头颈部肿瘤患者上呼吸道感染微生物检测及结果分析

目的：分析头颈部肿瘤患者放/放化疗期间咽试子培养和药敏结果。方法：回顾性分析229例患者503次咽试子培养、药敏结果及抗生素应用情况。结果：229例患者中培养阳性133例(58.1%)，细菌培养阳性98例(42.8%)，真菌培养阳性72例(31.4%)。其中13例患者双重细菌感染，2例患者三重细菌感染，37例患者细菌真菌双重感染。结论：头颈部肿瘤放/放化疗期间上呼吸道感染率高，以条件致病菌为主。治疗期间应重视致病微生物培养，合理应用抗生素，并积极预防真菌感染。     

重型肝炎和活动性肝硬化并发医院感染的临床分析

目的探讨重型肝炎及活动性肝硬化并发医院感染的病原菌、感染部位及临床耐药与疾病转归。方法对2006年1月至2009年10月住院的40例重型肝炎及活动性肝硬化患者合并感染培养阳性患者的病原菌进行回顾性研究。结果 304例患者并发医院感染者40例,感染率为13.16%。细菌感染者以革兰氏阴性杆菌为主,主要感染部位为呼吸道,真菌感染者以白色念珠菌为主。结论本院重型肝炎及肝硬化并发医院感染的主要危险因素与肝脏储备功能下降、有创性操作及预防性应用抗生素有关。     

肾移植术后肺部感染23例临床分析

目的分析肾移植术后肺部感染的临床特点和诊治措施。方法对23例肾移植术后并发肺部感染患者的临床资料进行回顾性分析。结果23例患者中巨细胞病毒感染9例,其中合并细菌感染2例。细菌感染7例,其中复合细菌感染1例,细菌合并真菌感染2例;肺部真菌感染4例。发生细菌败血症1例,真菌败血症1例。另3例未检出病原体。经综合治疗本组中22例治愈,1例死亡,为细菌合并真菌感染的重症肺部感染者,死亡原因为急性呼吸窘迫综合征。结论肾移植术后合并肺部感染病情复杂,死亡率较高;可靠的病原学诊断、及时而有效的综合治疗可提高其治愈率。     

慢性肝衰竭患者侵袭性真菌感染的危险因素分析

目的 探讨慢性肝衰竭(Chronic liver failure,CLF)患者合并侵袭性真菌感染(Invnsivefunsal infections,IFl)的危险因素及防治措施.方法 回顾性分析52例CLF合并IFI患者的I临床特点、危险因素以及预后,并与随机选取同期住院的52例CLF未合并真菌感染患者作为对照.结果 52例真菌感染者发生了69例次不同部位感染,感染部位虽然以浅部口腔为主,但是其他部位感染有上升趋势,尤其是肺部感染;感染真菌种属虽然仍以白色念珠菌为主,但是新型隐球菌及曲霉菌有上升趋势;卡方检验、多因素Logistic回归模型及Ridit检验分析显示,危险因素为细菌感染的种类、总胆红素水平、住院天数、抗细菌药物累积时间、侵袭性操作次数、抗细菌药物的种类以及合并腹水的程度;CLF合并IFI死亡率远高于未出现真菌感染患者.结论 CLF合并IFI预后差,有效的预防措施为:积极治疗原发病,缩短住院时间,严密监测患者体液标本,尽早明确感染源,合理使用抗生素,减少或避免侵袭性操作,给予免疫激活剂,注意定期空气消毒.     

慢性肝衰竭患者侵袭性真菌感染的危险因素分析

目的 探讨慢性肝衰竭(Chronic liver failure,CLF)患者合并侵袭性真菌感染(Invnsivefunsal infections,IFl)的危险因素及防治措施.方法 回顾性分析52例CLF合并IFI患者的I临床特点、危险因素以及预后,并与随机选取同期住院的52例CLF未合并真菌感染患者作为对照.结果 52例真菌感染者发生了69例次不同部位感染,感染部位虽然以浅部口腔为主,但是其他部位感染有上升趋势,尤其是肺部感染;感染真菌种属虽然仍以白色念珠菌为主,但是新型隐球菌及曲霉菌有上升趋势;卡方检验、多因素Logistic回归模型及Ridit检验分析显示,危险因素为细菌感染的种类、总胆红素水平、住院天数、抗细菌药物累积时间、侵袭性操作次数、抗细菌药物的种类以及合并腹水的程度;CLF合并IFI死亡率远高于未出现真菌感染患者.结论 CLF合并IFI预后差,有效的预防措施为:积极治疗原发病,缩短住院时间,严密监测患者体液标本,尽早明确感染源,合理使用抗生素,减少或避免侵袭性操作,给予免疫激活剂,注意定期空气消毒.     

慢性肝衰竭患者侵袭性真菌感染的危险因素分析

目的 探讨慢性肝衰竭(Chronic liver failure,CLF)患者合并侵袭性真菌感染(Invnsivefunsal infections,IFl)的危险因素及防治措施.方法 回顾性分析52例CLF合并IFI患者的I临床特点、危险因素以及预后,并与随机选取同期住院的52例CLF未合并真菌感染患者作为对照.结果 52例真菌感染者发生了69例次不同部位感染,感染部位虽然以浅部口腔为主,但是其他部位感染有上升趋势,尤其是肺部感染;感染真菌种属虽然仍以白色念珠菌为主,但是新型隐球菌及曲霉菌有上升趋势;卡方检验、多因素Logistic回归模型及Ridit检验分析显示,危险因素为细菌感染的种类、总胆红素水平、住院天数、抗细菌药物累积时间、侵袭性操作次数、抗细菌药物的种类以及合并腹水的程度;CLF合并IFI死亡率远高于未出现真菌感染患者.结论 CLF合并IFI预后差,有效的预防措施为:积极治疗原发病,缩短住院时间,严密监测患者体液标本,尽早明确感染源,合理使用抗生素,减少或避免侵袭性操作,给予免疫激活剂,注意定期空气消毒.     

慢性肝衰竭患者侵袭性真菌感染的危险因素分析

目的 探讨慢性肝衰竭(Chronic liver failure,CLF)患者合并侵袭性真菌感染(Invnsivefunsal infections,IFl)的危险因素及防治措施.方法 回顾性分析52例CLF合并IFI患者的I临床特点、危险因素以及预后,并与随机选取同期住院的52例CLF未合并真菌感染患者作为对照.结果 52例真菌感染者发生了69例次不同部位感染,感染部位虽然以浅部口腔为主,但是其他部位感染有上升趋势,尤其是肺部感染;感染真菌种属虽然仍以白色念珠菌为主,但是新型隐球菌及曲霉菌有上升趋势;卡方检验、多因素Logistic回归模型及Ridit检验分析显示,危险因素为细菌感染的种类、总胆红素水平、住院天数、抗细菌药物累积时间、侵袭性操作次数、抗细菌药物的种类以及合并腹水的程度;CLF合并IFI死亡率远高于未出现真菌感染患者.结论 CLF合并IFI预后差,有效的预防措施为:积极治疗原发病,缩短住院时间,严密监测患者体液标本,尽早明确感染源,合理使用抗生素,减少或避免侵袭性操作,给予免疫激活剂,注意定期空气消毒.     

慢性肝衰竭患者侵袭性真菌感染的危险因素分析

目的 探讨慢性肝衰竭(Chronic liver failure,CLF)患者合并侵袭性真菌感染(Invnsivefunsal infections,IFl)的危险因素及防治措施.方法 回顾性分析52例CLF合并IFI患者的I临床特点、危险因素以及预后,并与随机选取同期住院的52例CLF未合并真菌感染患者作为对照.结果 52例真菌感染者发生了69例次不同部位感染,感染部位虽然以浅部口腔为主,但是其他部位感染有上升趋势,尤其是肺部感染;感染真菌种属虽然仍以白色念珠菌为主,但是新型隐球菌及曲霉菌有上升趋势;卡方检验、多因素Logistic回归模型及Ridit检验分析显示,危险因素为细菌感染的种类、总胆红素水平、住院天数、抗细菌药物累积时间、侵袭性操作次数、抗细菌药物的种类以及合并腹水的程度;CLF合并IFI死亡率远高于未出现真菌感染患者.结论 CLF合并IFI预后差,有效的预防措施为:积极治疗原发病,缩短住院时间,严密监测患者体液标本,尽早明确感染源,合理使用抗生素,减少或避免侵袭性操作,给予免疫激活剂,注意定期空气消毒.     

慢性肝衰竭患者侵袭性真菌感染的危险因素分析

目的 探讨慢性肝衰竭(Chronic liver failure,CLF)患者合并侵袭性真菌感染(Invnsivefunsal infections,IFl)的危险因素及防治措施.方法 回顾性分析52例CLF合并IFI患者的I临床特点、危险因素以及预后,并与随机选取同期住院的52例CLF未合并真菌感染患者作为对照.结果 52例真菌感染者发生了69例次不同部位感染,感染部位虽然以浅部口腔为主,但是其他部位感染有上升趋势,尤其是肺部感染;感染真菌种属虽然仍以白色念珠菌为主,但是新型隐球菌及曲霉菌有上升趋势;卡方检验、多因素Logistic回归模型及Ridit检验分析显示,危险因素为细菌感染的种类、总胆红素水平、住院天数、抗细菌药物累积时间、侵袭性操作次数、抗细菌药物的种类以及合并腹水的程度;CLF合并IFI死亡率远高于未出现真菌感染患者.结论 CLF合并IFI预后差,有效的预防措施为:积极治疗原发病,缩短住院时间,严密监测患者体液标本,尽早明确感染源,合理使用抗生素,减少或避免侵袭性操作,给予免疫激活剂,注意定期空气消毒.     

慢性肝衰竭患者侵袭性真菌感染的危险因素分析

目的 探讨慢性肝衰竭(Chronic liver failure,CLF)患者合并侵袭性真菌感染(Invnsivefunsal infections,IFl)的危险因素及防治措施.方法 回顾性分析52例CLF合并IFI患者的I临床特点、危险因素以及预后,并与随机选取同期住院的52例CLF未合并真菌感染患者作为对照.结果 52例真菌感染者发生了69例次不同部位感染,感染部位虽然以浅部口腔为主,但是其他部位感染有上升趋势,尤其是肺部感染;感染真菌种属虽然仍以白色念珠菌为主,但是新型隐球菌及曲霉菌有上升趋势;卡方检验、多因素Logistic回归模型及Ridit检验分析显示,危险因素为细菌感染的种类、总胆红素水平、住院天数、抗细菌药物累积时间、侵袭性操作次数、抗细菌药物的种类以及合并腹水的程度;CLF合并IFI死亡率远高于未出现真菌感染患者.结论 CLF合并IFI预后差,有效的预防措施为:积极治疗原发病,缩短住院时间,严密监测患者体液标本,尽早明确感染源,合理使用抗生素,减少或避免侵袭性操作,给予免疫激活剂,注意定期空气消毒.     

肝移植后肺部细菌合并真菌感染的诊治

背景：肝移植患者因常规服用免疫抑制剂,免疫力低下,极易发生肺部病原微生物感染。 目的：回顾分析1例肝移植后突发肺部细菌联合真菌感染患者诊疗经过,总结相关临床治疗经验。 方法：1例乙肝肝硬化失代偿期女性患者行同种异体原位肝移植后8个月余突发畏寒高热入院,经实验室检查结合胸部CT检测考虑为细菌引起的肺部感染,给予头孢哌酮钠舒巴坦钠抗菌治疗。 结果与结论：治疗后临床症状缓解。1周后复查胸部CT提示：双肺下叶片状渗出较前有所吸收,但背段出现片状“毛玻璃样改变”,考虑合并真菌感染,停用头孢哌酮钠舒巴坦钠,改用氟康唑针,治疗1周后行胸部CT：双肺下叶背段渗出较前吸收,出院继续口服氟康唑10 d,复查CT：双肺渗出性改变完全吸收。     

肝炎肝硬化患者合并败血症病原学及耐药分析

目的总结肝炎肝硬化患者合并败血症的病原菌分布及耐药情况。方法回顾分析33例肝炎肝硬化合并败血症患者的肝功能指标、凝血指标、外周血象及血培养结果,分析导致败血症的原因。结果 33例患者合并败血症与其肝硬化严重程度相关,致病菌中革兰阳性菌7株（占21.0%）,革兰阴性菌26株（占79.0%）。革兰阳性菌株中肺炎链球菌和金黄色葡萄球菌对常用抗菌素普遍耐药,革兰阴性菌株中产酸克雷伯菌耐药率最高,左氧氟沙星对主要革兰阳性菌普遍敏感,哌拉西林/他唑巴坦、头孢替坦对主要革兰阴性菌普遍敏感。结论失代偿期肝硬化患者出现发热寒战首先应考虑败血症可能,致病菌以革兰阴性菌多见,主要为大肠埃希菌。经验性抗菌治疗可首选哌拉西林/他唑巴坦、头孢替坦或左氧氟沙星。     

Clinical impact of A/H1/N1/09 influenza in patients with cirrhosis: Experience from a nosocomial cluster of infection

A/H1N1/09 influenza is associated with a high risk of complications in patients with chronic diseases, but data on morbidity and mortality in patients with cirrhosis are limited. A cluster of A/H1N1/09 infection in 48 patients admitted to a Gastro‐Hepatology Unit is reported. Nosocomial spread, clinical outcome, and viral characteristics of A/H1N1/09 strains from a study group of 48 inpatients (21 and 27 with and without cirrhosis, respectively) were compared with those from a control group of 44 outpatients with mild influenza‐like illness and without cirrhosis. A/H1N1/09 infection was confirmed in 8/48 (17%) inpatients. A/H1N1/09 infection rate did not differ in patients with and without cirrhosis (4/21, 19%; 4/27, 15%), but three patients with cirrhosis died of pneumonia and acute respiratory distress syndrome, with fungal or bacterial superinfection in two cases, despite antiviral treatment. None of patients without cirrhosis died. Viral sequences showed the presence of hemagglutinin mutation D222G in two out of three fatal cases and S183P in seven out of eight infected patients. These mutants were not detected in the outpatients group. Even if A/H1N1/09 infection rate in hospitalized patients with and without cirrhosis was not significantly different, cirrhosis and D222G/S183P substitutions were significantly associated with severe disease and poor outcome, also suggesting fungal or bacterial superinfection and portal hypertension as risk factors for A/H1N1/09 disease severity in patients with cirrhosis. Vaccination, preventive and early treatment and a strict control of nosocomial spread should be activated carefully in patients with cirrhosis during epidemics influenza. J. Med. Virol. 85:1–7, 2012. © 2012 Wiley Periodicals, Inc.     

Use of markers of hospital strains in studying the occurrence of nosocomial infections]

The submitted paper deals with one of the possible aspects of the investigation of nosocomial infections, i.e. investigations of the properties of hospital strains, their importance and possible use. The incidence of bacterial hospital strains was investigated in a surgical department of a district hospital of the North Bohemian region in October 1990; at the time of the survey 29 nosocomial infections (36.1%) were revealed by the prevalence method. Bacterial hospital strains were isolated from patients with a nosocomial infection, from the attending staff and the hospital environment. The following markers were investigated: biotyping, phagotyping, serotyping, toxin production, sensitivity to antimicrobial substances and sensitivity to disinfectants. Based on results of marking of hospital strains 7 incidences with a possible epidemiological association were detected where the hospital strain of equal or very similar properties dominated. The results of the investigation confirmed the important participation of the attending staff in the spread of nosocomial infections, in particular via contaminated hands, and drew attention to shortcomings as regards adherence to the hygienic and epidemiological regime in the investigated department.     

The choice of antibiotic therapy for bacterial infections in patients with cirrhosis of the liver

Patients with liver cirrhosis have an impaired function of reticuloendothelial system; moreover they exhibit several defects of cellular and humoral immunity. These deficiencies enhance their susceptibility to bacterial infections. The prognosis is better if the infection is detected as early as possible and treated adequately. Except in cases of septicemia, empirical monotherapy is effective. Broad-spectrum beta-lactam antibiotics have proved efficient for the treatment of severe infections; a limitation of third-generation cephalosporins is their ineffectiveness against Enterococci; the acylureidopenicillins may be a good choice since they are active against Enterococci and most enteric, pulmonary and urinary pathogens, including Escherichia coli and Streptococcus pneumoniae which are the pathogens most frequently isolated from cirrhotic patients with severe infection. Similarly, the combination of a beta-lactamase inhibitor with a penicillin may offer an adequate antibacterial spectrum. Piperacillin, like other beta-lactam antibiotics, can induce leukopenia in patients with cirrhosis; the more severe the hepatic dysfunction, the greater the risk; a reduction in dosages is necessary. Meropenem monotherapy is effective and safe for the initial therapeutic regimen of bacterial infection. The fluoroquinolones may be useful for the treatment of infections in liver cirrhosis; however, the marginal activity against S. pneumoniae is a drawback. Oral long-term fluoroquinolone administration is utilized for the prevention of spontaneous bacterial peritonitis recurrence; selective intestinal decontamination with fluoroquinolones is useful in preventing bacterial infections in cirrhosis with gastrointestinal hemorrhage. Given the high risk of nephrotoxicity due to aminoglycosides in liver cirrhosis, these antibiotics should be used only in cases of severe infection with septicemia, in which beta-lactam-aminoglycoside combination is indicated for rapid bactericidal effect and enhanced killing afforded by synergism. Perhaps a short course (no more than 3 days) and a once-daily schedule of administration would minimize the risk of aminoglycoside-induced nephrotoxicity.     

Community-acquired versus nosocomial Klebsiella pneumoniae bacteremia: clinical features, treatment outcomes, and clinical implication of antimicrobial resistance

We conducted this study to compare clinical features, outcomes, and clinical implication of antimicrobial resistance in Klebsiella pneumoniae bacteremia acquired as community vs. nosocomial infection. A total of 377 patients with K. pneumoniae bacteremia (191 community-acquired and 186 nosocomial) were retrospectively analyzed. Neoplastic diseases (hematologic malignancy and solid tumor, 56%) were the most commonly associated conditions in patients with nosocomial bacteremia, whereas chronic liver disease (35%) and diabetes mellitus (20%) were the most commonly associated conditions in patients with community-acquired bacteremia. Bacteremic liver abscess occurred almost exclusively in patients with community-acquired infection. The overall 30-day mortality was 24% (91/377), and the mortality of nosocomial bacteremia was significantly higher than that of community-acquired bacteremia (32% vs. 16%, p<0.001). Of all community-acquired and nosocomial isolates, 4% and 33%, respectively, were extended-spectrum cephalosporin (ESC)-resistant, and 4% and 21%, respectively, were ciprofloxacin (CIP)-resistant. In nosocomial infections, prior uses of ESC and CIP were found to be independent risk factors for ESC and CIP resistance, respectively. Significant differences were identified between community-acquired and nosocomial K. pneumoniae bacteremia, and the mortality of nosocomial infections was more than twice than that of community-acquired infections. Antimicrobial resistance was a widespread nosocomial problem and also identified in community-acquired infections.     

Nosocomial infection in newborns by Pichia anomala in a Brazilian intensive care unit.

Disseminated candidiasis is the most common nosocomial fungal infection, and Candida albicans has been reported to account for 50% to more than 70% of cases of invasive candidiasis. However, recent reports have also suggested the emergence of infections caused by non-albicans species. In addition, less-common pathogenic yeasts (Malassezia, Trichosporon, Rhodotorula, Debaryomyces and Pichia) have recently been reported, with increased frequency, as causes of nosocomial infections with high mortality. This article describes two cases of fungemia caused by Pichia anomala in newborns that occurred in an intensive care unit (ICU), in November 2004 at the Instituto da Crian?a (Pediatric Institute) of the Hospital das Clínicas of the School of Medicine, S?o Paulo University, Brazil. The principal factors related to virulence (proteinase and phospholipase) and the susceptibility of the isolated strains to antifungal agents were also evaluated, and the biotype of each strain was determined through the use of an epidemiological marker (killer biotype).     

Diagnosis and management of cirrhosis in coinfected patients

HIV coinfection is associated with faster progression of liver disease resulting from hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Thus, liver complications have become a major cause of illness and death in coinfected patients. Controlling HIV through highly active antiretroviral therapy may slow disease progression to nearly the rate of HIV-negative persons. Several antiretroviral regimens have been associated with drug-induced liver injury, however, which is more common in patients coinfected with hepatitis B or C. After development of cirrhosis and decompensation, survival is shorter in coinfected patients. Diagnosis and management of cirrhosis should be the same for coinfected and monoinfected HBV/HCV patients. The main complications of cirrhosis are ascites, spontaneous bacterial peritonitis, bleeding esophageal varices, hepatic encephalopathy, the hepatorenal syndrome, and hepatocellular carcinoma. Liver transplantation is feasible in patients with HIV infection, and early evaluation for this option is crucial because of the accelerated course of complications in HIV coinfection.