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1.
Determinants for the Development of Oropharyngeal Colonization or Infection by Fluconazole-Resistant Candida Strains in HIV-Infected Patients 总被引:3,自引:0,他引:3
M. Masiá Canuto F. Gutiérrez Rodero V. Ortiz de la Tabla Ducasse I. Hernández Aguado C. Martín González A. Sánchez Sevillano A. Martín Hidalgo 《European journal of clinical microbiology & infectious diseases》2000,19(8):593-601
A point prevalence study to document oral yeast carriage was undertaken. Risk factors for the development of oropharyngeal
colonization or infection by fluconazole-resistant Candida strains in HIV-infected patients were investigated with a case-control design. Cases included all patients with fluconazole-resistant
strains (MIC≥64 μg/ml), and controls were those with susceptible (MIC≤8 μg/ml) or susceptible-dependent-upon-dose (MIC 16–32 μg/ml)
strains. One hundred sixty-eight Candida strains were isolated from 153 (88%) patients, 28 (16%) of whom had oropharyngeal candidiasis. Overall, 19 (12%) of the patients
harbored at least one resistant organism (MIC≥64 μg/ml). Among patients with resistant strains, tuberculosis (P<0.001), esophageal candidiasis (P=0.001), clinical thrush (P<0.001), and a CD4+ cell count <200/mm3 (P=0.03) were more frequent. These patients had also been treated more commonly with antituberculous drugs (adjusted odds ratio
[OR] 6.13; 95% confidence interval [CI] 2.11–17.80), ciprofloxacin (OR 6.0; 95% CI 1.23–29.26), fluconazole (OR 4.59; 95%
CI 1.55–13.52), and steroids (OR 4.13; 95% CI 1.11–15.39). Multivariate analysis showed that the determinants for fluconazole
resistance were therapy with antituberculous drugs (OR 3.61; 95% CI 1.08–12.07;P=0.03) and one of the following: previous tuberculosis (OR 3.53; 95% CI 1.08–14.57;P=0.03) or fluconazole exposure (OR 3.41; 95% CI 1.10–10.54). Findings from this study indicate that treatment with antituberculous
drugs, previous tuberculosis, and fluconazole exposure are the strongest determinants for development of oropharyngeal colonization
or infection by fluconazole-resistant Candida strains in HIV-infected patients. 相似文献
2.
Investigation on seroprevalence and risk factors of Toxoplasma gondii infections among indigenous and immigrant pregnant women in Mid-Taiwan showed that anti Taxoplasma-specific IgG antibody counts were significantly higher in indigenes (40.6%) than in immigrants (18.2%), with an odds ratio
of OR = 3.34 (95% CI: 1.93–4.80). The titre of Taxoplasma-specific IgG was also significantly higher in indigenes than in immigrants (P < 0.001). Differences of living styles for Toxoplasma infection between the two groups were drinking untreated water (OR = 2.34, 95% CI: 1.36–4.02), consumption of raw/undercooked
meats (OR = 10.11 95% CI: 4.92–20.78), especially raw/undercooked pork (P = 0.000), or raw/undercooked viscera (OR = 9.16, 95% CI: 2.97–27.94), contact with cats (OR = 5.69, 95% CI: 2.83–11.47),
or soil (OR = 2.55 95% CI: 1.72–3.80). Differences of risk factors for Toxoplasma infection in terms of positive IgG in the two groups were consumption of raw/undercooked meats (P = 0.005) especially raw/undercooked pork (P = 0.004), and contact with cats (P = 0.013) or soil (P = 0.028). It is concluded that seroprevalence of Toxoplasma infection is higher in indigenous pregnant women and related to their living styles. To prevent congenital toxoplasmosis,
health education seems required. 相似文献
3.
O. Santiago J. Gutierrez A. Sorlozano J. de Dios Luna E. Villegas O. Fernandez 《European journal of clinical microbiology & infectious diseases》2010,29(7):857-866
Numerous studies have been carried out to determine whether infection by the Epstein-Barr virus (EBV) can be considered as
a risk factor for multiple sclerosis (MS). This work is a meta-analysis of case–control observational studies published before
January 2009 aimed at assessing the degree of association between EBV and MS infections. A Medline electronic database search
was carried out using “Epstein-Barr virus” and “multiple sclerosis” as keywords, from which we selected 30 published studies
that met our methodology criteria. We found an association between MS and an exposure to EBV, studied by determining the anti-VCA
IgG antibodies (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 3.37–8.81; p < 0.0001), anti-complex EBNA IgG (OR = 5.4; 95% CI = 2.94–9.76; p < 0.0001) and anti-EBNA-1 IgG (OR = 12.1; 95% CI = 3.13–46.89; p < 0.0001). No significant association could be found when studying anti-EA IgG (OR = 1.3; 95% CI = 0.68–2.35; p = 0.457), EBV DNA in serum (OR = 1.8; 95% CI = 0.99–3.36; p = 0.051) and DNA in brain tissues and in cerebrospinal fluid (CSF) (OR = 0.9; 95% CI = 0.38–2.01; p = 0.768). This meta-analysis detected an association between infection by EBV and MS through the investigation of antibodies,
mainly anti-EBNA-1, anti-complex EBNA and anti-VCA IgG. 相似文献
4.
L. Lorente A. Jiménez M. M. Martín J. Castedo R. Galván C. García M. T. Brouard M. L. Mora 《European journal of clinical microbiology & infectious diseases》2009,28(9):1141-1145
Although there are many studies on catheter-related infection, there are scarce data about the influence of tracheostomy in
the incidence of central venous catheter-related bacteremia (CRB). In this cohort study, we found a higher incidence of CRB
in patients with tracheostomy than without (11.25 vs. 1.43 per 1,000 catheter-days; odds ratio [OR] = 7.99; 95% confidence
interval [CI] = 4.38–infinite; P < 0.001). Besides, we found a higher incidence of CRB in patients with tracheostomy using the jugular access compared to
subclavian access (21.64 vs. 5.11 per 1,000 catheter-days; OR = 4.23; 95% CI = 1.44–infinite; P = 0.0097). 相似文献
5.
M. Ortega F. Marco A. Soriano M. Almela J. A. Martínez J. López C. Pitart J. Mensa 《European journal of clinical microbiology & infectious diseases》2011,30(12):1599-1605
We attempt to describe the epidemiology and outcome associated with cefotaxime-resistant (CTX-R) Klebsiella spp bacteraemia. Klebsiella spp bloodstream infection episodes prospectively collected through a blood culture surveillance programme from January 1991
to December 2008 in a single institution were analysed. A total of 910 monomicrobial episodes of Klebsiella spp bacteraemia were identified during the study period. The most important sources were from urinary tract infection, unknown
sources, billiary focus and catheter related infection. There were 112 (12%) CTX-R isolates. Out of 112 isolates, 98 were
CTX-R by Extended-Spectrum β-Lactamase production. Shock on presentation and mortality were significantly more frequent in
CTX-R than in CTX susceptible isolates. Inappropriate empirical therapy was received in 50 (45%) cases in the CTX-R Klebsiella spp group (13 cases of death, 26%). Predictive factors associated with CTX-R Klebsiella spp isolate were: previous β-lactam therapy (OR = 4.16), nosocomial acquired bacteraemia (OR = 1.93), solid organ trasplantation
(OR = 2.09) and shock (OR = 1.90). Independent risk factors associated with mortality in Klebsiella spp bacteraemia were: age (OR = 1.03), liver cirrhosis (OR = 2.63), ultimately or rapidly fatal prognosis of underlying disease
(OR = 2.44), shock (OR = 8.60), pneumonia (OR = 4.96) or intraabdominal (OR = 3.85) source of bacteraemia and CTX-R isolate
(OR = 4.63). Klebsiella spp is an important cause of bloodstream infection. CTX-R isolates have been increasing since 2000. CTX-R is an independent
factor associated with mortality in Klebsiella spp bacteraemia. 相似文献
6.
Anubha Mahajan Rubina Tabassum Sreenivas Chavali Om Prakash Dwivedi Ganesh Chauhan Nikhil Tandon Dwaipayan Bharadwaj 《Journal of molecular medicine (Berlin, Germany)》2010,88(5):515-522
Six common genetic variants (rs2229094, rs1041981, rs1800630, rs1800629, rs361525, and rs1800610) in the TNF-LTA locus encoding the pro-inflammatory cytokines tumor necrosis factor-alpha (TNF-α) and lymphotoxin-α have been shown to be
associated with various metabolic traits including susceptibility to type 2 diabetes, metabolic syndrome, insulin resistance,
and increased body mass index (BMI) in Caucasians from different geographic locations and have yielded mixed results. We tested
for the association of these variants with type 2 diabetes in North Indians by studying 2,115 participants comprising of 1,073
type 2 diabetes patients and 1,042 controls. We report the association of a promoter region variant of TNF: rs1800630 and non-synonymous LTA variant: rs2229094 with type 2 diabetes [OR = 0.83 (95% CI 0.72–0.95), P = 0.005 and OR = 0.86 (95% CI 0.75–0.98), P = 0.02, respectively]. Although these associations were BMI-dependent, no interactive effect of BMI and variants on type
2 diabetes was detectable. Further, the haplotype carrying all the six major alleles conferred susceptibility to type 2 diabetes
[OR = 1.23 (95% CI 1.06–1.42), P = 0.005; P
permuted = 0.02], with the effect much enhanced in non-obese subjects [OR = 1.45 (95% CI 1.19–1.78), P = 2 × 10−4: P
permuted = 3 × 10−4]. The minor allele of rs2229094 was associated with lower hsCRP, BMI, and waist circumference (WC), while the minor allele
of rs1800630 showed association with lower BMI and WC (all P < 0.01). This is the first report demonstrating association of rs1800630 and rs2229094 with type 2 diabetes in any population,
suggesting an important role of the TNF-LTA locus in type 2 diabetes in North Indians. 相似文献
7.
D. Bendayan A. Hendler V. Polansky M. Weinberger 《European journal of clinical microbiology & infectious diseases》2011,30(3):375-379
MDR-TB has emerged in Israel following an immigrations wave from the Former Soviet Union (FSU) and Ethiopia. The purpose of
this study was to outline characteristics and outcome of hospitalized MDR-TB patients. We retrospectively summarized charts
of MDR-TB patients hospitalized in the national referral tuberculosis centers from January 2000 to December 2005, and followed
them for 2 years. One hundred thirty-two patients were identified with a median age of 40 years and male predominance (77%).
The majority of the patients were immigrants from FSU (83%) and Ethiopia (7.6%). They were characterized by alcohol (25.8%)
and IV drug abuse (23.5%), presented with advanced disease manifested by hypoalbuminemia (50.8%) and smear positivity (70.5%).
Cure was achieved in 50.3% and 30.4% died. Factors independently associated with death were patients’ age (OR = 1.036 for
each year, 95%CI 1.0–1.1, p = 0.014), hypoalbuminemia (OR = 2.95, 95%CI 1.1–7.6, p = 0.025), smear positivity at diagnosis (OR = 3.7, 95%CI 1.2–11.4, p = 0.023), alcohol abuse (OR = 4.8, 95%CI 1.7–13.7, p = 0.004) and XDR-TB resistance pattern (OR 8.3, 95%CI 1.5–44.6, p = 0.014). This study brings out the poor prognosis of a highly vulnerable immigration population. Efforts should be focused
on earlier diagnosis and treatment in a well controlled hospital environment and to professional support groups to attend
to this population’s special needs. 相似文献
8.
Ü. Parm T. Metsvaht E. Sepp M.-L. Ilmoja H. Pisarev M. Pauskar I. Lutsar 《European journal of clinical microbiology & infectious diseases》2010,29(7):807-816
The purpose of this study was to compare the impact of ampicillin and penicillin used for empiric treatment of early onset
sepsis (EOS) on initial gut colonization by aerobic and facultative anaerobic microorganisms. A cluster-randomized, two-center,
switch-over study was conducted in two paediatric intensive care units in Estonia and included 276 neonates. Rectal swabs
were collected twice a week until discharge or day 60. Colonizing microbes were identified on species level and tested for
ampicillin resistance (AR). The number of patients colonized with Gram negative microorganisms and Candida spp was similar in both treatment arms but ampicillin resulted in longer colonization duration (CD) of K. pneumonia (p = 0.012), AR Serratia spp (p = 0.012) and Candida spp (p = 0.02) and penicillin in that of AR Acinetobacter spp (p = 0.001). As for Gram positive microorganisms penicillin treatment was associated with a greater number of colonized patients
and higher CD of Enterococcus spp and S. aureus but lower ones of S. haemolyticus and S. hominis. Influence of ampicillin and penicillin on initial gut colonization is somewhat different but these differences are of low
clinical relevance and should not be a limiting step when choosing between these two antibiotics for the empiric treatment
of EOS. 相似文献
9.
H.-L. Hsu C.-C. Lai M.-C. Yu F.-L. Yu J.-C. Lee C.-H. Chou C.-K. Tan P.-C. Yang P.-R. Hsueh 《European journal of clinical microbiology & infectious diseases》2011,30(3):319-326
All patients with urine culture-confirmed genitourinary tuberculosis (GUTB) diagnosed between 1995 and 2007 at two medical
centers in northern Taiwan were included in this retrospective study. Genotypes of 48 preserved Mycobacterium tuberculosis (MTB) isolates from these patients were determined by spoligotyping and double repetitive element PCR (DRE-PCR) analysis.
Among the 64 patients, 38 (59.4%) were male with a mean ±SD age of 60.3 ± 16.1 years old. The overall mortality rate was 26.2%.
Poor prognostic factors included age over 65 years (HR = 4.03; 95%; CI: 1.27–12.76), cardiovascular disease (HR = 5.96; 95%
CI: 1.98–17.92), receiving steroids (HR = 10.16; 95% CI: 2.27–45.47), not being treated (HR 4.81; 95% CI 1.12–20.67). Spoligotyping
and DRE-PCR of the 48 MTB isolates revealed that 20 (41.7%) belonged to the Beijing family and 40 (83.3%) had a clustering
pattern. Identification of a Beijing family isolate was not correlated with drug resistance or mortality. Clustering strains
were likely to be resistant to isoniazid (OR = 4.71; 95% CI: 1.10 to 23.53). In this study of patients with urine culture-confirmed
GUTB, age and coexisting diseases were independently associated with an unfavorable outcome. The Beijing family was the dominant
genotype of GUTB isolates, but did not correlate with drug resistance or outcome. 相似文献
10.
J. Acosta M. Catalan A. del Palacio-Pérez-Medel J.-C. Montejo J. De-La-Cruz-Bértolo M.-D. Moragues J. Pontón M. A. Finkelman A. del Palacio 《European journal of clinical microbiology & infectious diseases》2012,31(5):721-731
Diagnosis of invasive fungal disease (IFD) in patients under intensive care is challenging. Circulating biomarkers, (1,3)-β-D-glucan
(BG) and galactomannan (GM), were prospectively assessed in 98 critically ill patients at risk of IFD. There were 11 cases
of invasive aspergillosis (IA; 4 proven and 7 probable), 9 cases of proven invasive candidiasis (IC), 1 case of mixed proven
IC and probable IA, 1 case of proven zygomycosis, and 1 case of mixed mycelial proven IFD. In all IA cases there was no significant
difference when the area under the receiver operating characteristic curve (AUC) of GM (0.873 [95%CI, 0.75–0.99]) and BG (0.856
[95% CI, 0.71–0.99]) were compared (p = 0.871). The AUC for BG in IC and for the rest of the IFD cases was 0.605 (95% CI, 0.39–0.82) and 0.768 (95% CI, 0.63–0.90)
respectively. Positive BG (40%) predated blood culture (n = 3) and abdominal pus (n = 1) a mean of 3.25 days before Candida was grown. In patients with IFD caused by molds, BG appeared a mean of 5.65 days before culture results. For the diagnosis
of patients at risk of IC, BG has shown a high NPV (94.5%), with positive results also predating blood cultures in 30% of
patients. In conclusion, early BG results permit a timely initiation of antifungal therapy in patients at risk of IFD. 相似文献
11.
Alagarasu K Selvaraj P Swaminathan S Narendran G Narayanan PR 《Journal of clinical immunology》2009,29(2):196-204
Introduction Vitamin D receptor (VDR) gene polymorphisms in the 5′ regulatory region (Cdx2 and A-1012G), coding region (FokI), and 3′ untranslated region (UTR; BsmI, ApaI, and TaqI) were studied to find out whether these polymorphisms are associated with susceptibility to or protection against HIV-1
and development of tuberculosis (TB) in human immunodeficiency virus (HIV)-1-infected patients.
Study Subjects and Methods The study was carried out in 131 HIV patients without TB (HIV+ TB−) and 113 HIV patients with TB (HIV+ TB+; includes 82 patients
with pulmonary TB (HIV+ PTB+) and 31 with extra pulmonary TB), 108 HIV-negative pulmonary TB patients (HIV− PTB+), and 146
healthy controls.
Results Among the 5′ regulatory and coding region polymorphisms, significantly increased frequency of G/A genotype of Cdx-2 was observed
in HIV+ TB− group compared to controls (p = 0.012, odds ratio (OR) 1.89 95% confidence interval (CI) 1.14–3.15). In the 3′ UTR genotypes, a decreased frequency of
b/b genotype of BsmI in total HIV patients (p = 0.014, OR 0.54 95% CI 0.32–0.89) and increased frequencies of A/A genotype of ApaI in HIV+ TB+ patients (p = 0.041, OR 1.77 95% CI 1.02–3.06) and t/t genotype of TaqI in HIV+ PTB+ patients (p = 0.05, OR 2.32 95% CI 0.99–5.46) were observed compared to controls. Haplotype analysis revealed significantly increased
frequencies of 3′ UTR haplotype B-A-t in HIV+ TB+ and HIV+ PTB+ groups (Pc = 0.030, OR 1.75 95% CI 1.14–2.66) and decreased
frequencies of b-A-T haplotype in total HIV patients (Pc = 0.012, OR 0.46 95% CI 0.27–0.77), HIV+ TB− (p = 0.031 OR 0.48 95% CI 0.25–0.89), and HIV+ PTB+ groups (Pc = 0.04, OR 0.47 95% CI 0.23–0.89) compared to controls.
Conclusions The results suggest that VDR gene 3′ UTR haplotype b-A-T may be associated with protection against HIV infection while B-A-t
haplotype might be associated with susceptibility to development of TB in HIV-1-infected patients. 相似文献
12.
V. G. Alexiou A. Michalopoulos G. C. Makris G. Peppas G. Samonis M. E. Falagas 《European journal of clinical microbiology & infectious diseases》2012,31(4):557-566
We sought to identify risk factors for postoperative infections, caused by multi-drug-resistant gram-negative bacteria (MDR-GNB)
in surgical patients. This was a retrospective cohort study among patients hospitalized in the intensive care unit (ICU) for
more than 5 days, following general surgical operations. Comparison of patients who developed infection caused by MDR-GNB
with the remainder of the cohort showed that every minute of operative time, use of special treatments during hospitalization
(antineoplastic, immunosuppressive or immunomodulating therapies), every day of metronidazole, and every day of carbapenems
use, increased patients’ odds to acquire an infection caused by MDR-GNB by 0.7%, 8.9 times, 9%, and 9%, respectively [OR (95%
CI): 1.007 (1.003–1.011), p = 0.001; 8.9 (1.8–17.3), p = 0.004; 1.09 (1.04–1.18), p = 0.039; 1.09 (1.01–1.18), p = 0.023, respectively]. The above were adjusted in the multivariable analysis for the confounder of time distribution of
infections caused by MDR-GNB. Finally, the secondary comparison, with patients that did not develop any infection, showed
that patients who had received antibiotics, within 3 months prior to admission, had 3.8 times higher odds to acquire an infection
caused by MDR-GNB [OR (95% CI): 3.8 (1.07–13.2), p = 0.002]. This study depicts certain, potentially modifiable, risk factors for postoperative infections in patients hospitalized
in the ICU for more than 5 days. 相似文献
13.
Ramani P Dungwa JV May MT 《Virchows Archiv : an international journal of pathology》2012,460(2):183-191
Neuroblastoma (NB) accounts for 15% of all childhood cancer deaths. The majority of patients have widespread lymphatic and/or
haematogenous metastases at diagnosis, but lymphangiogenesis has not been well documented. Sixty-seven NBs were immunostained
for the lymphatic endothelial marker, LYVE-1, and the lymphatic density (LD) and lymphatic invasion (LI), were counted in
LYVE-1-expressing lymphatics. LYVE-1-stained lymphatic vessels and LI were present in 26/67 (39%) and 14/67 (21%) of the NBs,
respectively. Central LD (CLD) and LI were higher in NBs from stage 4 (p = 0.012, p = 0.004, respectively), high-risk group (p = 0.030, p = 0.002), NBs with high mitosis karyorrhexis index (MKI) (p = 0.011, p = 0.005), unfavourable histology group (p = 0.040, p = 0.017) and distant lymph node metastasis (LNM) (p < 0.001 for each). Marginal LD (MLD) was higher in patients with LNM (p < 0.001). CLD and MLD correlated with LI (p < 0.001 each). Total LYVE-1 protein levels, quantified by a sensitive enzyme-linked immunosorbent assay (n = 55), were also higher in NBs from patients with stage 4 disease (p = 0.046), high-risk group (p = 0.028), MYCN-amplified NBs (p = 0.034) and LNM (p = 0.038). Kaplan–Meier analysis showed that the presence of CLD was associated with both worse OS at 5 years (77% [95% CI:
62–87%] versus 60% [95% CI: 32–80%], p = 0.062) and EFS (74% [95% CI: 58–85%] versus 43% [95% CI: 15–69%], p = 0.070) and LI with OS (71% [95% CI: 57–81%] versus 56% [95% CI: 26–78%], p = 0.055). Significant upregulation of LYVE-1 and the presence of LI in patients with stage 4 and high-risk disease, MYCN-amplification and LNM suggests that LYVE-1 may have value as predictors of outcome. 相似文献
14.
Y. Bitterman A. Laor S. Itzhaki G. Weber 《European journal of clinical microbiology & infectious diseases》2010,29(4):391-397
The purpose of this study was to identify differences in the sensitivity of anatomical sites sampling for methicillin-resistant
Staphylococcus aureus (MRSA) colonization related to age, gender, clinical situation, and acquisition source as a base for screening protocols.
We used a database that included all MRSA-positive cultures (Carmel Medical Center, 2003–2006) taken from nares, throat, perineum,
and infection sites. The study population of 597 patients was divided into: “screening sample” (SS), which were cases of routine
screening, and “clinical diagnostic sample” (CDS), which were patients with concurrent MRSA infection. MRSA acquisition sources
were classified as internal medicine, surgical, referral patients, or intensive care unit (ICU). CDS patients were older than
SS patients (median age 78 vs. 74 years, p = 0.0002), more commonly throat colonized (47.5% vs. 31.8%, p = 0.0001), and colonized in more multiple sites (65.7% vs. 43.3% were colonized in three sites in the CDS and SS groups,
respectively, p < 0.001) than SS patients. In the SS, group throat colonization was higher in internal medicine wards than in the ICU (odds
ratio [OR] = 3.98, p < 0.0001). In the CDS group, perineal colonization was more common in referral patients than in the ICU (OR = 4.52, p < 0.05). Patient age was the most influential factor on nares and multiple sites colonization in the SS and CDS groups, respectively.
Our data support multiple sites sampling. Throat cultures are crucial in MRSA-infected patients and internal medicine ward
patients. Multiple body sites colonization is more likely in older or MRSA-infected patients, affecting decisions regarding
eradication using topical antibiotics. 相似文献
15.
Ewa Lech-Maranda Jacques Bienvenu Florence Broussais-Guillaumot Krzysztof Warzocha Anne-Sophie Michallet Tadeusz Robak Bertrand Coiffier Gilles Salles 《Archivum immunologiae et therapiae experimentalis》2010,58(2):131-141
Tumor necrosis factor (TNF)-α and interleukin (IL)-10 are key cytokines involved in lymphoma development. Their pretreatment
plasma levels were reported to influence the clinical course of non-Hodgkin’s lymphoma. In this study the impact of combined
elevation of TNF-α and IL-10 on disease features and outcome of patients with diffuse large B-cell lymphoma (DLBCL) were investigated.
Plasma TNF-α and IL-10 levels were determined at the time of diagnosis in a group of 106 DLBCL patients uniformly treated
with anthracycline-based regimens. Three risk groups depending on the pretreatment levels of the cytokines were identified:
low-, intermediate-, and high-risk groups. In univariate analysis, the cytokine intermediate- and high-risk groups were associated
with lower probability of achieving a complete remission (odds ratio [OR] = 0.2, 95% confidence interval [CI] 0.06–0.6, p = 0.006 and OR = 0.05, 95% CI 0.01–0.2, p < 0.0001, respectively) and shorter progression-free survival (PFS) (OR = 4.4, 95% CI 1.9–10.2, p < 0.001 and OR = 9.7, 95% CI 4.1–23.0, p < 0.0001, respectively) and overall survival (OS) (OR = 4.2, 95% CI 1.7–10.1, p = 0.002 and OR = 11.2, 95% CI 4.4–28.4, p < 0.0001, respectively) in comparison with the cytokine low-risk group. In multivariate analysis, the cytokine intermediate-
and high-risk groups also correlated with shorter PFS (relative risk [RR] = 4.5, 95% CI 1.9–10.9, p = 0.001 and RR = 5.8, 95% CI 2.2–15.3, p < 0.0001, respectively) and OS (RR = 4.6, 95% CI 1.8–12.0, p = 0.001 and RR = 7.5, 95% CI 2.7–20.9, p < 0.0001, respectively) regardless of the International Prognostic Index (IPI) scoring system. The TNF-α and IL-10 level-based
index may work as an additional model to the IPI for predicting the survival of DLBCL patients. This model may help to identify
patients in a given IPI risk group for whom more accurate and risk-adapted treatment could be advised. 相似文献
16.
M. L. Fernández Guerrero J. González López M. Górgolas 《European journal of clinical microbiology & infectious diseases》2010,29(10):1271-1275
The purposes of this paper was to discover whether cirrhosis is a predisposing cause of infectious endocarditis (IE) and to
determine the microbiology, prognosis and the role of cardiac surgery on mortality. A review of cases of IE at a university-affiliated
hospital over a period of 10 years was conducted. Thirty-one (9.8%) patients among 316 cases of IE had hepatic cirrhosis.
Valve disorders were present in 62.2% of cirrhotic patients and infection occurred on the aortic (48%) and mitral valves (45%).
Endocarditis was hospital-acquired in 14 (45%) and 11 (17.7%) cirrhotic patients and controls, respectively (odds ratio [OR]
3.82; 95% confidence interval [CI]: 1.46–9.99; p = 0.005). Staphylococcus aureus was the most common causative microorganism, but β-hemolytic streptococci were most frequently isolated in cirrhotic patients
(OR 8.75; 95% CI: 1.7–45.2; p = 0.001). Renal failure was more frequent in patients with cirrhosis (OR 8.23; 95% CI: 3.06–22.2; p = 0.001). Cirrhotic patients had a higher mortality (51% vs. 17.7%; OR 4.95; 95% CI: 1.89–12.91; p = 0.001) associated with the severity of liver disease. Valve replacement was performed less frequently in cirrhotic patients
(56.2% vs. 92%) and the operative mortality was extremely high in patients at stages B and C. Hepatic cirrhosis is a frequent
comorbid condition in patients with endocarditis. Due to the presence of severe hepatic dysfunction, cardiac surgery is not
undertaken even when indicated and mortality is high in stages B and C. Endocarditis is a serious hazard for hospitalized
cirrhotic patients. 相似文献
17.
A. Abbo Y. Carmeli S. Navon-Venezia Y. Siegman-Igra M. J. Schwaber 《European journal of clinical microbiology & infectious diseases》2007,26(11):793-800
We conducted a retrospective matched cohort study to examine the impact of isolation of multi-drug-resistant (MDR) Acinetobacter baumannii on patient outcomes. Cases from whom MDR A. baumannii was isolated in a clinical culture (n = 118) were compared with controls from whom MDR A. baumannii was not isolated (n = 118). Cases and controls were matched according to ward, calendar month of hospitalization, and duration of hospitalization
before culture. The following outcomes were compared in multivariable analysis: in-hospital mortality, length of stay, need
for mechanical ventilation, and functional status at discharge. MDR A. baumannii was determined to be a pathogen in 72% of cases. In 36% of cases, the patient died, versus 21% of controls (odds ratio [OR]
2.21, 95% confidence interval [CI] 1.17–4.16, P = 0.014). Median length of stay for surviving cases was 17 days, versus 11 for surviving controls (multiplicative effect
1.55, 95% CI 0.99–2.44, P = 0.057). Fifty-two percent of cases required mechanical ventilation, versus 25% of controls (OR 3.72, 95% CI 1.91–7.25,
P<0.001); 60% of surviving cases were discharged with reduced functional status, versus 38% of controls (OR 4.4, 95% CI 1.66–11.61,
P = 0.003). In multivariable analysis, clinical isolation of MDR A. baumannii remained a significant predictor of mortality (OR 6.23, 95% CI 1.31–29.5, P = 0.021), need for mechanical ventilation (OR 7.34, 95% CI 2.24–24.0, P<0.001), and reduced functional status on discharge (OR 7.93, 95% CI 1.1–56.85, P = 0.039). Thus, MDR A. baumannii acquisition is associated with severe adverse outcomes, including increased mortality, need for mechanical ventilation, and
reduced functional status. 相似文献
18.
José Wilton Pinheiro Rinaldo Aparecido Mota Andréa Alice da Fonseca Oliveira Eduardo Bento Faria Luis Fernando Pita Gondim Aristeu Vieira da Silva Giulliano Aires Anderlini 《Parasitology research》2009,105(3):709-715
The aim of this study was to evaluate the prevalence of anti-Toxoplasma gondii antibodies and to identify risk factors associated to the infection in the three meso-regions of the State of Alagoas, Brazil.
A total count of 23 towns and 27 meat sheep farms were visited where blood samples were collected in order to perform the
indirect immunofluorescence test to evaluate the antibodies presence. Questionnaires exploring the production system and nutritional,
sanitary, and reproduction handling were handed out. The prevalence rate was 32.9% and the number of foci was 100%. In the
multivariate statistical analysis, there was a significant association for the following variables: age (OR = 4.01; C.I. 2.03–7.94),
size of the property (or the farm; OR = 0.48; C.I. 0.26–0.90), semi-intensive rearing system (OR = 3.17; C.I. 1.24–8.13),
running water source (OR = 3.13; C.I.–1.66–5.87), and presence of cats (OR = 1.72; C.I. 1.08–2.75). It is concluded that sheep
of the three meso-regions of the State of Alagoas are exposed to the infection caused by T. gondii with high prevalence. Control and prophylactic measures must be adopted seeking the improvement of the rearing system and
the implantation of health promoting programs in cooperation with sheep farmers in order to elucidate the transmission means
of this disease. 相似文献
19.
I. Suárez-García A. Rodríguez-Blanco J. L. Vidal-Pérez M. A. García-Viejo M. J. Jaras-Hernández O. López A. Noguerado-Asensio 《European journal of clinical microbiology & infectious diseases》2009,28(4):325-330
The setting for this retrospective cohort study was a specialised tuberculosis unit in Madrid, Spain. The objective was to
describe the risk factors for multidrug-resistant tuberculosis (MDR-TB). The medical records of all patients admitted to the
unit were reviewed retrospectively to identify factors associated with multidrug resistance. Patients with positive culture
for M. tuberculosis and with available drug-susceptibility tests were included. The variables assessed were age, gender, country of origin, homelessness,
alcohol consumption, intravenous drug use, methadone substitution therapy, contact with a tuberculosis patient, sputum smear,
site of disease, previous tuberculosis treatment, HIV infection, history of imprisonment, diabetes mellitus and chronic obstructive
pulmonary disease. Thirty patients with MDR-TB and 666 patients with non-MDR-TB were included from the years 1997 to 2006.
The only factors associated with MDR-TB in multivariate analysis were previous tuberculosis treatment (OR: 3.44; 95% CI: 1.58–7.50;
p = 0.003), age group 45–64 years (OR: 3.24; 95% CI: 1.34–7.81; p = 0.009) and alcohol abuse (OR: 0.12; 95% CI: 0.03 to 0.55; p = 0.003). In our study, patients who had had previous treatment for tuberculosis, who were 45–64 years of age or who had
no history of alcohol abuse were more likely to have MDR-TB. 相似文献
20.
Tahara T Shibata T Nakamura M Okubo M Yamashita H Yoshioka D Yonemura J Hirata I Arisawa T 《Virchows Archiv : an international journal of pathology》2011,458(2):205-211
CpG island hypermethylation (CIHM) is frequently observed in the colonic mucosa in ulcerative colitis (UC) and is deeply involved
in UC-associated colorectal carcinogenesis. We evaluated the influence of common polymorphisms related to DNA repair or xenobiotic
pathway (XRCC1, GSTP1, GSTT1, and GSTM1) on the individual susceptibility to CIHM status in the non-neoplastic rectal mucosa
in UC patients. XRCC1 Arg399Gln and Arg194Trp, GSTP1 Ile104Val, and GSTT1, GSTM1 null polymorphisms were genotyped in 84 UC
patients without neoplastic lesions, in relation to CIHM in the rectal mucosa of three candidate CpG loci (p14, p16, and CDH1)
assessed by methylation-specific polymerase chain reaction. XRCC1 codon 399 Arg/Gln genotype (odds ratio (OR) = 0.31, 95%CI = 0.12–0.81,
p = 0.017) and 399 Gln carrier (GlnGln+Arg/Gln: OR = 0.30, 95%CI = 0.12–0.76, p = 0.01) were significantly associated with reduced susceptibility to CIHM of the CDH1 promoter. GSTP1 Val carrier (Ile Val+Val/Val)
also held a significantly lower susceptibility to CIHM of the p16 promoter (OR = 0.26, 95%CI = 0.08–0.86, p = 0.028). In contrast, GSTT1 present genotype (OR = 3.16, 95%CI = 1.27–7.89, p = 0.01) was significantly associated with increased susceptibility to CIHM of the same gene. XRCC1 codon 399 Gln/Gln genotype
was significantly associated with lower mean number of CIHM when compared to the Arg/Arg genotype (1.53 ± 1.01 vs. 0.63 ± 1.06,
p = 0.024). In addition, the GSTP1 Ile/Val carrier (Ile/Val+Val/Val) was also significantly associated with lower mean number
of CIHM (1.43 ± 1.03 vs. 0.84 ± 1.07, p = 0.03). XRCC1 Arg399Gln and GSTP1 Ile104Val polymorphisms may influence the CIHM status in the rectal mucosa of UC patients
and may be substantially involved in UC-associated carcinogenesis. 相似文献