医院获得性铜绿假单胞菌肺炎危险因素分析

目的分析医院获得性铜绿假单胞菌肺炎的危险因素,指导初始经验性抗菌治疗。 方法选择空军军医大学第二附属医院2019年1月至2019年6月的所有医院获得性革兰阴性杆菌肺炎(GNB-HAP)患者374例,根据细菌培养结果分为医院获得性铜绿假单胞菌肺炎组(PA-HAP)81例,医院获得性非铜绿假单胞菌肺炎组(non-PA-HAP)293例,在获得呼吸道合格标本当天对变量进行评估,将单因素分析P<0.05的自变量纳入多因素Logistic回归分析,找到因变量的危险因素。 结果在单因素分析中,与PA-HAP相关的潜在危险因素包括呼吸道标本收集日期距离住院日的天数、未入住ICU、未接受脑科手术、无颅腔引流管、无昏迷、无误吸风险、无脑梗塞、无脑出血、胸科手术、留置胸腔引流管、布地奈德吸入、肿瘤、脾切除术。多因素Logistic回归分析确定PA-HAP的独立危险因素：胸科手术[adjusted odds ratio (aOR) 2.462, 95%CI 1.237~4.900]、无昏迷(2.516, 1.368~4.627)、布地奈德吸入(1.883, 1.049~3.393)、脾切除术(5.039 , 1.051~24.154)。 结论住院期间伴有胸科手术、吸入布地奈德、脾切除术而无昏迷的GNB-HAP患者应警惕铜绿假单胞菌感染。     

院内多重耐药大肠埃希菌肺炎的耐药现状及影像学特征分析

目的分析院内多重耐药大肠埃希菌(MDR-ECO)肺炎的耐药现状及影像学特征,并探讨发生MDR-ECO感染的危险因素。方法选择2018-07-01~2020-06-30潍坊市人民医院经呼吸道或者血标本分离检测确认的大肠埃希菌所致院内获得性肺炎(HAP)患者178例的病历资料,根据致病菌是否为多重耐药菌将其分为MDR-ECO组(153例)和非MDR-ECO组(25例)。分析其耐药情况及影像学特征,采用多因素logistic回归分析模型探讨发生MDR-ECO感染的危险因素。结果在178例标本中共检出MDR-ECO标本153株(85.96%)。药敏试验结果显示,MDR-ECO对头孢唑林、头孢呋辛及青霉素类耐药率达95%以上,对庆大霉素、氨曲南及环丙沙星耐药率均高达50%以上,对三代头孢菌素头孢他定、头孢噻肟的耐药率分别为46.41%和83.01%,对四代头孢菌素头孢吡肟的耐药率为30.07%。MDR-ECO对厄他培南耐药率最低,为0.65%。与非MDR-ECO组比较,MDR-ECO组病变多累及双侧肺部,有斑片渗出、实变、间质改变、空洞的比例以及无结节的比例较高,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,合并基础疾病、入住ICU是发生MDR-ECO感染的危险因素(P<0.05)。结论MDR-ECO所致HAP的耐药现状严峻,临床医师应根据危险因素及影像学特点,合理使用抗生素,减少耐药菌产生。     

Back Muscle Function in Older Women With Age-Related Hyperkyphosis: A Comparative Study

ObjectiveThe purpose of this study was to compare static maximal back extensor muscle force, endurance, and characteristics of flexion relaxation phenomenon (FRP) in older women with and without age-related hyperkyphosis.MethodsMaximum back extensor force and endurance measured in a sitting position with a designed load cell setup; appearance, onset, and offset angles of FRP; and extension relaxation ratio (ERR) during a dynamic flexion-extension task were compared between 24 older women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 65 ± 4.4 years, and 24 older women without hyperkyphosis (thoracic kyphosis angle ?50°), mean age 63 ± 4.3 years. Variables of force, endurance, angles of FRP, and ERR were analyzed using an independent sample t test. A χ² test was used to identify differences between groups in FRP appearance.ResultsStatic back extensor force and endurance were significantly lower among those with versus those without hyperkyphosis (P ? .001). Although the 2 groups did not differ in FRP appearance and ERR in the superficial erector spinal muscles (P ? .05), FRP in the hyperkyphosis group started sooner and ended later than in the group without hyperkyphosis (P ? .05).ConclusionOur study indicates that women with age-related hyperkyphosis had decreased static maximal force and endurance of the back extensor muscles and prolonged myoelectrical silence of the superficial erector spinal muscles. Reduced endurance of the superficial erector spinal muscles may trigger early onset of FRP and prolonged relaxation of these muscles.     

Bacterial peritonitis in a patient with malignant ascites caused by pancreatic carcinoma: Case report and review of literature

Bacterial peritonitis, an infection of the ascitic fluid, can be classified etiologically as spontaneous or secondary bacterial peritonitis. The former is mainly caused by portal hypertension and its subsequent effects, whereas the latter is caused by the direct dissemination of bacteria into the peritoneal cavity. Previous reports have described some distinguishing features of these two entities. Here, we report the first known case of bacterial peritonitis with Aeromonas hydrophilia and Escherichia coli in a patient with malignant ascites associated with pancreatic carcinoma who exhibited features of both spontaneous and secondary peritonitis. Our report suggests that clinicians should also consider bacterial peritonitis in patients with malignant ascites who present with ostensibly cancer-related symptoms.     

Pre-transfusion testing for Ebola virus disease patients in serious communicable infectious diseases hospitals in Tokyo: A cross-sectional study

BackgroundEbola virus disease (EVD) was endemic to Africa in 2014–2016. Supportive therapies have been shown to improve the outcome of EVD, and additional supportive therapy including blood transfusion therapy and external circulation could be needed in the event of a future global outbreak. However, pre-transfusion testing policies and guidelines have not yet been established in Japan.MethodsWe conducted a cross-sectional study of blood transfusion therapy for EVD patients at three designated hospitals for serious communicable diseases in Tokyo. In each hospital, we surveyed blood transfusion therapy policy, blood transfusion protocol, presence of a specialist in the department of transfusion medicine, facility capacity for pre-transfusion compatibility testing, and types of personal protective equipment available.ResultsOne hospital had a cross-matched compatible blood transfusion policy, one had a cross-matched compatible blood transfusion policy only when the patient's ABO and RhD type is previously known, and the third had not created a policy. Two hospitals had a department of transfusion medicine. These two hospitals had a special testing unit for serious communicable diseases, while the other had a portable unit for testing. There were no major differences noted in available personal protective equipment.ConclusionPolicies and protocols differ among hospitals. The choice of blood transfusion policy and pre-transfusion testing is largely dependent on equipment and human resources. Further discussion is required to develop national guidelines for blood transfusion therapy in patients with serious communicable diseases, including countermeasures against complications and ethical issues related to the safety of patients and healthcare workers.