Impact of traffic related air pollution indicators on non-cystic fibrosis bronchiectasis mortality: a cohort analysis

Background

Mortality in non-cystic fibrosis bronchiectasis (NCFB) is known to be influenced by a number of factors such as gender, age, smoking history and Pseudomonas aeruginosa, but the impact of traffic related air pollution indicators on NCFB mortality is unknown.

Methods

We followed 183 patients aged 18 to 65 years with a HRCT proven diagnosis of NCFB and typical symptoms, who had visited the outpatient clinic at the University Hospital of Leuven, Belgium, between June 2006 and October 2012. We estimated hazard ratios (HR) for mortality in relation to proximity of the home to major roads and traffic load, adjusting for relevant covariables (age, gender, disease severity, chronic macrolide use, smoking history, socioeconomic status and Pseudomonas aeruginosa colonization status).

Results

Fifteen out of the 183 included patients died during the observation period. Residential proximity to a major road was associated with the risk of dying with a HR 0.28 (CI 95% 0.10-0.77; p = 0.013) for a tenfold increase in distance to a major road. Mortality was also associated with distance-weighted traffic density within 100 meters (HR for each tenfold increase in traffic density 3.80; CI 95% 1.07-13.51; p = 0.04) and 200 meters from the patient’s home address (HR for each tenfold increase in traffic density 4.14; CI 95% 1.13-15.22; p = 0.032).

Conclusion

Traffic-related air pollution appears to increase the risk of dying in patients with NCFB.

Trial registration

The study was approved by the local ethical committee of the UZ Leuven, Belgium (ML-5028), registered at ClinicalTrial.gov ({"type":"clinical-trial","attrs":{"text":"NCT01906047","term_id":"NCT01906047"}}NCT01906047).     

支气管扩张合并支气管哮喘患者的病原菌检测及危险因素分析

目的分析支气管扩张合并支气管哮喘患者的病原菌及危险因素。方法选取湖州市中心医院115例支气管扩张合并支气管哮喘患者作为观察组,另选取同期110例健康体检者作为对照组。分析患者病原菌的组成、耐药性及发病危险因素。结果观察组患者送检痰样本经痰培养,阳性检出者68例,阳性率为59.13%(68/115)。全部样本共分离出104株病原菌,其中革兰阴性菌92株(以铜绿假单胞菌最多,占54.81%),革兰阳性菌8株,真菌4株。药敏试验结果表明革兰阴性菌对复方新诺明、头孢曲松、左旋左氧氟沙星和阿莫西林/克拉维酸等药物的耐药性均较高,对妥布霉素、亚胺培南、头孢哌酮/舒巴坦和哌拉西林的耐药性较低。Logistic回归分析显示,吸烟史、药物过敏史、食物过敏史、过敏性鼻炎、哮喘、过敏性肺炎、慢性支气管炎及慢性阻塞性肺疾病均是支气管扩张伴支气管哮喘发生的危险因素。结论支气管扩张合并支气管哮喘患者其病原菌以革兰阴性菌为主,吸烟史、药物过敏史、食物过敏史、过敏性鼻炎等是支气管扩张伴支气管哮喘发生的危险因素。     

Lung function,symptoms and inflammation during exacerbations of non-cystic fibrosis bronchiectasis: a prospective observational cohort study

Background

Exacerbations of non-cystic fibrosis bronchiectasis cause significant morbidity but there are few detailed data on their clinical course and associated physiological changes. The biology of an exacerbation has not been previously described.The purpose of this study was to describe changes in lung function, symptoms, health status and inflammation during the development and recovery from community-treated exacerbations.

Methods

This was a prospective observational cohort study of 32 outpatients with non-cystic fibrosis bronchiectasis conducted between August 2010 and August 2012. Patients completed a symptom diary card and measured their peak expiratory flow rate (PEFR) daily. Exacerbations were defined as oral antibiotic treatment taken for a worsening of respiratory symptoms. Symptoms and peak flow at exacerbation were analysed, and further measurements including the COPD Assessment Test (CAT) and inflammatory markers were also compared to baseline values.

Results

At baseline, health status was significantly related to lung function, prognostic severity and systemic inflammation. 51 exacerbations occurred in 22 patients. Exacerbation symptoms began a median (interquartile range) of 4 (2, 7) days before treatment started and the median exacerbation duration was 16 (10, 29) days. 16% had not recovered by 35 days. At exacerbation, mean PEFR dropped by 10.6% (95% confidence interval 6.9-14.2, p < 0.001) and mean CAT score increased by 6.3 units (3.6-9.1, p = 0.001), median symptom count by 4 (2.25, 6, p < 0.001), and mean CRP by 9.0mg/L (2.3-15.8, p = 0.011). Exacerbations where PEFR fell by ≥10% were longer with more symptoms at onset.

Conclusion

Exacerbations of non-CF bronchiectasis are inflammatory events, with worsened symptoms, lung function and health status, and a prolonged recovery period. Symptom diary cards, PEFR and CAT scores are responsive to changes at exacerbation and may be useful tools for their detection and monitoring.

Electronic supplementary material

The online version of this article (doi:10.1186/s12931-015-0167-9) contains supplementary material, which is available to authorized users.     

恶性血液病患者医院侵袭性真菌感染的危险因素分析

目的了解恶性血液病患者袭性真菌感染的发生率及危险因素,为重症患者的真菌感染防治提供依据。方法回顾性调查2013年1月至12月期间的495例恶性血液病住院患者资料,用卡方检验及多因素Logistic回归分析等统计方法分析侵袭性真菌感染的危险因素。结果 16.4%(81/495)的患者发生侵袭性真菌感染,其中急性白血病、慢性白血病、骨髓增生异常综合征、淋巴瘤和多发性骨髓瘤患者的真菌感染发生率分别为31.1%(66/212)、0.0%(0/19)、31.2%(5/16)、4.8%(10/207)和0.0%(0/41)。外周血白细胞计数低值≤1.0E+9/L、粒细胞缺少时间≥8天、使用糖皮质激素及抗生素使用种类≥3种是恶性血液病患者侵袭性真菌感染的独立危险因素,预防性使用抗真菌药物是独立保护因素(OR值分别为15.830、41.667、3.745、8.264及39.085,P值分别为0.000、0.011、0.035、0.007及0.000)。结论合理使用抗生素和糖皮质激素、在粒细胞缺少时间较长病例中及时使用集落刺激因子、抗真菌药或重建微生态是防治恶性血液病患者真菌感染的必要措施。     

Proteomic analysis of nasal cells from cystic fibrosis patients and non-cystic fibrosis control individuals: search for novel biomarkers of cystic fibrosis lung disease

Potential biological markers for cystic fibrosis (CF) lung disease were identified by comparative proteomics profiling of nasal cells from deletion of phenylalanine residue 508 (F508del)-homozygous CF patients and non-CF controls. From the non-CF 2-DE gels, 65 spots were identified by MS, and a reference 2-DE map was thus established. The majority of those correspond to ubiquitously expressed proteins. Consistent with the epithelial origin of this tissue, some of the identified proteins are epithelial markers (e.g. cytokeratins, palate lung and nasal epithelium clone protein (PLUNC), and squamous cell carcinoma antigen 1). Comparison of this protein profile with the one similarly obtained for CF nasal cells revealed a set of differentially expressed proteins. These included proteins related to chronic inflammation and some others involved in oxidative stress injury. Alterations were also observed in the levels of cytoskeleton proteins, being probably implicated with cytoskeleton organization changes described to occur in CF-airways. Lower levels were found for some mitochondrial proteins suggesting an altered mitochondrial metabolism in CF. Differential expression was also found for two more enzymes that have not been previously associated to CF. Further studies will clarify the involvement of such proteins in CF pathophysiology and whether they are targets for CF therapy.     

肝硬化合并严重肝损伤并发感染的临床特点及危险因素分析

目的 了解肝硬化合并严重肝损伤患者的继发感染发生率、感染特征、危险因素以及病死率。方法 从浙江大学附属第一医院感染科2014年5月—2015年4月住院治疗的1 264例肝硬化病例中筛选出150例合并严重肝损伤的病例进行回顾性分析。分析上述人群发生感染的情况,包括感染率、感染发生部位、细菌培养结果及预后。同时行多因素Logistic回归分析及Cox比例风险模型分析,探讨肝硬化合并严重肝损伤患者合并感染及90天病死的危险因素。结果 （1）本研究150例患者中,52例患者发生58次感染,感染率34.67%,6例患者发生二次感染。其中社区获得性感染36次,院内感染22次;感染常见部位依次为肺、腹腔（自发性腹膜炎）、泌尿道、血流、皮肤软组织;感染伴肝外器官衰竭23人,占44.23%;病原菌培养阳性感染发生17次,占总感染次数的29.31%,大肠埃希菌、肺炎克雷伯杆菌感染7次,排在前两位,其中产ESBLs菌株占57.14%（4/7）。（2）感染和未感染组比较,谷丙转氨酶、国际标准化比值、白细胞总数、MELD评分、28天病死率、90天病死率差异具有统计学意义（Ps<0.05）。（3）入院90天内病死人群与存活人群比较,年龄、血清总胆红素、国际标准化比值、白细胞数、肌酐、肝性脑病、MELD评分等指标差异具有统计学意义（Ps<0.05）。（4）采用多因素Logistic回归分析发现,血钠水平下降是肝硬化合并严重肝损伤患者并发院内感染独立危险因素（OR＝1.112,P＝0.047）;Cox比例风险模型分析发现年龄（HR＝1.039,P＝0.001）、性别（HR＝2.010,P＝0.043）、白蛋白（HR＝1.073,P＝0.030）、白细胞（HR＝1.081,P＝0.010）、MELD评分（HR＝1.308,P＜0.001）及院内感染（HR＝2.136,P＝0.021）是90天病死率的高危因素。结论 肝硬化患者在发生严重肝损伤后易继发感染最常见的部位为肺及腹腔,病原体以革兰阴性菌为主;血钠水平下降与院内感染相关。感染增加了肝硬化合并严重肝损伤患者的病死率。     

诊断性脑血管造影的术后并发症及其风险因素(附437例临床分析)

目的:观察脑血管造影患者的术后并发症,并分析影响并发症的风险因素。方法:437例动脉粥样硬化脑血管病、脑肿瘤、蛛网膜下腔出血、动脉瘤、动静脉畸形、癫痫、血管炎等的患者接受脑血管造影,观察术后24h以内发生的神经系统和局部并发症。用多因素分析方法确定与术后并发症相关的因素。结果:15例(3.43%)发生神经系统并发症,其中2例发生脑卒中并遗留永久残疾;2例死亡。手术造影侧穿刺部位血肿是最常见的并发症。与神经系统并发症相关的危险因素增包括动脉粥样硬化脑血管病,蛛网膜下腔出血,频繁TIA发作。结论:诊断性脑血管造影并发症发生率较低。具有并发症风险因素的患者应尽量减小手术创伤,加强术后观察。     

酵母菌血症流行病学及影响近期病死率的危险因素分析

酵母,尤其是假丝酵母（又称念珠菌）导致的血流感染逐年上升,且病死率高。本文回顾性研究上海交通大学附属瑞金医院2008年1月～2012年12月医院内获得性酵母菌血症患者的临床资料,分析其发生率、菌种分布、28d病死率及抗真菌治疗对预后的影响。结果显示,酵母菌血症发生率为0．34／1000人院患者。28d医院内病死率达27．1％。129例血流感染患者中,白念珠菌血症45例（34．9％）,非白念珠菌血症84例（65．1％）,其中近平滑念珠菌占18．6％、热带念珠菌占14．O％、光滑念珠菌占7．0％、季也蒙念珠菌占5．4％、清酒念珠菌占4．7％。101例患者（78．3％）行经验性抗真菌治疗,其中90例（69．8％）的经验性抗真菌治疗合适;28例（21．7％）未接受任何抗真菌治疗。发病5d内接受合适经验性抗真菌治疗患者的病死率（20．0％）显著低于未接受合适治疗患者（45．5％）。多因素Cox回归分析显示,年龄（HR=1．036,P=0．005）、中性粒细胞减少（HR=15．497,P〈0．001）及合适的抗真菌治疗与28d病死率有关（HR=0．325,P=0．002）。因此,早期诊断并进行及时适当的治疗是减少酵母菌血症病死率的有效方法。     

恶性肿瘤患者院内细菌感染临床高危因素调查分析

目的探讨恶性肿瘤患者院内细菌感染的危险因素。方法收集2009年1月至2011年12月大连医科大学附属二院肿瘤内科恶性肿瘤院内细菌感染的98例患者的临床资料,对感染相关高危因素采用单因素及Logistic多因素回归分析。结果单因素分析显示性别、感染部位、留置导尿、WBC下降程度及PS评分与G＋/G-菌感染种类有关（P〈0.05）,但进一步进行多因素分析后显示只有性别和留置导尿对细菌感染种类有影响（OR值分别为0.257、7.726）;细菌种类、性别、深静脉置管及化疗疗程数是血液感染发生的危险因素（OR值分别为8.634、8.000、2.012、0.025）。结论女性较男性更易发生G＋菌感染,而留置导尿则以发生G-菌感染为主;G-菌感染、女性、深静脉置管及多疗程化疗者易发生血液感染。应针对各种危险因素采取有效的预防措施,减少恶性肿瘤患者院内细菌感染的发生。     

重症监护病房患者多重耐药鲍曼不动杆菌感染及病死危险因素分析

目的 探讨重症监护病房患者多重耐药鲍曼不动杆菌（MDRAb）感染的危险因素及MDRAb感染患者病死的危险因素,为防治MDRAb提供依据。方法 回顾性分析2014年1月至2017年10月遂宁市中心医院重症监护病房197例鲍曼不动杆菌（Ab）感染患者,采用病例对照研究,根据抗生素敏感实验结果,将111例MDRAb感染者作为病例组,86例非MDRAb感染者作为对照组,收集其人口学资料、感染前的临床资料和实验室数据,应用单因素分析及多因素Logistic回归分析其感染的危险因素。同时将病例组分为病死组与存活组,分析其病死危险因素。结果 MDRAb检出率为56.35%。单因素Logistic分析显示,ICU停留时间、使用抗生素＞7 d、使用喹诺酮类抗生素、有创通气和胃管插管可能是MDRAb感染的危险因素（P＜0.05）。多因素Logistic回归分析显示,使用抗生素＞7 d（OR=2.338,95%CI：1.252~4.368）、使用喹诺酮类抗生素（OR=3.703,95%CI：1.665~8.234）、有创通气（OR=4.356,95%CI：1.695~11.192）是MDRAb感染的独立危险因素。单因素Logistic分析显示,年龄、高血压、血红蛋白量、昏迷可能是MDRAb感染患者病死的危险因素。多因素Logistic回归分析显示,高血压（OR=5.185,95%CI：2.012~13.361）、血红蛋白量（OR=0.976,95%CI：0.957~0.996）和昏迷（OR=4.061,95%CI：1.517~10.873）是MDRAb感染患者病死的独立危险因素。结论 使用抗生素＞7 d、使用喹诺酮类抗生素、有创通气是MDRAb感染的独立危险因素;高血压、血红蛋白量、昏迷是MDRAb感染患者病死的危险因素。     

Risk of mycobacterial disease among cancer patients: A population-based cohort study in a TB endemic area

ObjectivesTuberculosis (TB) and nontuberculous mycobacteria (NTM) disease have similar symptoms, which makes them difficult to distinguish clinically and leads to the danger of NTM disease being neglected. The aim of this study was to assess the risk of developing mycobacterial disease among cancer patients.MethodsWe conducted a retrospective cohort study using a population-based database. The multivariable Cox proportional hazards model was adjusted to identify independent factors contributing to the development of mycobacterial disease in the cancer cohort.ResultsThe results showed that the increased risk of developing TB and NTM disease was 1.84-fold and 4.43-fold, respectively, in cancer patients compared with the general population. Advanced age (≥65years) and being male were risk factors for developing TB disease. There was a 4.09-fold significantly increased risk of TB disease within six months of a cancer diagnosis. Hematological cancer patients were most likely to develop mycobacterial disease. Younger hematological cancer patients (< 45years) had a higher risk of NTM disease development.ConclusionThere is an increasing risk of mycobacterial disease in cancer patients. We suggest that the possibility of mycobacterial disease in cancer patients should be assessed during the period of cancer therapy, particularly in those who have risk factors.     

中国大陆女性HPV感染危险因素的Meta分析

了解评价中国大陆女性HPV感染的相关危险因素, 为预防和控制提供参考依据。

采用系统评价法综合评价1995年1月1日至2020年12月31日在PubMed、CNKI、VIP和WanFang数据库收录的所有关于中国女性人群中发表的有关HPV感染相关危险因素的相关研究。由2位研究者独立筛选文献、提取数据资料和评价纳入研究的文献质量后, 采用Stata 12.0软件进行分析。

共有48篇文献纳入研究, 总人数为210 009人, HPV感染病例26 653例, 分析模型结果显示: 孕次 > 1次为1.14(1.07~1.20), 产次 > 1次为1.35(1.06~1.74), 流产次数 > 1次为1.30(0.97~1.74), 避孕药为1.11(0.91~1.34), 避孕套为0.56(0.35~0.89), 宫内节育器避孕为1.02(0.91~1.13), 滴虫性阴道炎为1.33(1.04~1.69), 宫颈糜烂为2.2(1.03~4.70), 吸烟为1.28(1.09~1.51), 饮酒为1.15(1.07~1.24), 文化程度初中及以下为1.03(0.74~1.44), 无工作为0.94(0.73~1.21), 已婚为0.60(0.47~0.78), 结婚次数 > 1次为1.47(1.25~1.73), 性伴侣数 > 1个为1.96(1.46~2.62), 丈夫婚外性行为1.68(1.35~2.09), 丈夫性伴侣数 > 1个为2.14(1.45~3.15), 性生活频率 > 2次/周为1.37(0.79~2.37), 绝经为1.65(1.11~2.46), 初次性生活年龄≤20岁为1.48(1.23~1.78)。

HPV感染主要危险因素为多孕, 多产, 滴虫性阴道炎, 宫颈糜烂, 吸烟, 饮酒, 结婚次数过多, 多个性伴侣, 丈夫婚外性行为, 丈夫有多个性伴侣, 绝经, 初次性生活年龄过早, 而避孕套和已婚是其保护因素。

     

Targets for cystic fibrosis therapy: proteomic analysis and correction of mutant cystic fibrosis transmembrane conductance regulator

Proteomic analysis has proved to be an important tool for understanding the complex nature of genetic disorders, such as cystic fibrosis (CF), by defining the cellular protein environment (proteome) associated with wild-type and mutant proteins. Proteomic screens identified the proteome of CF transmembrane conductance regulator (CFTR), and provided fundamental information to studies designed for understanding the crucial components of physiological CFTR function. Simultaneously, high-throughput screens for small-molecular correctors of CFTR mutants provided promising candidates for therapy. The majority of CF cases are caused by nucleotide deletions (ΔF508 CFTR; >75%), resulting in CFTR misfolding, or insertion of premature termination codons (～10%), leading to unstable mRNA and reduced levels of truncated dysfunctional CFTR. In this article, we review recent results of proteomic screens, developments in identifying correctors for the most frequent CFTR mutants, and comment on how integration of the knowledge gained from these studies may aid in finding a cure for CF and a number of other genetic disorders.     

Risk factors for helminth infections in a rural and a peri-urban setting of the Dongting Lake area, People's Republic of China

Schistosomiasis japonica and soil-transmitted helminthiasis are endemic parasitic diseases in the People’s Republic of China (PR China). As very few studies have reported on the distribution and interaction of multiple species helminth infections, we carried out a comparative study of households in a rural village and a peri-urban setting in the Dongting Lake area of Hunan province in November and December 2006 to determine the extent of single and multiple species infections, the underlying risk factors for infection, and the relationships with clinical manifestations and self-reported morbidity. In each household, stool samples were collected and subjected to the Kato-Katz method for identifying Schistosoma japonicum, Ascaris lumbricoides, hookworm and Trichuris trichiura infections. Clinical examinations were performed and questionnaire surveys conducted at both household and individual subject levels. Complete parasitological, clinical and questionnaire data were obtained for 1,298 inhabitants of the two settings. The overall prevalences of single infections of S. japonicum, A. lumbricoides, hookworm and T. trichiura were 6.5%, 5.5%, 3.0% and 0.8%, respectively; the majority of the infections were of light intensity. We found significant negative associations between wealth and infections with S. japonicum and A. lumbricoides. Clinical manifestations of splenomegaly, hepatomegaly and anaemia were prevalent (9.0%, 3.7% and 10.9%, respectively), the latter two being significantly (P < 0.05) associated with schistosomiasis. Self-reported symptoms were more common among females but there was considerable under-reporting in both sexes when relying only on spontaneous recall. Our findings may guide the design and targeting of a more equitable, comprehensive and integrated parasitic disease control programme in Hunan province and in other areas of PR China.     

Risk factors for physical disability in patients with leprosy disease in Yunnan,China: Evidence from a retrospective observational study

BackgroundLeprosy is potentially debilitating. The risk factors related to physical disabilities associated with leprosy disease in Yunnan, China was not clear.Methodology/Principal findingsWe studied 10644 newly detected leprosy patients from Yunnan, China, from 1990 to 2019. Factors associated with Grade 1 (G1D) and Grade 2 (G2D) physical disabilities or overall physical disabilities (combined G1D and G2D) associated with leprosy were analyzed using multinomial and ordinal logistic regression analyses. The following factors were associated with the development of physical disability in these patients with leprosy: delayed diagnosis [odds ratio (OR): 5.652, 4.399, and 2.275; 95% confidence intervals (CIs): 4.516–7.073, 3.714–5.212, and 2.063–2.509; for ≥ 10, 5–10 y, and 2–5 years, respectively], nerve damage (OR: 3.474 and 2.428; 95% CI: 2.843–4.244, and 1.959–3.008; for 2 and 1 damaged nerves, respectively), WHO classification of PB (OR: 1.759; 95% CI: 1.341–2.307), Ridley-Jopling classification (OR: 1.479, 1.438, 1.522 and 1.239; 95% CI: 1.052–2.079, 1.075–1.923, 1.261–1.838, and 1.072–1.431; for TT, BT, BB, and BL when compared with LL, respectively), advanced age (OR: 1.472 and 2.053; 95% CI: 1.106–1.960 and 1.498–2.814; for 15–59 and over 60 years old, respectively), zero skin lesions (OR: 1.916; 95% CI: 1.522–2.413), leprosy reaction (OR: 1.528; 95% CI: 1.195–1.952), rural occupation (OR: 1.364; 95% CI: 1.128–1.650), Han ethnicity (OR: 1.268; 95% CI: 1.159–1.386), and male sex (OR: 1.128; 95% CI: 1.024–1.243).ConclusionsDelayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability.     

重症急性胰腺炎合并腹腔感染的感染特点和相关因素分析

目的 探讨重症急性胰腺炎（SAP）合并腹腔感染的感染特点及其相关因素分析。方法 回顾性分析2008年1月至2015年6月我院收治的125例SAP患者的临床资料,分析腹腔感染细菌菌谱的特点及影响腹腔感染发生的危险因素。结果 125例患者中48例（38.40%）合并腹腔感染,死亡12例（9.60%）。共培养出病原菌92株,其中革兰阴性菌61株（66.30%）,革兰阳性菌25株（27.17%）和真菌6株（6.52%）。单因素分析显示病因、APACHEⅡ评分、合并多器官功能障碍综合征（MODS）、外科干预及全肠外营养时间与SAP发生腹腔感染有关（P0.05）。多因素分析结果显示,APACHE Ⅱ评分≥11、合并MODS、全肠外营养时间≥1周是SAP发生腹腔感染的独立危险因素（P<0.05）。结论 SAP合并腹腔感染多为多重感染,以革兰阴性菌感染为主。APACHE Ⅱ评分≥11、合并MODS、全肠外营养时间≥1周的SAP患者,易并发腹腔感染。     

嗜麦芽窄食单胞菌感染的临床特征、高危因素及预后分析

目的了解嗜麦芽窄食单胞菌感染的临床特点、危险因素、预后及耐药现状,为有效预防和治疗该病原菌感染提供依据。方法收集2013年11月至2014年4月浙江大学医学院附属第一医院收治的129例细菌培养为嗜麦芽窄食单胞菌患者的临床资料进行回顾性统计分析。结果 129例细菌培养确诊嗜麦芽窄食单胞菌感染患者平均年龄（65.1±17.0）岁,包括下呼吸道感染和非呼吸道感染患者分别为100例和29例,下呼吸道感染患者存在原发肺部疾病的患病率、ICU入住率、气管切开比例、广谱抗生素的使用率、患病年龄等均高于非呼吸道感染患者（P〈0.05）。而非呼吸道感染患者的外科手术、无菌腔内置管比例及免疫抑制剂使用率高于下呼吸道感染患者（P〈0.05）。嗜麦芽窄食单胞菌感染后选择敏感抗生素治疗的患者的死亡率明显低于未选择敏感抗生素的患者（15.0%/30.4%,P〈0.05）。结论原发肺部疾病、入住ICU、气管切开、广谱抗生素使用、年龄大是下呼吸道感染嗜麦芽窄食单胞菌的高危因素,外科手术、无菌腔内置管、免疫抑制剂使用是非呼吸道感染嗜麦芽窄食单胞菌的高危因素。使用敏感抗生素可以降低嗜麦芽窄食单胞菌感染患者的死亡率。     

老年腰椎骨折术后深部切口感染患者病原菌和感染危险因素分析

分析老年腰椎骨折术后切口深部感染患者的病原菌分布特征及感染危险因素,为该类患者的治疗提供参考。

选择2018年2月至2021年2月于我院行腰椎手术治疗且符合纳入标准的患者589例,记录患者感染发生率,并对感染病原菌分布特征及感染的危险因素进行单因素和多因素分析,同时探讨相应对策。

589例腰椎骨折手术患者有41例（6.96%）出现切口深部感染。41例感染患者的渗出液或分泌物中鉴定分离出53株病原菌,其中30例患者为单菌株感染,占73.17%;11例患者为多菌株感染,占26.83%。53株病原菌中革兰阴性菌30株,革兰阳性菌22株,真菌1株。革兰阴性菌中,大肠埃希菌对哌拉西林的耐药率最高,为91.67%;对美罗培南、亚胺培南及厄他培南的耐药率相对较低,为16.67%;铜绿假单胞菌对头孢吡肟、头孢曲松、头孢唑林和复方磺胺甲噁唑的耐药率最高,为90.00%;对环丙沙星和阿米卡星的耐药率相对较低,为20.00%。革兰阳性菌中金黄色葡萄球菌对青霉素和红霉素的耐药率最高,为76.92%;对万古霉素、利奈唑胺的耐药率为0.00%。术后感染患者与非感染患者在年龄分布、BMI、是否合并糖尿病、手术持续时间、是否输血等方面的差异有统计学意义（均P＜0.05）;在性别、是否存在烟酒史、是否合并高血压或冠心病、术中失血量等方面差异无统计学意义（均P＞0.05）。Logistic回归分析显示,年龄≥60岁、BMI≥28 kg/m²、合并糖尿病、手术时间≥2 h及预防性应用抗生素为腰椎骨折术后患者切口深部感染的独立危险因素（均P＜0.05）。

腰椎骨折术后患者深部切口感染病原菌种类较多,以金黄色葡萄球菌和大肠埃希菌为主,且药敏性普遍较低。年龄≥60岁、BMI≥28 kg/m²、合并糖尿病、手术时间≥2 h及预防性应用抗生素为腰椎骨折术后患者切口深部感染的独立危险因素,临床应根据药敏情况合理选择抗菌药物以降低感染发生率。