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Clinical Research on Correlation Factors of Concurrent Fungal Infections in Old Patients with Pulmonary Diseases: 49 Case Reports

摘要:目的: 探讨我院呼吸内科病房老年肺部疾病患者并发真菌感染发病的相关因素,分析其易患因素、临床特征和治疗。 方法 : 采用回顾性调查方法对2002年1月至2008年6月收住内科的经微生物检查证实49例继发真菌感染的患者进行分析,并与同期无真菌感染的肺部疾病患者(对照组)比较。 结果 : 在呼吸内科病房中,老年患者院内肺部真菌感染发生率为378%,主要感染部位为泌尿系(218%),呼吸道(269%),消化道(409%)。慢性阻塞性肺疾病(498%)是继发院内肺部真菌感染最常见的基础疾病,其感染因素为长期使用广谱抗生素(962%)和糖皮质激素(332%)、营养状况不良(583%)出现低蛋白血症及合并糖尿病、白细胞减少和侵袭性诊疗操作等。肺部真菌感染的临床表现无特异性,确诊需结合痰培养,组织病理学和临床表现来确定,感染菌种以白色念珠菌为主,占626%。氟康唑治疗有效率914%。研究组与同期无真菌感染的肺部疾病患者(对照组)比较:病死率分别为612%和082%,两组治疗无效的病例(恶化和死亡病例)比较差异有显著性。 结论 : 院内真菌是呼吸系统疾病继发感染的重要病原体,而白色假丝酵母菌是院内肺部真菌感染的主要致病菌,宿主免疫状态、感染播散和疾病严重程度是影响预后的因素。该研究认为老年肺部疾病患者并发真菌感染的相关因素和影响预后的因素对其预防、诊断、治疗、改进预后和生存质量有重要的临床意义。除有效的抗真菌治疗外,积极的综合治疗有助于提高真菌感染的治愈率。Abstract: Objective: To study the susceptible factors,clinical features and treatments of nosocomial pulmonary fungal infection in the ward of respiratory department.〖WTHZ〗Methods : The chart files of 49 patients with nosocomial pulmonary fungal infection admitted from January 2002 to June 2008 in the ward of Respiratory Department were reviewed. Results : The incidence rate of nosocomial pulmonary fungal infection was 378%.COPD(498%)was the main predisposing disease,and candidiasis(626%) was the most common pathogen. The main susceptible factors associated with nosocomial pulmonary fungal infection are longterm use of broadspectrum antibiotics(962%),hypoalbuminemia(583%),longterm use of adrenocortical steroid(332%),and diabetes mellitus.There is no specific clinical feature.Fluconazole(914%)is more efficient in the treatment.〖WTHZ〗Conclusion : Nosocomial pulmonary fungis are important pathogenin the secondary infection in respiratory disease.The most common pathogen is candida albicans.Combined therapy as well as treating fungus infection are important measures to increase the cure rate of nosocomial pulmonary fungal infection.

蒙古族地区不同年龄组幽门螺杆菌感染临床研究

目的　对蒙古族聚集地区不同年龄组幽门螺杆菌（Hp）感染情况进行临床研究。 方法　2009年2月－2011年9月采用深圳市中核海得威生物科技有限公司生产的尿素14C呼气试验检测仪检测，共检测3 705例，年龄5～80岁。根据年龄分成6个组，受试者在早上空腹或进食2 h以上，先漱口，然后进行检测。 结果　5～14岁Hp感染率37%，15～30岁Hp感染率45%，31～40岁Hp感染率44%，41～50岁Hp感染率45%，51～60岁感染率46%，60岁以上感染率46%，共检测3 705例，平均Hp感染率43%。 结论　Hp感染率儿童低于成人，成人组间人群Hp感染率无明显差异。蒙古族地区人群Hp感染率与国内其他地区人群感染率相似，无明显差异。

Clinical Investigation of Severe Acute Pancreatitis Complicated with Infection

摘要:目的:探讨重症急性胰腺炎(SAP)继发感染的临床特点。方法:将我院20039~20053收治的SAP140例,按是否感染,分成感染组和对照组,对比分析其临床资料。结果:感染组病死率高于对照组(P=0023);感染组入院初期,Ranson评分、CT评分、APACHE Ⅱ评分、血糖、ARDS和肠麻痹发生率、感染前手术率及呼吸机辅助呼吸率高于对照组(Plt;005);以G感染胰腺、胰周围及肺部为主;肺部感染时间为107±25d,胰腺或胰周为176±29d。结论:急性期全身反应轻重及胰腺坏死程度是SAP继发感染的基础;临床有创治疗措施是促进因素。

Analysis of thrombotic events and mortality in patients with sever pneumonia in intensive care unit

Objective To explore the thromboembolic events and mortality in patients with different types of severe pneumonia, and to analyze the related high-risk factors. Methods A total of 161 severe pneumonia patients who admitted in intensive care unit from January 2018 to February 2023 were included in the study. The patients were divided into a COVID-19 group (n=88) and a community-acquired pneumonia (CAP) group (n=73) according to the type of pneumonia, and divided into a thrombosis group and a non-thrombosis group according to the occurrence of thrombosis. The patients were followed-up until discharge or in-hospital death, registering the occurrence of thrombotic events. Results During the in-hospital stay, 32.9% of CAP and 36.4% of COVID-19 patients experienced thrombotic events (P>0.05). In CAP group all the events (including 24 paitents) were venous thromboses, while in COVID-19 group 31 patients were venous and 3 were arterial thromboses (2 were cerebral infarction, and 1 with myocardial infarction). There were statistically significant difference in gender, age, venous thromboembolism score (VTE score), activated partial thromboplastin time (APTT), and procalcitonin (PCT) between the TE group and the Non-TE group. Logistic regression analysis showed that thrombotic events was associated with sex, age and APTT; gender (female: OR=2.47, 95%CI 1.13 - 5.39, P<0.05) and age (OR=1.04, 95%CI 1.01 - 1.07, P<0.05) were positively associated with thrombotic events. During the in-hospital follow-up, 44.3% of CAP patients and 42.5% of COVID-19 patients died (P>0.05). Receiver operator characteristic (ROC) curve analysis showed that APACHEⅡ score was more accurate in predicting mortality of severe pneumonia, and the area under the ROC curve (AUC) was 0.77 (95%CI 0.70 - 0.84, sensitivity 74.3%, specificity 68.1%), the AUC of the VTE score was 0.61 (95%CI 0.53 - 0.70, Sensitivity 31.4%, specificity 81.7%); the AUC of the creatinine was 0.64 (95%CI 0.56 - 0.73, sensitivity 72.9%, specificity 51.2%). While the Kappa value for kidney disease was 0.409 (P<0.05) presenting moderate consistency. Conclusions The incidence of thromboembolic events and mortality are high in patients with different types of severe pneumonia. Thrombophilia was associated with sex, age, and APTT. APACHEⅡ score, VTE score, and creatinine value were independent risk factors for predicting death from severe pneumonia.

ＲＩＳＫ　ＦＡＣＴＯＲＳ　ＯＦ　ＰＡＮＣＲＥＡＴＩＣ　ＡＮＤ　ＰＥＲＩＰＡＮＣＲＥＡＴＩＣ　ＳＥＰＴＩＣ　ＮＥＣＲＯＳＩＳ　ＩＮ　ＡＣＵＴＥ　ＰＡＮＣＲＥＡＴＩＴＩＳ

Ａ　ｒｅｖｉｅｗ　ｏｆ　ｐａｔｉｅｎｔｓ　ｗｉｔｈ　ａｃｕｔｅ　ｐａｎｃｒｅａｔｉｔｉｓ　ｔｒｅａｔｅｄ　ｉｎ　ｔｈｉｓ　ｈｏｓｐｉｔａｌ　ｉｎ　ｒｅｃｅｎｔ　１０　ｙｅａｒｓ　ｗａｓ　ｍａｄｅ．Ｔｏ　ｄｅｔｅｒｍｉｎｅ　ｔｈｅ　ｒｉｓｋ　ｆａｃｔｏｒｓ　ｏｆ　ｓｅｐｔｉｃ　ｎｅｃｒｏｓｉｓ　ｉｎ　ａｎｄ　ａｒｏｕｎｄ　ｔｈｅ　ｐａｎｃｒｅａｓ，３２　ｃａｓｅｓ　ｗｉｔｈ　ｓｅｐｔｉｃ　ｎｅｃｒｏｓｉｓ　ｗｈｉｃｈ　ｗｅｒｅ　ｐｒｏｖｅｄ　ｉｎ　ｓｕｒｇｉｃａｌ　ｏｐｅｒａｔｉｏｎ　ａｎｄ　４４　ｃａｓｅｓ　ｗｉｔｈｏｕｔ　ｓｅｐｔｉｃ　ｎｅｃｒｏｓｉｓ（ａｓ　ｃｏｎｔｒｏｌ）ｗｅｒｅ　ｉｎｃｌｕｄｅｄ　ｉｎ　ｔｈｉｓ　ｓｔｕｄｙ．Ｔｈｅ　ｐｏｓｓｉｂｌｅ　ｆａｃｔｏｒｓ　ｗｅｒｅ　ｃｏｍｐａｒａｔｉｖｅｌｙ　ａｎａｌｙｓｅｄ．Ｔｈｅ　ｒｅｓｕｌｔｓ　ｓｈｏｗｅｄ　ｔｈａｔ　ｓｅｐｔｉｃ　ｎｅｃｒｏｓｉｓ　ｉｎ　ａｎｄ　ａｒｏｕｎｄ　ｔｈｅ　ｐａｎｃｒｅａｓ　ｏｂｖｉｏｕｓｌｙ　ｒｅｌａｔｅｄ　ｔｏ　ｔｈｅ　ｄｉａｇｎｏｓｔｉｃ　ｏｒ　ｔｈｅｒａｐｅｕｔｉｃ　ｐｕｎｃｔｕｒｅｓ，ｅａｒｌｙ　ｓｕｒｇｉｃａｌ　ｄｒａｉｎａｇｅ　ａｎｄ　ｐａｒａｌｙｔｉｃ　ｉｌｅｕｓ（ＯＲ　３０２－５４８，Ｐ＜００５)，ｂｕｔ　ｔｈｅｒｅ　ｗｅｒｅ　ｎｏ　ａｓｓｏｃｉａｔｉｏｎｓ　ｗｉｔｈ　ａｇｅ，ｅｔｉｏｌｏｇｙ，ｓｈｏｃｋ，ｒｅｓｐｉｒａｔｏｒｙ　ｆａｉｌｕｒｅ　ａｎｄ　ｔｏｔａｌ　ｐａｒｅｎｔｅｒａｌ　ｎｕｔｒｉｔｉｏｎ（ＯＲ　０７８－１２６，Ｐ＞００５）．Ｔｈｅ　ａｕｔｈｅｒｓ　ｓｕｇｇｅｓｔ　ｔｈａｔ　ｅｉｔｈｅｒ　ｐａｎｃｒｅａｔｉｃ，ｐｅｒｉｐａｎｃｒｅａｔｉｃ　ｐｕｎｃｔｕｒｅ　ｏｒ　ｅａｒｌｙ　ｓｕｒｇｉｃａｌ　ｄｒａｉｎａｇｅ　ｓｈｏｕｌｄ　ｂｅ　ｌｉｍｉｔｅｄ　ａｎｄ　ａｎｙ　ｍｅｄｉｃａｔｉｏｎ　ｗｈｉｃｈ　ｍａｋｅｓ　ｐａｒａｌｙｔｉｃ　ｉｌｅｕｓ　ｄｅｔｅｒｉｏｒａｔｅｄ　ｓｕｃｈ　ａｓ　ａｔｒｏｐｉｎｅ　ｓｈｏｕｌｄ　ｂｅ　ａｖｏｉｄｅｄ　ｉｎ　ｔｈｅ　ｔｒｅａｔｍｅｎｔ　ｏｆ　ａｃｕｔｅ　ｐａｎｃｒｅａｔｉｔｉｓ．

Study on the Effectiveness and Problems in Implementing Acquired Immune Deficiency Syndrome Control and Prevention in Community Health Service Centers

ObjectiveTo analyze the effectiveness and problems existing in implementing acquired immune deficiency syndrome (AIDS) control and prevention in community health service centers, and to provide scientific evidence for promoting AIDS control and prevention. MethodsRelated information on AIDS control and prevention in community health service centers in a community in the whole year of 2013 was acquired. The effectiveness and problems existing in case management, laboratory testing and highly active antiretroviral therapy (HAART) based on the current community health service system were analyzed. ResultsBy the end of 2013, the rate of AIDS case management was from zero to 100%, the rate of CD4 T detection was from 76.60% (360/470) to 88.35% (508/575), and the rate of receiving highly active antiretroviral therapy among AIDS patients was from 81.40% (175/215) to 84.41% (287/340). But in the actual work on AIDS in community health service centers, there were still some common problems needing to be solved. ConclusionThe community level management mode of AIDS can promote the accuracy of AIDS patients' information, improve the rate of case management, the rate of CD4 T detection and HAART. It is suggested that the community level management mode of AIDS should be promoted in the cities where AIDS patients are concentrated.

Efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy: a meta-analysis

ObjectivesTo systematically review the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy.MethodsPubMed, EMbase, The Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect clinical studies on the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy from January 1990 to September 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software and Stata 15.0 software.ResultsA total of 8 retrospective cohort studies and 1 randomized controlled trial involving 60 136 subjects were included. The results of the meta-analysis showed that: there was no difference in the post-operational infection rate among patients with and without antimicrobial prophylaxis for arthroscopies (OR=0.51, 95%CI 0.25 to 1.04, P=0.06). For knee arthroscopies, the post-operational infection rate had no difference between patients with and without antimicrobial prophylaxis (OR=0.89, 95% CI 0.65 to 1.23, P=0.48). However, for shoulder arthroscopies, the post-operational infection rate in the antimicrobial prophylaxis group was significantly lower than that in the group without the antimicrobial prophylaxis(OR=0.18, 95%CI 0.08 to 0.37, P<0.000 01).ConclusionsCurrent evidence shows that there is no association between preoperative antimicrobial prophylaxis and a decreased infection rate for knee arthroscopies. Antimicrobial prophylaxis appears to lead to fewer infections after shoulder arthroscopies. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.

Risk factors of nosocomial infection during induction remission chemotherapy in children with acute lymphoblastic leukemia

ObjectiveTo explore the risk factors of nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy.MethodsThe children with acute lymphoblastic leukemia who were admitted to the Department of Pediatrics, Huai’an First Hospital Affiliated to Nanjing Medical University between December 2012 and December 2018 were divided into the infection group (including the severe infection subgroup and the non-severe infection subgroup) and the non-infection group according to whether nosocomial infection occurred during induction and remission chemotherapy. The clinical data of patients were collected. Univariate analysis and multivariate logistic regression were used to analyze the risk factors of nosocomial infection during induction remission chemotherapy in children with acute lymphoblastic leukemia.ResultsA total of 96 patients were included. There were 67 cases in the infection group (26 in the severe infection subgroup and 41 in the non-severe infection subgroup) and 29 cases in the non-infection group. Univariate analysis showed that the granulocyte deficiency time and the prevalence of skin and mucosal damage in the infection group were significantly higher than those in the non-infection group, and the infection group had significantly lower laminar bed use and serum albumin level than the non-infection group did (P< 0.05). Multivariate logistic regression analysis showed that prolonged agranulocytosis [odds ratio (OR)=23.075, 95% confidence interval (CI) (3.682, 144.617), P=0.001], skin and mucosal lesions [OR=12.376, 95%CI (1.211, 126.507), P=0.034], hypoalbuminemia [OR=5.249, 95%CI (1.246, 22.113), P=0.024] were independent risk factors for nosocomial infection during induction and remission of childhood acute lymphoblastic leukemia, while laminar bed [OR=0.268, 95%CI (0.084, 0.854), P=0.026] was the protective factor.ConclusionsLong-term agranulocytosis, skin and mucosal lesions, and hypoalbuminemia are independent risk factors for nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy. Laminar flow bed is its protective factor.

充填式无张力疝修补术后网塞感染的探讨及处理

A prediction model for the 30-day mortality of the critical patients with pulmonary infection and sepsis

Objective To explore independent risk factors for 30-day mortality in critical patients with pulmonary infection and sepsis, and build a prediction model. Methods Patients diagnosed with pulmonary infection and sepsis in the MIMIC-Ⅲ database were analyzed. The CareVue database was the training cohort (n=934), and the Metavision database was the external validation cohort (n=687). A COX proportional hazards regression model was established to screen independent risk factors and draw a nomogram. We conducted internal cross-validation and external validation of the model. Using the receiver operator characteristic (ROC) curve, Calibration chart, and decision curve analysis, we detected the discrimination, calibration, and benefit of the model respectively, comparing with the SOFA scoring model. Results Age, SOFA score, white blood cell count≤4×109/L, neutrophilic granulocyte percentage (NEU%)>85%, platelet count (PLT)≤100×109/L, PLT>300×109/L, red cell distribution width >15%, blood urea nitrogen, and lactate dehydrogenase were independent risk factors. The areas under the ROC curve of the model were 0.747 (training cohort) and 0.708 (external validation cohort), respectively, which was superior to the SOFA scoring model in terms of discrimination, calibration, and benefit. Conclusion The model established in this study can accurately and effectively predict the risk of the disease mortality, and provide a visual assessment method for early identification of high-risk patients.