老年慢性阻塞性肺疾病急性加重合并肺部感染的病原菌分布及高危因素分析

目的探讨老年慢性阻塞性肺疾病(COPD)急性加重合并肺部感染的病原菌分布及高危因素。方法老年COPD急性加重患者260例按照其肺部感染发生情况分为感染组与非感染组,记录所有患者的临床资料,并对感染组患者进行病原菌分布及高危因素分析。结果 260例老年COPD急性加重患者中共发现30例肺部感染,感染率为11.5%,在感染组30例患者中,共检出病原菌45株,其中革兰阴性菌25株,革兰阳性菌18株,念珠菌2株,排名前4位的病原菌为铜绿假单胞菌、肺炎克雷伯菌、粪肠球菌、金黄色葡萄球菌等。铜绿假单胞菌、肺炎克雷伯菌对红霉素、庆大霉素有比较高的耐药率,而粪肠球菌、金黄色葡萄球菌对左氧氟沙星、美罗培南都比较高的耐药率。单因素回归分析发现感染组与非感染患者的糖尿病史、吸烟、长期使用抗菌药物、长期使用激素、长期卧床等比较差异具有统计学意义(P0.05);多因素非条件Logistic回归分析结果显示糖尿病史(OR=10.593,P=0.000)、吸烟(OR=6.194,P=0.008)、长期使用抗菌药物(OR=3.255,P=0.014)为导致肺部感染的高危因素(P0.05)。结论老年慢性阻塞性肺疾病急性加重合并肺部感染比较常见,病原菌中主要为革兰阴性菌,对多种抗菌药物有耐药性,发病高危因素主要为糖尿病、吸烟与长期使用抗菌药物。     

社区获得性肺炎并发革兰阴性菌感染的病原菌分布及危险因素分析

目的:探讨社区获得性肺炎(CAP)并发革兰阴性菌感染的病原菌分布及危险因素,以降低感染率。方法:选择2013年6月到2015年6月我院确诊CAP患者80例,收集所有患者的临床资料,分析CAP并发革兰阴性菌感染的病原菌分布及危险因素。结果:CAP并发革兰阴性菌感染的病原菌以肺炎克雷伯菌株数最多,13株(占30.23%),其次为大肠埃希菌8株(占18.60%)和鲍曼不动杆菌7株(占16.28%)。感染阳性组入院治疗前使用抗生素、白细胞水平异常、PORT≥3级以及血尿素氮水平7.1 mmol/L的比例较感染阴性组显著更高,差异均有统计学意义(均P0.05)。由Logistic回归分析可知,入院治疗前使用抗生素、白细胞水平异常、PORT≥3级以及血尿素氮水平7.1 mmol/L均为影响CAP患者发生革兰阴性菌感染的危险因素。结论:CAP并发革兰阴性菌感染的病原菌主要以肺炎克雷伯菌,大肠埃希菌和鲍曼不动杆菌为主,临床上应重视CAP并发革兰阴性菌感染危险因素,以降低感染率。     

脑出血患者血肿清除术后合并手术部位感染危险因素分析

目的分析脑出血患者血肿清除术后合并手术部位感染的病原菌分布与相关危险因素。方法回顾性分析2017年5月至2019年5月在我院接受血肿清除术治疗的109例脑出血患者的临床资料,依据术后是否并发感染分为感染组(n=45)与非感染组(n=64),分析感染组患者感染部位及病原菌分布情况,比较感染组与非感染组氧化应激指标[超氧化物歧化酶(SOD)、高级氧化蛋白产物(AOPP)、丙二醛(MDA)]水平,同时采用多因素Logistic回归分析脑出血患者血肿清除术后感染的危险因素。结果 45例血肿清除术后感染患者感染部位以呼吸道为主(31.11%),共分离病原菌83株,其中革兰阴性菌57株(68.67%),革兰阳性菌17株(20.48%),真菌9株(10.84%)。感染组患者血清MDA、AOPP水平显著高于非感染组,而SOD水平显著低于非感染组(均P0.05)。Logistic分析显示MDA、SOD、AOPP水平是脑出血患者血肿清除术后感染的独立危险因素(均P0.05)。结论脑出血患者血肿清除术后以呼吸道感染为主,感染病原菌以革兰阴性菌为主,且病原菌感染与氧化应激反应密切相关。临床治疗时应严格规范使用抗菌药物,同时针对其危险因素进行预防,以防止血肿清除术后感染,促进患者术后恢复。     

糖尿病并发尿路感染患者病原菌分布与危险因素分析

目的研究糖尿病并发尿路感染患者病原菌分布情况及其影响因素,为此类患者的治疗提供参考。方法选取我院2016年1月至2019年6月收治的60例糖尿病合并尿路感染患者为观察组,选取同期我院治疗的60例单纯性糖尿病患者为对照组,分析糖尿病合并尿路感染患者病原菌分布情况,并分析糖尿病患者合并尿路感染的危险因素。结果患者尿路感染病原菌以革兰阴性菌为主(75.00%),其次为革兰阳性菌(20.00%)及真菌(5.00%)。观察组患者住院时间,空腹血糖水平,糖化血红蛋白水平均显著高于对照组;尿液IL-6水平低于对照组(均P0.05)。观察组患者联合抗生素用药比例高于对照组(P0.05)。住院时间15 d、联合应用抗生素、空腹血糖10.00 mmol/L、糖化血红蛋白7%以及尿液IL-6水平48 pg/mL均为糖尿病患者合并尿路感染的独立危险因素。结论糖尿病患者合并尿路感染主要致病菌为革兰阴性菌。住院时间15 d、联合应用抗生素、空腹血糖过高、糖化血红蛋白过高以及较低的尿液IL-6水平均为糖尿病合并尿路感染的危险因素。     

糖尿病足感染患者病原菌分布 和C-肽及视黄醇结合蛋白-4水平分析

摘要：目的 探讨糖尿病足感染患者病原菌分布、C-肽和视黄醇结合蛋白-4（RBP4）的水平以及感染相关危险因素。方法 收集乌鲁木齐市友谊医院和新疆生产建设兵团医院2016年2月至2017年6月住院的201例糖尿病足患者临床资料，依据是否发生感染分为感染组（n=63）和未感染组（n=138）。采用ELISA法检测两组患者血清中hs-CRP、PCT、D-二聚体、纤维蛋白原（FIB）、C-肽和RBP4水平并分析感染组患者病原菌分布情况。感染相关危险因素采用Logistic回归分析。结果 感染组患者血清hs-CRP、PCT、D-二聚体、FIB、RBP4、餐后2 h C-肽水平均显著高于未感染组（均P<0.05）。63例糖尿病足感染患者足部分泌物共分离培养出83株病原菌，其中革兰阴性菌46株（55.42%），以铜绿假单胞菌（24.10%）、大肠埃希菌（13.25%）居多；革兰阳性菌37株（44.58%），以金黄色葡萄球菌（37.34%）为主。单因素分析显示，两组患者在病程、使用抗菌药物、使用三代头孢、患糖尿病肾病、合并骨髓炎和神经缺损性伤口方面差异有统计学意义（均P<0.05）。多因素分析显示，患者病程、既往使用抗菌药物、使用三代头孢、合并骨髓炎和神经缺损性伤口均是感染发生的独立危险因素。结论 需依据病原菌分布及耐药性情况合理应用抗生素，并针对病程长、既往使用抗菌药物、使用三代头孢、合并骨髓炎和神经缺损性伤口等独立危险因素做好相应预防措施。     

普外科患者术后切口感染病原菌分布情况及影响因素logistic回归分析

目的:探讨普外科患者术后切口感染的病原菌分布情况及影响因素。方法:回顾性分析2017年9月-2019年1月河北省秦皇岛市第一医院普通外科一病区接受手术治疗的150例患者的临床资料,术后发生切口感染的75例患者作为感染组,术后未发生切口感染的75例患者作为对照组,分析术后切口感染的病原菌分布情况,并比较两组患者的临床资料,对普外科患者术后切口感染的影响因素进行多因素Logistic回归分析。结果:感染组分离出病原菌75株,包括43株革兰阴性菌(57.33%)、28株革兰阳性菌(27.33%)、4株真菌(5.33%),经单因素分析显示,年龄、手术时间、有无合并糖尿病、有无植入性器械、住院时间与普外科患者术后切口感染有关(P0.05);经多因素Logistic分析显示,年龄≥60岁、合并糖尿病、手术时间≥2 h、有植入性器械、住院时间≥1月为普外科患者术后切口感染的独立危险因素(P0.05)。结论:普外科患者术后切口感染病原菌株以革兰阴性菌和革兰阳性菌为主,针对术后切口感染的危险因素实施干预措施,可以降低术后切口感染率,保证患者手术效果和改善预后。     

乳腺癌术后医院感染患者病原菌分布和危险因素及血清炎症因子水平分析

目的分析乳腺癌术后医院感染患者病原菌分布、危险因素及血清炎症因子水平,并探讨其临床意义。方法收集2016年3月至2018年3月我院诊治的80例乳腺癌术后医院感染患者为观察组。同期选取80例乳腺癌术后未发生感染者为对照组。利用全自动微生物分析仪对感染患者进行病原菌分布检测。对乳腺癌术后医院感染的危险因素进行单因素回归分析,同时检测并比较两组患者血清中白细胞介素-10(IL-10)、干扰素-γ(IFN-γ)及肿瘤坏死因子-α(TNF-α)的水平。结果80例乳腺癌术后医院感染患者共检出病原微生物97株。其中革兰阴性菌55株,以大肠埃希菌及铜绿假单胞菌为主;革兰阳性菌39株,以金黄色葡萄球菌为主(16株);真菌3株。观察组患者血清中IL-10、INF-γ及TNF-α水平均显著高于对照组(均P<0.05)。患者合并疾病情况、引流天数、住院天数及辅助化疗均与乳腺癌术后发生医院感染有密切联系(均P<0.05)。结论乳腺癌术后医院感染病原菌分布较广,以革兰阴性菌为主。患者合并疾病情况、引流天数、住院天数及辅助化疗均为医院感染的危险因素。血清中炎症因子水平可作为乳腺癌术后医院感染的诊断标志物。     

冠心病患者PCI术后感染病原菌分布特征及支架内再狭窄的影响因素分析

目的:研究冠心病患者经皮冠状动脉介入(PCI)术后感染病原菌分布特征及支架内再狭窄(ISR)的影响因素。方法:纳入从2015年1月～2018年1月于我院接受PCI术治疗的冠心病患者460例作为研究对象。采集PCI术后发生感染患者感染部位的分泌物或血液标本,分析病原菌分布特征。此外,将所有患者按照PCI术后是否存在ISR分成ISR组120例与非ISR组340例。比较两组基线资料、生化指标水平,并采用多因素Logistic回归分析影响ISR的危险因素。结果:29例患者发生医院感染,共培养分离获得病原菌38株,其中革兰阴性菌13株,占比34.21%,革兰阳性菌22株,占比57.89%,真菌3株,占比7.89%。ISR组男性、糖尿病、吸烟史人数占比均显著高于非ISR组(均P0.05)。ISR组空腹血糖(FPG)、总胆固醇(TC)、血尿酸(UA)、超敏C反应蛋白(hs-CRP)水平均显著高于非ISR组(均P0.05)。经多因素Logistic回归分析可得:糖尿病、吸烟史、TC(较高)、UA(较高)、hs-CRP(较高)均是影响ISR的危险因素(均P0.05)。结论:引起冠心病患者PCI术后感染的病原菌以革兰阳性菌为主,冠心病患者合并糖尿病、吸烟史以及随着TC、UA、hs-CRP水平的升高,PCI术后ISR的发生风险随之增加。     

开颅术后合并感染病原菌种类与降钙素原水平的相关性分析

目的探讨降钙素原(PCT)在判断开颅术后合并感染病原菌种类中的价值。方法回顾分析近五年我院神经外科103例开颅术后合并感染患者,根据合并感染的病原学诊断和临床诊断标准分为革兰阴性菌组、革兰阳性菌组和非细菌性组,并分析各组病原菌与PCT水平的相关性。结果开颅术后合并感染患者的PCT浓度:革兰阴性菌组革兰阳性菌组非细菌性组,而CRP水平在三组间差异无统计学意义。结论开颅术后合并感染病原菌种类与PCT水平有一定相关性,监测PCT水平对辅助临床判断开颅术后合并感染病原菌种类有临床应用价值。     

急性心肌梗死合并肺部感染患者多药耐药菌分布特征及心肌酶谱指标与炎性因子的关系分析

目的:分析急性心肌梗死合并肺部感染患者多药耐药菌分布特征及炎性因子与心肌酶谱指标的关系。方法:选择2015年2月~2018年10月期间中国人民解放军联勤保障部队第940医院收治的67例急性心肌梗死合并肺部感染患者作为感染组,选取同期收治的60例单纯急性心肌梗死患者作为未感染组,分析感染组多药耐药菌的分布及其耐药性,比较两组炎性因子与心肌酶谱指标水平,采用Pearson相关性分析感染组患者炎性因子与心肌酶谱指标的相关性。结果:67例患者痰培养标本中共分离出136株病原菌,其中有64株属于多药耐药菌,多药耐药菌中革兰阴性菌38株,占59.37%,革兰阳性菌26株,占40.63%。其中主要革兰阴性菌对哌拉西林/舒巴坦、头孢哌酮/舒巴坦、阿米卡星、美罗培南、亚胺培南等较为敏感,主要革兰阳性菌对替考拉宁、万古霉素、利福平等较为敏感。感染组患者白细胞介素-6(IL-6)、乳酸脱氢酶(LDH)、促血管生成素-2(Ang-2)、肌酸激酶(CK)、肿瘤坏死因子-α(TNF-α)、谷草转氨酶(AST)、肌酸激酶同工酶(CKMB)水平均高于未感染组患者(P0.05)。经Pearson相关性分析可得,感染组患者血清IL-6、Ang-2、TNF-α水平与AST、LDH、CK、CK-MB水平均呈正相关(P0.05)。结论:急性心肌梗死合并肺部感染患者心肌酶谱与炎性因子水平关系密切,有助于判断患者病情严重程度,且急性心肌梗死合并肺部感染患者多药耐药现象较为严重,临床应针对病原菌合理选取抗菌药物。     

The systematic histologic elaboration of urinary bladders with different pathologic findings (urinary bladder carcinoma, tumor-free aging urinary bladders)

We report our systematic histological examinations of 16 urinary bladders (11 bladders with cancer, 5 bladders was tumour-free). All residual tumour-free portions in bladder with multiple or solitary cancers demonstrated various precancerous variations of urothelium, not only near the tumours. In 1 urinary bladder among 5 from elder patients, we diagnosed a clinically undetected cancer. In a few cases, we correlated histological examinations with graphical demonstration (through a computer) of the exophytic tumour portions. Our results agree with individual therapy of urinary bladder cancer.     

Assessing menstrual cycles with urinary hormone assays

The Study of Women's Health Across the Nation (SWAN) is a multiethnic cohort study of middle-aged women enrolled at seven US sites. A subset of 848 women completed a substudy in which their urinary gonadotropins and sex steroid metabolites were assessed during one complete menstrual cycle or up to 50 consecutive days. Urine was analyzed for LH, FSH, estrone conjugates (E1c), and pregnanediol glucuronide (Pdg). To prepare for serial analysis of this large, longitudinal database in a population of reproductively aging women, we examined the performance of algorithms designed to identify features of the normal menstrual cycle in midreproductive life. Algorithms were based on existing methods and were compared with a "gold standard" of ratings of trained observers on a subset of 396 cycles from the first collection of Daily Hormone Substudy samples. In evaluating luteal status, overall agreement between and within raters was high. Only 17 of the 396 cycles evaluated were considered indeterminate. Of the 328 cycles rated as containing evidence of luteal activity (ELA), 320 were considered ELA by use of a Pdg threshold detection algorithm. Of 51 cycles that were rated as no evidence of luteal activity, only 2 were identified by this algorithm as ELA. Evaluation of the day of the luteal transition with methods that detected a change in the ratio of E1c to Pdg provided 85-92% agreement for day of the luteal transition within 3 days of the raters. Adding further conditions to the algorithm increased agreement only slightly, by 1-8%. We conclude that reliable, robust, and relatively simple objective methods of evaluation of the probability and timing of ovulation can be used with urinary hormonal assays in early perimenopausal women.     

Relationship of urinary kallikrein excretion to urinary potassium excretion during furosemide administration with and without amiloride

The relationship of urinary kallikrein excretion to urine volume, and to urinary sodium and potassium excretions was studied in normal rats during furosemide diuresis and superimposed injection of amiloride, a K+-sparing diuretic. Continuous infusion of furosemide increased urinary kallikrein, sodium and potassium excretions and the urine volume. Amiloride injection during furosemide diuresis caused further increase in diuresis and natriuresis, but a prompt decrease in urinary kallikrein excretion to basal level, and potassium excretion to below the basal level. The significant correlation of urinary kallikrein excretion to urinary potassium excretion, but not to urine volume and urinary sodium excretion after amiloride injection suggests that the major determinant of urinary kallikrein excretion is renal potassium secretion through a mechanism that is affected by amiloride.     

Treatment of stress urinary incontinence with duloxetine hydrochloride

Currently, there are no approved medications for the treatment of stress urinary incontinence (SUI) in the United States. The effectiveness of duloxetine in the treatment of SUI is linked to its inhibition of presynaptic neuronal reuptake of serotonin and norepinephrine in the central nervous system, resulting in elevated levels of serotonin and norepinephrine in the synaptic cleft. In animal studies, this agent leads to an increase in nerve stimulation to the urethral striated sphincter muscle. A similar mechanism in women is believed to result in stronger urethral contractions, with improved sphincter tone during urine storage and physical stress. In 3 randomized, placebo-controlled clinical trials, patients receiving duloxetine had a statistically significant and clinically relevant reduction in the number of incontinence episodes and a corresponding improvement in quality of life. If this use of duloxetine is approved by the U.S. Food and Drug Administration, as it has been by the European regulatory agencies, it will be the first drug indicated for the treatment of SUI. This pharmacologic therapy is an additional option for women and is likely to become an integral component of patient management.     

Measurement of urinary 3-methylhistidine with cationic-exchange resin

A simple method is presented for measurement of urinary 3-methylhistidine (3MH) using a cationic exchange resin treatment followed by colorimetric analysis. Equations are given to correct for the interference by histidine (4.3% by mole) in the colorimetric analysis. This correction is especially important for measurement of urinary 3MH in pregnant women or in other subjects with elevated histidine excretion. Good recovery of added standard and good reproducibility of results are documented. Preliminary data from a study of pregnant women are reported, suggesting an increased excretion of 3MH during pregnancy. Large day-to-day variability of 3MH excretion was observed within subjects. It is recommended that repeated measurements be done on each subject when determining 3MH excretion.