jan 2004 to Oct 2005.Totally 157 patients were enrolled in this study，whose flora was identified and tested by Kirby Bauer disk diffusion susceptibility test.The univariate analysis method was used to analyze the prognostic parameters.Results The average onset time of VAP was 7.7 days after mechanical ventilation with a mortality rate of 38.2%.The proportion of Gram-negative bacilli，Gram-positive cocci and eumycete was 68.0%，23.4% and 8.7% respectively in 184 isolated strains.The most common pathogens were Pseudomonas aeruginosa (18.5%)，Stenotrophomonas maltophilia (14.1％)，Burkholderia cepacia (10.9%)，Staphylococcus aureus (10.3%) and Acinetobacter baumannii (8.7%).Pseudomonas aeruginosa，Stenotrophomonas maltophilia，and Acinetobacter baumannii were resistant to most common antibacterials such as cephalosporin and imipenem.18 strains oxacillin resistant Staphylococcus aureus，7 strains oxacillin resistant Staphylococcus simulans and one vancomycin resistant Staphylococcus aureus were isolated.Expect for vancomycin，teicoplanin and fusidic acid，the resistance of Gram-positive cocci were above 50% to other 9 antibacterials.Conclusions The antibiotic resistance situation of VAP in Guangzhou is very serious with high mortality.It is important to reinforce the prevention and guidance on the proper treatment of VAP.
ObjectiveTo analyze the trend of hospital infection, so as to provide a scientific basis for hospital infection prevention and control. MethodsFrom 2011 to 2013, according to the criteria of diagnosis of nosocomial infections set up by the Ministry of Health, the prevalence rates of nosocomial infections in patients who were hospitalized on the survey day were investigated by the combination of bedside investigation and medical records checking. ResultsThe incidence rates of nosocomial infections from 2011 to 2013 were 2.99%, 2.31% and 1.95%, respectively, presenting a downward trend. The rate of hospital infection was the highest in comprehensive Intensive Care Unit, and the main infection site was the lower respiratory tract. Gram-negative bacteria were the main pathogens causing hospital infections, including Klebliella pnermoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter baumannii and Escherichia coli. The utilization rates of antibacterial agents in these three years were respectively 39.84%, 34.58% and 34.22%. ConclusionTargeted surveillance and management of key departments and sites should be strengthened. It is necessary to strengthen the surveillance and management of antibiotics, raise the submission rate of pathogens, and use antibiotics appropriately.
ObjectiveTo systematically review the clinical features of chronic fatigue syndrome (CFS) cases with pathogens infection. MethodsWe electronically searched databases including VIP, WanFang Data, CNKI, CBM, PubMed, MEDLINE, EMbase, The Cochrane Library, Web of Science, Elsevier and Google Scholar from 1994 to 2014 for CFS-related studies. Two reviewers independently screened literature and extracted data. Then we systematically reviewed and analyzed the information on demographic characteristics, clinical manifestations, types of infected pathogens, and results of some biochemical examinations. ResultsA total of 84 studies (case reports and case series) involving 2 565 CFS cases from 18 countries were included. The major infected pathogens of included CFS cases were mycoplasma, EB virus, intestinal virus, Bernat rickettsia, human-herpes virus, and Gram-negative intestinal bacteria. Fifty-seven studies reported that there might be associations between the pathogenic infection and CFS pathogenesis. Although there were different types of CFS-related pathogens, almost all the studies inferred that pathogens infection linked with immune dysfunction, which might cause CFS symptoms. ConclusionThere may be associations between the pathogenic infection and CFS pathogenesis.
ObjectiveTo explore the risk factors for surgical patients associated with postoperative nosocomial infection through monitoring the infection conditions of the patients, in order to provide a scientific basis for the development of hospital infection control measures in a second-grade class-A hospital in Chengdu City. MethodsWe conducted the survey with cluster sampling as the sampling method and the uniform questionnaire in the departments of orthopedic, neural and thoracic surgery from July 2011 to June 2012. The main parameters we observed were the patients'general and surgical conditions, antibiotics usage and hospital infection situation. Data were analyzed using the National Nosocomial Infection Surveillance Network software and chi-square test of single factors. ResultsIn this survey, we monitored 50 cases of postoperative hospital infection. The infection rate was 7.73% and the highest infection rate was in the Neurosurgery Department. The main site of infection was lower respiratory tract, followed by surgical site. The different usage time of antimicrobial drug in perioperative period resulted in different infection rates, and the difference was statistically significant (χ2=601.50, P<0.005). The rate of adjusted postoperative hospital infection was higher than pre-adjusted rate except that of the neurosurgery doctor 4. The risk factors associated with hospital postoperative infection in our hospital were:patients'conditions including underlying disease, emergency surgery, type of anesthesia, operative duration, hospital stay and postoperative drainage. Most of the hospital infection cases were caused by bacteria of the gram-negative bacilli, and the major pathogens were Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii in our hospital. ConclusionThe hospital should particularly strengthen the prevention and control of hospital infection in patients after neurosurgical operations. For patients with basic diseases, we should actively improve the patients'physical conditions before operation and control the primary lesion. Targeted control measures should be taken for different factors related to surgery. Reasonable selection of antimicrobial agents should be based on the epidemic strains in our hospital.
ObjectiveTo summarize basic research progress and current status of clinical diagnosis and therapy for gastroesophageal reflux disease. MethodRelated literatures were collected to review the pathogenesis, clinical manifestations, diagnosis and therapy of gastroesophageal reflux disease. ResultsGastroesophageal reflux disease was caused by many factors, such as hiatus hernia, hypotensive lower esophageal sphincter pressure, acid pocket, prolonged esophageal clearance, and delayed gastric emptying. Extra-esophageal symptoms was a common clinical presentation to gastroesophageal reflux disease. The diagnosis methods for gastroesophageal reflux disease included the symptom observation, gastroscopy examination, 24 h pH monitoring of esophageal, proton pump inhibitor test, questionnaire of gastroesophageal reflux disease and so on. The laparoscopic fundoplication could essentially treat the pathophysiologic abnormalities of gastroesophageal reflux disease, which had an obvious curative effect and wide application prospect. ConclusionPathogenesis, diagnosis, and therapy of gastroesophageal reflux disease are associated with multiple factors, which is still controversial and remains to be further studied.
Objective To explore the clinical epidemiological characteristics of the lung infection after orthotopical liver transplantation. Methods The clinical data included infection morbidity, mortality, infectious times and relative factors, clinical manifestations, the bacterial strains and distributions of the pathogens, the bacterial resistances of the 53 liver transplantation recipients from 2003.3～2006.12 were summarized and analyzed retrospectively. Results Among 53 recipients, 33 developed lung infectious and 6 died .The mobidity was 62.3% and mortality was 18.2%, with a OR of 1.0. Lung infection predominantly occurred in the first month, especially in the first week after transplantation.There were many factors related to lung infections.Various pathogens, especially Klebsialla, Escherichia Coli and Staphylococus Hominis were isolated from sputum, airway suction drainages and throat swabs. Most of the G- bacteria were sensitive to aminoglycosides,β lactam and lactamase compounds and carbapenems while G+ bacteria were sensitive only to glycopeptides. All the bacteria were resistant to quinolones, β lactams of third and forth generation. Conclusions After liver transplantation, the morbidity and mortality of the lung infections are high.The infections develope at earlier stage, manifest nontypical clinical features.Many factors are revealed to be relevant to the lung infections,meanwhile, various drug-resistant pathogen strains are isolated.
Community-acquired pneumonia (CAP) is still a common disease that seriously affects people’s health. It is of great clinical significance for proper anti-infective therapy to identify the characteristics and changes of the pathogens. Along with the accelerated process of aging population, increased use of immunosuppression agents, and increased morbidity of malignant tumor and underlying diseases, the pathogenic spectrum of patients with CAP varies as well. This article reviews the important pathogenic changes of CAP in recent years.
The synthesis and secretion of inflammatory cytokines in the monocytes of 68 cases of multiple system organ failure (MSOF) patients was investigated by the method of MTT stained in cytokines dependent defferential cell strain. The data showed that the serum levels of tumor necrosis factor, interleukine 1 and interleukine 6 were increased (Ｐ＜0.01) in the monocytes of MSOF patients. The synthesis and secretion of these inflammatory cytokines gradually increased in the monocytes after onset of MSOF. After 5 days of treatment with antibiotics and electrolytes intravenous infusion, the secretion of TNF, IL-1 and IL-6 were decreased respectively. These results suggested that the TNF, IL-1 and IL-6 are integrated into system inflammatory responese and caused the injury to the tissues and organs. The production levels of these cytokines can be regarded as the index of MSOF and its severity.