Risk factors for trimethoprim-sulfamethoxazole resistance in patients with acute uncomplicated cystitis

Emerging antimicrobial resistance among uropathogens makes the management of acute uncomplicated cystitis increasingly challenging. Few prospective data are available on the risk factors for resistance to trimethoprim-sulfamethoxazole (TMP-SMX), the drug of choice in most settings. In order to evaluate this, we prospectively enrolled women 18 to 50 years of age presenting to an urban primary care practice with symptoms of cystitis. Potentially eligible women provided a urine sample for culture and completed a questionnaire regarding putative risk factors for TMP-SMX resistance. Escherichia coli isolates were tested for clonal group A (CGA) membership by a fumC-specific PCR. Of 165 women with cystitis symptoms, 103 had a positive urine culture and were eligible for participation. E. coli was the predominant uropathogen (86%). Fifteen (14.6%) women had a TMP-SMX-resistant (TMP-SMX r) organism (all of which were E. coli). Compared with the women who had a TMP-SMX-susceptible organism, women in the TMP-SMX r group were more likely to have traveled (odds ratio [OR], 15.4; 95% confidence interval [CI], 4.4 to 54.3; P < 0.001) and to be Asian (OR, 6.1; 95% CI, 1.0 to 36.4; P = 0.048). CGA was also independently associated with TMP-SMX resistance (OR, 105; 95% CI, 6.3 to 1,777.6; P = 0.001). No association with TMP-SMX resistance was demonstrated for the use of either TMP-SMX or another antibiotic in the past 3 months or with having a child in day care. Among these women with acute uncomplicated cystitis, Asian race and recent travel were independently associated with TMP-SMX resistance. TMP-SMX r isolates were more likely to belong to CGA. Knowledge of these risk factors for TMP-SMX resistance could facilitate the accurate selection of empirical therapy.     

认知三步疗法对女性腺性膀胱炎患者焦虑抑郁的影响

目的探讨认知三步疗法对女性腺性膀胱炎(cystitis glandularis,CG)患者焦虑抑郁情绪的影响。方法用随机数字表法将48例女性CG伴焦虑抑郁的患者分为两组,对照组给予常规护理及一般性心理护理,试验组在此基础上实施为期8周的认知三步疗法,采用焦虑自评量表、抑郁自评量表评价干预效果。结果试验组干预后焦虑、抑郁评分低于干预前(P<0.01),低于对照组干预后(P<0.01)。结论认知三步疗法可有效缓解女性CG患者的焦虑抑郁情绪。     

Exploration of the protein-dependent mechanism of Lactobacillus crispatus GAI98322 to prevent recurrent cystitis

ObjectivesTo elucidate the mechanism of Lactobacillus crispatus (L. crispatus) suppositories to prevent patients from recurrent cystitis (RC), independent from viable-Lactobacilli-bacteria- and acid-dependent ones such as hydrogen peroxide and lactate.MethodsWe used the GAI98322 strain of L. crispatus in all experiments and pH-matched.cell-free culture supernatant of L. crispatus (CFCS) was collected. The growth inhibitory activity and the biofilm formation inhibitory activity of the CFCS against uropathogenic Escherichia coli (UPEC), Extended Spectrum beta (β) Lactamase producing (ESBL+) UPEC, and Pseudomonas aeruginosa (P. aeruginosa) was assessed by agar-disk diffusion tests and crystal violet assay. Also, CFCS was subjected to mass spectrometry to specify ingredients.ResultsThe CFCS suppressed the proliferation of E. coli, ESBL + E. coli, and P. aeruginosa. Also, the CFCS at a concentration of 40% significantly impeded the biofilm formation of these three bacteria. The aggregation-promoting factor and Lysin was detected from CFCS.ConclusionsThe cell-free supernatant from the GAI98322 strain of L. crispatus inhibits the growth/biofilm formation of broad pathogens by aggregation promoting factor and lysin, which may prevent hosts from RC regardless of the antimicrobial resistance of the pathogens and even under pH modulation.     

Intravesical therapy in recurrent cystitis: a multi-center experience

Approximately 20–30 % of women suffer from recurrent cystitis. Recently, the problem of bacterial internalization, especially by Escherichia coli, has been significantly emerging as the main cause of recurrent episodes. It is believed that such a process is favored by damage to the urothelial mucous membrane. Concerning this, intravesical therapy with hyaluronic acid alone or in association with chondroitin sulfate was shown to improve urothelium thickness and reduction of bacterial load in the urine. The aim of our study was to assess whether intravesical therapy with hyaluronic acid (HA) and chondroitin sulfate (CS) is more effective than antibiotic therapy in reducing episodes and symptoms of recurrent urinary tract infections. We compared the number of recurring episodes in three groups of patients affected by recurrent urinary tract infections assigned to three different therapeutic regimens: the first group was treated only with HA and CS, the second group with HA and CS associated with fosfomycin, and the third group was treated only with fosfomycin (F). We assessed the number of recurrent episodes for each patient that occurred during a 6- to 12-month follow-up. The results showed 72.7 % of patients in the HA-CS group, 75 % in the fosfomycin + HA-CS group, and only 30.4 % in the fosfomycin group were event free at follow-up. The results were analyzed using the Fisher’s exact test. In conclusion, intravesical therapy with hyaluronic acid and chondroitin sulfate is an effective therapeutic approach to treat and prevent episodes of recurrent cystitis.     

超声检查在腺性膀胱炎诊断中的应用

目的探讨超声检查在腺性膀胱炎诊断中的临床价值。方法使用彩色超声诊断仪观察腺性膀胱炎患者膀胱壁及其周围情况,尤其要清晰显示膀胱三角区及膀胱颈部,总结其声像图特点。结果本组28例腺性膀胱炎经超声确诊24例,误诊为膀胱肿瘤4例,符合率85．7l％。结论超声检查方便、经济、对人体无伤害,可重复检查,并能直观显示膀胱内病灶的大小、部位、形态及病变处膀胱各层受侵犯程度,可作为腺性膀胱炎诊断的首选方法。     

儿童反复肺炎相关危险因素分析

目的探讨儿童反复患肺炎的相关危险因素,筛查高危人群,指导医生对儿童反复肺炎早期预防及临床干预。方法采用病例-对照研究方法,对103例反复肺炎患儿,及同期就诊的103例非反复肺炎的患儿进行研究,采用单因素χ2检验及多因素logistic回归模型调查反复肺炎的危险因素。结果经过χ2检验显示组间存在明显差异的变量为早产史、反复上呼吸道感染史、既往住院史、每天户外活动时间少于30 min)、居住平房、被动吸烟史。多因素lo-gistic回归分析结果显示:反复上呼吸道感染史(OR=4.006,95%CI:1.827～8.786)、既往住院史(OR=9.408,95%CI:4.419～20.030)、每天户外活动时间少于30 min(OR=2.934,95%CI:1.289～6.679)、居住平房(OR=3.441,95%CI:0.786～15.060)、被动吸烟(OR=2.23,95%CI:1.030～4.861)是儿童反复肺炎的独立危险因素。结论反复上呼吸道感染、既往住院史、居住环境差、每天户外活动时间少、被动吸烟等可以增加儿童患反复肺炎的风险。     

急性白血病在不同级别医院误诊的危险因素分析

目的：探讨急性白血病（AL）在不同级别医院误诊的危险程度。方法：采用回顾性调查方法,通过x^2检查和Ridit分析,研究了173例AL在不同级别医院的误诊率和误诊危险程度。结果：省级医院血液专科AL首诊误诊率为7．69％,其他各级别医院误诊率为57．14～92．96％。医院级别和误诊的危险程度相关,基层医院误诊率高,省级医院非血液专科误诊的危险程度高。结果：加强全科医生的培养,在不同地区配置合理的AL诊断网络,同时特别重视骨髓穿刺检查,将有助于在短期内降低AL误诊率。     

异基因造血干细胞移植后出血性膀胱炎发生率及其危险因素分析

目的分析异基因造血干细胞移植（HSCT）后出血性膀胱炎（HC）的发生率、危险因素及其与其他并发症的关系。方法对2003年9月至2005年9月在北京大学人民医院接受HSCT的250例患者发生HC的情况进行回顾分析。结果72例患者发生了HC，移植后180天的累积发生率为（28．80±0．29）％，其中轻度HC（Ⅰ-Ⅱ度）51例（70．83％），重度HC（Ⅲ～Ⅳ度）21例（29．17％）；全部为迟发性（LOHC）；中位发病时间为术后33（14—170）天，中位持续时间为[35．0±4．9（3～185）]d。单因素分析发现，年龄小于25岁、预处理使用抗胸腺细胞球蛋白（ATG）、疾病高危、巨细胞病毒（CMV）感染、移植物抗宿主病（GVHD）Ⅱ-Ⅳ度、非血缘关系或HLA不相合的血缘关系供者移植为HC发病的高危因素；多因素分析发现急性Ⅱ-Ⅳ度GVHD[相对危险度（RR）=2．75；95％可信区间（CI）=1．63—4．66；P〈0．01]和非血缘关系或HLA不相合供者（RR=2．60；95％CI 1．52—5．20；P〈0．01）移植为HC发生的独立危险因素。Kaplan—Meier生存分析显示HC发生对移植后1年的生存率无影响（RR=0．67，95％ CI0．33—1．36）。结论HC是异基因HSCT后常见的并发症，GVHD和非血缘关系或HLA不相合供者移植是其发生的危险因素。     

1086例腺性膀胱炎患者围手术期心理护理

目的 通过对腺性膀胱炎的护理回顾分析,探讨腺性膀胱炎患者的心理护理方法.方法 对1086例腺性膀胱炎患者进行术前、术中、术后心理护理和随访.结果 腺性膀胱炎患者通过心理护理,减轻了心理负担,总疗效达到96%.结论 对腺性膀胱炎患者进行心理护理能显著提高疗效.     

经尿道汽化电切加膀胱灌注治疗膀胱白斑合并腺性膀胱炎的护理

膀胱黏膜上皮增生性病变包括VonBrunn巢、囊性膀胱炎、腺性膀胱炎、鳞状上皮化生和移行上皮增生,是同一病理过程的不同阶段表现,可发生于整个尿路系统。大部分学者认为其中部分或全部病变为癌前病变,应予高度重视,及时治疗[1]。膀胱白斑过去认为是少见病,近年来报道呈增多趋势,可同时合并腺性膀胱炎[1]。2006年8月-2010年9月我院收治了98例女性膀胱白斑患者,     

女性抑郁障碍复发患者的社会心理因素分析

目的探讨社会心理因素与女性抑郁障碍复发的关系,旨在为女性抑郁障碍复发患者的有效护理提供可靠依据。方法选择210名女性抑郁障碍复发患者（观察组）以及217名女性抑郁障碍未复发患者（对照组）,使用自制调查表统计患者一般情况,汉密尔顿抑郁量表（HAMA-17）评估其临床症状,社会支持评定量表（SSRS）、生活事件量表（LES）、艾森克人格问卷（EPQ）评定其社会心理因素,并进行对比分析及Logistic回归分析。结果（1）观察组女性年龄偏大,首次发病年龄偏小,家族史明显,伴有焦虑症状更明显（P〈0．05）;SSRS量表中,社会主观支持、客观支持因子分均显著低于对照组[（21．69±5．24）分比（23．18±4．80）分,（9．00±2．77）分比（9．70±3．14）分],差异均有统计学意义（t值分别为3．07,2．45;P均〈0．05）;LES量表中,总生活事件量、负性生活事件量均高于对照组[（46．25±18．38）分比（32．39±19．34）分,（37．01±16．04）分比（26．86±12．07）分],差异均有统计学意义（t值分别为2．04,2．02;P均〈0．05）;EPQ问卷中,神经质分（16．37±4．93）高于对照组（9．21±4．52）,内外向分（6．75±4．56）低于对照组（13．44±4．37）,差异均有统计学意义（t值分别为9．47,9．51;P均〈0．05）。（2）Logistic回归分析结果显示：婚姻状况、阳性家族史、负性生活事件、神经质人格以及客观支持是女性抑郁障碍患者复发的重要危险因素。结论女性抑郁障碍反复发作与其一般状况及社会心理因素有关,为心理护理干预的实施提供了理论依据。     

舒适护理干预在高危腺性膀胱炎护理中的应用

目的:探讨对腺性膀胱炎患者实施舒适护理的有效方法,从而全面提升腺性膀胱炎的临床护理质量。方法:将我科2007年1月~2009年12月收治的60例腺性膀胱炎患者随机分为实验组和对照组,实验组应用常规护理+舒适护理干预,对照组给予常规护理。结果:实验组患者对护理工作满意度高于对照组,术后72 h内膀胱痉挛发生率低于对照组(P<0.05)。结论:舒适护理干预是腺性膀胱炎患者有效的护理方法,是实现人文关怀和整体护理的有效途径,体现了以人为本的护理内涵,提高了护理质量。     

复发性急性胰腺炎的影响因素和预后分析

目的 分析引起急性胰腺炎反复发作的影响因素及复发性胰腺炎的预后.方法 对我院收集的191例急性胰腺炎根据急性胰腺炎发作次数分为单发组和复发组,对两组的病史特点、临床表现和预后进行分析比较.结果 单发组156例(81.7%),复发组35例(18.3%),两组平均年龄无显著差异;男性复发率明显高于女性(P＜0.005),年龄相对集中于21～40岁.单因素分析显示:饮酒、高脂血症病史、血清高三酰甘油(TG)及高血糖与复发性急性胰腺炎(RAP)相关;逐步Logistic回归发现高TG血症、饮酒为RAP最有可能的影响因素.复发组病人发生重症胰腺炎的比例明显高于单发组(P＜0.005).结果 高TG血症及饮酒是急性胰腺炎反复发作重要的影响因素;RAP更容易发生急性重症胰腺炎.     

Risk factors for acute renal failure in trauma patients

Abstract Objective: To elucidate the risk factors for the development of acute renal failure (ARF) in severe trauma. Design: Prospective observational study. Setting: A general intensive care unit (ICU) of a university hospital. Patients: A cohort of 153 consecutive trauma patients admitted to the ICU over a period of 30 months. Results: Forty-eight (31 %) patients developed ARF. They were older than the 105 patients without ARF (p = 0.002), had a higher Injury Severity Score (ISS) (p < 0.001), higher mortality (p < 0.001), a more compromised neurological condition (p = 0.007), and their arterial pressure at study entry was lower (p = 0.0015). In the univariate analysis, the risk of ARF increased by age, ISS > 17, the presence of hemoperitoneum, shock, hypotension, or bone fractures, rhabdomyolysis with creatine phosphokinase (CPK) > 10 000 IU/l, presence of acute lung injury requiring mechanical ventilation, and Glasgow Coma Score < 10. Sepsis and use of nephrotoxic agents were not associated with an increased risk of ARF. In the logistic model, the need for mechanical ventilation with a positive end-expiratory pressure > 6 cm H₂O, rhabdomyolysis with CPK > 10 000 IU/l, and hemoperitoneum were the three conditions most strongly associated with ARF. Conclusions: The identified risk factors for post-traumatic acute renal failure may help the provision of future strategies. Received: 22 September 1997 Accepted: 14 May 1998     

彩色多普勒超声对腺性膀胱炎的声像图分型及诊断价值

目的探讨彩色多普勒超声对腺性膀胱炎的临床诊断价值。方法对39例腺性膀胱炎患者,采用彩色多普勒超声观察病变的位置、形态、边界、内部回声及病变与膀胱壁的关系,并应用彩色多普勒血流成像观察病变边缘及内部的血流分布,同时将其声像图表现进行分型。对比分析超声检查与膀胱镜活检或手术病理诊断结果。结果声像图表现分为囊状结节型5例、实体结节型8例、局部壁增厚型21例,弥漫性壁增厚型5例,59．0％（23／39）的病变位于膀胱三角区及尿道内口周围,69．2％（27／39）的病变内部见小囊状无回声区。彩色多普勒超声检查诊断腺性膀胱炎的准确率达84．6％（33／39）。结论彩色多普勒超声检查能清晰显示腺性膀胱炎病变的位置、边界、形态、内部回声及病变与膀胱壁的关系,对腺性膀胱炎的诊断、鉴别诊断和临床随访有重要作用。     

再发性心肌梗死患者的相关危险因素

目的:分析再发性心肌梗死的相关危险因素。方法:选择2000-05/2004-10阜新地区阜新市中心医院、阜新市第二人民医院、阜新矿务局总医院心内科住院的再发性心肌梗死患者47例为再发性心肌梗死组,男33例,女14例。选择同期在3家医院住院确诊为急性首发心肌梗死患者271例为对照组,男169例,女102例。两组患者均知情同意,并分别接受了下面内容调查和检测:①心血管病危险因素调查表(包括吸烟、饮食习惯、生活方式、是否参加体育锻炼、血糖、血脂等)。②症状自评量表,分值越高,代表精神状况越差。③生活事件量表中生活事件精神紧张值评分越高,遭遇负性生活事件越多,精神状况越差。④生物学和血生化指标检查。结果:按意向处理分析,进入结果分析再发性心肌梗死和急性心肌梗死患者分别为47和271例。①再发心肌梗死组的平均年龄、吸烟指数、未参加体育锻炼例数、平均症状自评量表总分和遭遇生活事件精神紧张值平均值均明显高于对照组犤(59±15)岁,(36.3±13.4)年支,68.1%(32/47),166.4±44.8,18.6±5.2;(56±11)岁,(25.0±9.3)年支,50.9%(138/271),141.6±39.6,10.2±3.3,t=2.249～4.131,χ2=4.092～4.550,P<0.05～0.01犦。②再发性心肌梗死组的平均收缩压、平均舒张压、体质量指数、平均静息心率、空腹血糖、总胆固醇和三酰甘油浓度均明显高于对照组(t=2.147～3.383,P<0.05～0.01),高密度脂蛋白胆固醇浓度明显低于对照组(t=3.126,P<0.01)。结论:首发性心肌梗死后行为因素及遭遇均为再发的危险因子,具有多项高危因子累积者是再发性心肌梗死的主要危险人群。     

Risk factors for acute pancreatitis in patients with accidental hypothermia

Background

Pancreatic damage is commonly observed as a consequence of accidental hypothermia (core body temperature below 35?°C). We aimed to investigate the risk factors for pancreatic damage and the causal relationship in patients with accidental hypothermia.

复发性胰腺炎139例病因分析

目的 探讨急性胰腺炎反复发作的诱发因素及复发性胰腺炎的预后.方法 对昆明医学院第一附属医院消化内科收集的832例急性胰腺炎患者根据发作次数分为单发组和复发组,对两组的病史特点、临床表现及预后分别进行比较.结果 单发组693例(83.3%),复发组139例(16.7%),两组患者年龄比较差异无统计学意义(P>0.05);而在复发组中男性比例明显高于女性(P<0.01),年龄相对集中在31~59岁,通过单因素分析显示:饮酒、胆结石病史、胆囊切除术后、高脂血症病史、血清高三酰甘油及高脂饮食病史等与复发性急性胰腺炎(RAP)相关;逐步Logistic回归分析发现:胆囊切除术后及胆结石病史为急性胰腺炎反复发作的最有可能的潜在危险因素.结论 胆囊切除术及胆结石病史是急性胰腺炎反复发作的高危因素,饮酒、高脂血症病史及高脂饮食也是RAP不容忽视的危险因素.     

彩色多普勒超声对腺性膀胱炎的鉴别诊断价值

目的 探讨彩色多普勒超声检查对腺性膀胱炎的鉴别诊断价值.方法 采用彩色多普勒超声检查39例腺性膀胱炎和192例膀胱癌患者,观察膀胱病变的位置、形态、边界、内部回声及其与膀胱壁的关系,并检查病变内部的血流分布,将其声像图表现进行对比分析.超声检查结果与膀胱镜活检或手术病理结果对照.结果 59.0%(23/39)腺性膀胱炎和52.9%(74/140)的单发膀胱癌病灶位于膀胱三角区及输尿管口周围;53.8%(21/39)的腺性膀胱炎表现为膀胱壁局限性增厚,72.9%(140/192)的膀胱癌为单发结节或团块,两者的病灶形态分布差异有统计学意义(P＜0.01);69.2%(27/39)的腺性膀胱炎病灶内部见囊状无回声区,而膀胱癌病变内均未见此声像改变;膀胱癌病灶边缘见点状强回声者占48.4%(93/192),而腺性膀胱炎仅为7.7%(3/39),二者差异有统计学意义(P＜0.01);彩色多普勒显示84.9%(163/192)膀胱癌病变内检出血流信号,其血流检出率明显高于腺性膀胱炎.彩色多普勒超声对腺性膀胱炎与膀胱癌的诊断准确率分别为84.6%(33/39)、95.3%(183/192).结论 彩色多普勒超声检查能清晰显示腺性膀胱炎的位置、边界、形态、内部回声及其与膀胱壁的关系,对腺性膀胱炎的鉴别诊断和临床随访有重要作用.     

Risk factors for recurrent emergency department visits for hyperglycemia in patients with diabetes mellitus

Background

Patients with poorly controlled diabetes mellitus may present repeatedly to the emergency department (ED) for management and treatment of hyperglycemic episodes, including diabetic ketoacidosis and hyperosmolar hyperglycemic state. The objective of this study was to identify risk factors that predict unplanned recurrent ED visits for hyperglycemia in patients with diabetes within 30 days of initial presentation.

Methods

We conducted a 1-year health records review of patients ≥18 years presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, diabetic ketoacidosis, or hyperosmolar hyperglycemic state. Trained research personnel collected data on patient characteristics and determined if patients had an unplanned recurrent ED visit for hyperglycemia within 30 days of their initial presentation. Multivariate logistic regression models using generalized estimating equations to account for patients with multiple visits determined predictor variables independently associated with recurrent ED visits for hyperglycemia within 30 days.

Results

There were 833 ED visits for hyperglycemia in the 1-year period. 54.6% were male and mean (SD) age was 48.8 (19.5). Of all visitors, 156 (18.7%) had a recurrent ED visit for hyperglycemia within 30 days. Factors independently associated with recurrent hyperglycemia visits included a previous hyperglycemia visit in the past month (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.1–5.8), age <25 years (OR 2.6, 95% CI 1.5–4.7), glucose >20 mmol/L (OR 2.2, 95% CI 1.3–3.7), having a family physician (OR 2.2, 95% CI 1.0–4.6), and being on insulin (OR 1.9, 95% CI 1.1–3.1). Having a systolic blood pressure between 90–150 mmHg (OR 0.53, 95% CI 0.30–0.93) and heart rate >110 bpm (OR 0.41, 95% CI 0.23–0.72) were protective factors independently associated with not having a recurrent hyperglycemia visit.

Conclusions

This unique ED-based study reports five risk factors and two protective factors associated with recurrent ED visits for hyperglycemia within 30 days in patients with diabetes. These risk factors should be considered by clinicians when making management, prognostic, and disposition decisions for diabetic patients who present with hyperglycemia.