Ecthyma gangrenosum in Saudi Arabia

We report a diagnosis of ecthyma gangrenosum EG in 4 females of mean age 54.8 range 43-64 years, within 10 months. Severe drug reaction treated with high dose systemic corticosteroids in patient one, acute myelocytic leukemia treated with high dose dexamethasone, and multiple broad-spectrum antibiotics in patient 2 preceded the onset of EG. Patients 3 and 4 had vasculitic purpura and hemodialysis. In addition, patient 3 was receiving multiple broad-spectrum antibiotics plus anti-tuberculosis TB drugs for gastric TB, while patient 4 was on melphalan and high dose systemic corticosteroids. Pseudomonas aeruginosa was isolated from blood culture of the first 3 patients, and skin culture of patient one. Blister aspirate from patient 4 yielded Candida albicans. Factors enhancing skin invasion by pathogenic organisms in our patients were breached skin integrity, therapy with high dose corticosteroids and multiple broad-spectrum antibiotics, hematologic malignancies and chemotherapy with severe neutropenia.     

311例新生儿败血症病原体分离及其耐药性分析

目的分析新生儿重症监护病房新生儿败血症的病原体分布、临床特点、细菌耐药情况及治疗效果。方法回顾性分析新生儿重症监护病房新生儿败血症311例患儿的临床资料。结果早发型败血症患者中,病原菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、B族溶血性链球菌、屎肠球菌等;晚发型败血症患者中,依次为凝固酶阴性葡萄球菌、肺炎克雷伯菌、大肠杆菌、铜绿假单胞菌、白色念珠菌等。早发型和晚发型败血症中都是凝固酶阴性葡萄球菌败血症发生率最高,且耐药率很高。肺炎克雷伯菌和大肠杆菌中产超广谱β-内酰胺酶高,感染致败血症病情危重。肺炎克雷伯菌是医院感染的主要致病菌,占50%。结论凝固酶阴性葡萄球菌已成为新生儿血培养的首位菌,其耐药性日渐严重。肺炎克雷伯菌是新生儿重症监护病房内医院感染的重要致病菌,它和大肠杆菌败血症的病情均凶险,病死率高。     

Inhibition of intestinal epithelial apoptosis and survival in a murine model of pneumonia-induced sepsis

CONTEXT: Increased intestinal epithelial apoptosis is present in both human autopsy studies and animal models of sepsis. Whether altering gut apoptosis decreases mortality in sepsis induced by pathogenic bacteria outside the gut is unknown. OBJECTIVE: To determine if decreasing levels of intestinal cell death improves survival in a murine model of Pseudomonas aeruginosa pneumonia-induced sepsis. DESIGN AND MATERIALS: Prospective study in which transgenic mice that overexpress the antiapoptotic protein Bcl-2 in their intestinal epithelium (n = 25) and control littermates (n = 26) were subjected to intratracheal injection of P aeruginosa. MAIN OUTCOME MEASURES: Survival at 7 postoperative days, compared between the 2 groups. Secondary outcomes included quantification of gut epithelial apoptosis. RESULTS: Survival in transgenic mice that overexpress Bcl-2 in the intestinal epithelium was 40% (10/25) compared with 4% (1/26) in control littermates 7 days after intratracheal injection of P aeruginosa (P =.001), with differences in survival noted within 24 hours of surgery. Overexpression of Bcl-2 was associated with a decrease in gut epithelial apoptosis demonstrated by active caspase 3 staining, the terminal deoxynucleotidyltransferase-mediated dUTP nick end-labeling assay, and hematoxylin-eosin staining. CONCLUSIONS: In this murine model, inhibiting gut epithelial apoptosis by overexpression of Bcl-2 was associated with a survival advantage in P aeruginosa pneumonia-induced sepsis. These results suggest that intestinal epithelial apoptosis may play a role in sepsis-related mortality.     

16SrRNA基因聚合酶链反应快速检测烧伤脓毒症细菌病原体的研究

目的为早期诊断烧伤脓毒症，探索一种能迅速检测细菌感染的方法。方法按标准收集可疑脓毒症患者39人外周静脉血标本共41份。将每份标本一分为二分别行血培养和用细菌通用引物行16SrRNA基因聚合酶链反应检测，用琼脂糖凝胶电泳分析PCR产物，比较两种方法在检测细菌病原体时的快速性和敏感性，分析血培养及药敏结果。结果16SrRNA基因PCR方法的阳性率（41．16％）是血培养阳性率（21．95％）的近两倍。P〈0．05。16SrRANA基因PCR方法出结果需4、5h，血培养需12～24h（多数需2、3d）。9例血培养阳性患者中，8例为单一铜绿假单孢菌感染，1例为单一溶血链球菌感染。结论16SrRNA基因PCR检测细菌感染的方法具有特异性、快速性、敏感性的优点。在该中心，使用抗生素治疗后，引起脓毒症的细菌主要为铜绿假单孢菌。该菌对目前常用广谱抗生素耐药。     

Pulmonary complications of septicaemia in women

Twenty-five female patients of septicaemia aged 15-50 years comprised this study. Twenty-three patients (92%) were in the reproductive age group (15-35 years). Sixteen patients (64%) had some relation to parity, suggesting an increased risk of septicaemia in women with puerperal sepsis. The commonest primary source of infection was the female genital tract (48%). Gram-negative septicaemia was the commonest. The pleuropulmonary complications observed were pneumonia (10 cases), lung abscess (7 cases), empyema (3 cases), septic pulmonary embolisation (4 cases) and adult respiratory distress syndrome (4 cases). Seven cases of the total 25 died. Adult respiratory distress syndrome with septicaemia was the commonest cause of mortality in these patients.     

Neonatal sepsis bacterial isolates and antibiotic susceptibility patterns at a NICU in a tertiary care hospital in western Nepal: A retrospective analysis

Background: Neonatal sepsis is one of the commonest causes of neonatal mortality in the developing world. The neonatal intensive care units (NICUs) today face one common problem of tackling sepsis and neonatologists remain constantly baffled by the changing patterns of microbial flora and their sensitivity patterns. With the neonatal services coming of age in Nepal this retrospective analysis spread over a period of six years has become very pertinent. Materials and methods: We conducted a retrospective study over a period of six years to study the prevalence of different organisms causing septicaemia in the community and at our hospital and the antibiotic susceptibility pattern. In all 265 cases of suspected sepsis were screened using a panel consisting of CRP, ANC and I/T ratio and subsequently confirmed by cultures. The cases were early onset (n=44), late onset (n=56) and nosocomial groups (n=40). The data for the intramural (n=32) and extramural (n=68) cases was analysed separately. Results: One hundred nineteen cultures out of the 131 positives were obtained from blood (44.92%) and the remaining were isolated from urine (6.11 %) and CSF (4.58 %). The most common organism to be isolated was staphylococcus aureus (42.75%) followed by klebsiella pneumoniae (18.32%)and escherechia coli (12.21%). Staphylococcus was isolated from 36.84%, 45.16% and 31.81% of the cultures obtained from neonates in the in-born, out-born and the nosocomial groups respectively while klebsiella pneumoniae [18.32 %] was seen in 21.05 %, 17.39 % and 36.36 % in each of the three groups. Pseudomonas aeruginosa [6.11 %] was isolated from 13.64 % of the nosocomial cultures compared to 8.7 % of the out-borns while it was not seen in the in-borns. Other organisms isolated were much less in number, included - pathogenic streptococci, acinetobacter and enterobacter species. Coagulase negative staphylococci (CoNS) was seen in 4.39 % [n=4] and 9.09 % [n=4] of the same groups respectively. The gram positive organisms displayed a high degree of resistance to most penicillins and cephalosporins but glycopeptides and monobactams were effective in them. There was a high incidence of resistance noted with most third generation cephalosporins and aminoglycosides amongst most gram negative organisms where-in cefepime and imepenem were effective in most cases. Conclusions: Staphylococcal sepsis is not only common in community acquired infections but also in nosocomial sepsis. There is an emerging resistance to cephalosposrins probably attributable to extended spectrum betalactamases. Further large-scale multicentre studies are required to generalise the data for the whole country. Key words: neonatal sepsis, culture and susceptibility patterns.     

Septicemia in adults: II. Factors in prognosis

Over the period of 2 months between October and November, 1987, 190 episodes of septicemia in adults were monitored at Veterans General Hospital-Taipei. The most common causative microorganisms were Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus. The most frequent sources of infection came from intra-abdominal (gastro-intestinal as well as hepato-biliary), urinary and respiratory tract. Its overall mortality was 34.7%. Factors associated with a higher mortality from septicemia were old age, rapidly fatal underlying disease, hospital acquired infection, hypothermia, hypotension/shock, high-risk source of infection (from respiratory tract, skin/soft tissue, surgical wound or other unknown source), high-risk microorganisms (Candida species, Ps. aeruginosa or K. Pneumoniae) and inappropriate antimicrobial therapy. Identification of these factors may help early correction of reversible factors and improve its prognosis.     

系统性红斑狼疮合并败血症14例临床分析

目的 分析系统性红斑狼疮(SLE)合并败血症的临床特点.方法 选取2013年1月至2016年12月14例患者在海南省人民医院肾病风湿科住院确诊的SLE合并败血症,分析其临床资料和实验室检查结果.结果 所有患者均表现球蛋白及C3降低,CRP升高;85.71％的患者表现出ESR升高及血白蛋白、淋巴细胞比例降低;78.57％的患者白细胞计数正常或降低,71.43％的患者中性粒细胞比例升高.14例患者中革兰阳性菌有9例,分别是溶血性葡萄球菌2例、金黄色葡萄球菌3例、表皮葡萄球菌2例、粪肠球菌1例、藤黄微球菌1例;革兰阴性菌有5例,分别为液化沙雷菌1例、醋酸不动杆菌1例、铜绿假单胞菌2例和产酸克雷伯菌1例.依据药敏结果,革兰阳性菌建议选择万古霉素、利奈唑胺等,革兰阴性菌建议头孢哌酮他唑巴坦、左氧氟沙星等.结论 SLE患者合并败血症病情凶险,当患者出现发热、畏寒等临床表现需高度警惕,依据药敏选择合适用药,注意平衡激素及免疫抑制剂关系,尽早控制病情.     

Invasive external otitis: review of 12 cases.

Invasive external otitis is an infection caused by Pseudomonas aeruginosa that often occurs in elderly people with diabetes. Twelve cases that illustrate the problems associated with the clinical recognition and successful outcome of the condition were reviewed. The patients' average age was 62.5 years, and they had been ill for an average of 1.8 months before admission to hospital. Predisposing factors included diabetes, swimming in a warm climate and the use of a hearing aid. Radionuclide bone scanning and surgical exploration revealed pathognomonic findings. Initial therapy was often suboptimal: one or more relapses occurred in seven of the patients. All of the patients were cured without relapse after a minimum of 4 weeks of therapy with tobramycin plus an anti-Pseudomonas penicillin. The average duration of the illness was 3.9 months. The outcome in invasive external otitis should be excellent if the condition is diagnosed early and appropriate therapy is instituted.     

败血症的肝功能特点及其对败血症的诊断价值

目的：探讨肝功能对败血症诊断的价值。方法：选择2010年2月-2012年4月住本院重症医学科的脓毒症患者,动态监测入选患者的血培养及肝功能,根据按败血症诊断标准回顾性将患者分为败血症组和非败血症组,分析各肝功能指标在两组中的变化特点及对败血症的诊断意义。结果：败血症组肝功能早期常见γ-谷氨酰转肽酶（γ-GGT）、碱性磷酸酶（AIJP）、谷草转氨酶（AST）中1～3项升高。对比两组的第一次肝功能结果,败血症组的γ-GGT、ALP、AST显著高于非败血症组（P〈0．01）,其中γ-GGT升高对诊断败血症的诊断价值最高,以61．5μmmol／L为截断值,诊断败血症的灵敏度为87．5％,特异度为97．6％。21例1～GGT升高,γ-GGT阳性时间早于败血症血病原菌培养阳性时间3-9d。败血症组高胆红素血症发生率为33.3％,显著高于非败血症组（9．5％）。结论：γ-GGT升高可作为败血症的早期筛查指标,特定的肝功能变化特点可能作为败血症临床诊断的依据之一。     

Epidemiological features and risk factors of sepsis-associated encephalopathy in intensive care unit patients: 2008–2011

Background  Encephalopathy is a common complication of sepsis, and its onset can occur at any stage of sepsis and implies worse prognosis. However, the incidence, epidemiology, and pathogenesis of sepsis-associated encephalopathy remain controversial. The purpose of this study was to investigate the epidemiological features and risk factors for sepsis-associated encephalopathy.

Methods  Our retrospective study included all patients with sepsis admitted to our intensive care unit from 2008 to 2011. After excluding 91 patients, 232 patients were assigned to either a sepsis-associated encephalopathy group or sepsis without encephalopathy group. Between-group differences in baseline patient data including vital signs, disease severity, pathogens, sites of infection, biochemical indicators, and time on a mechanical ventilator, intensive care unit (ICU) stay, and 28-day mortality rate were analyzed.

Results  The incidence of sepsis-associated encephalopathy was 17.7%. The sepsis-associated encephalopathy group had significantly higher 28-day mortality (56.1% vs. 35.1%; P=0.013), spent a significantly longer time on a ventilator ((8.2±2.2) days vs. (2.9±0.4) days; P=0.021), and had a significantly longer ICU stay ((12.4±2.4) days vs. (7.1±0.6) days; P=0.042). Acute physiology and chronic health evaluation II score, Glasgow coma scale, heart rate, blood lactate, serum sodium, platelets, serum albumin, and pH values were related to the presence of encephalopathy. Patients with biliary tract infections and intestinal infections caused by Staphylococcus aureus, Enterococcus faecium, Acinetobacter spp, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia, were more prone to develop sepsis-associated encephalopathy.

Conclusions  Encephalopathy increases mortality rate in septic patients. Clinical intervention to reduce risk factors and thereby morbidity and mortality depends on a correct understanding of the differences between patients with sepsis and patients with both sepsis and encephalopathy.

     

Bone-marrow transplantation for haematological malignancy in childhood

Twenty-three children with haematological malignancies and a poor prognosis underwent bone-marrow transplantation. Thirteen children had acute lymphoblastic leukaemia, eight had acute nonlymphoblastic leukaemia, one had chronic myeloid leukaemia and one had malignant histiocytosis. One child was in relapse at the time of transplant and 22 were in first or subsequent remission. Before transplantation all patients received cyclophosphamide (60 mg/kg) on two consecutive days followed by total body irradiation given as a single dose of 10 Gy at 0.18 Gy/min (one patient) or 0.07 Gy/min (three patients), or as a fractionated dose of 10-12 Gy at 0.07-0.1 Gy/min (19 patients). One child with malignant histiocytosis also received two doses of etoposide (5 mg/kg). Methotrexate was given after transplantation to prevent or modify graft-versus-host disease (GVHD). One patient who received a transplant in relapse died early from overwhelming bacterial sepsis. Twenty-two patients engrafted, and of these 11 developed acute GVHD; five developed chronic GVHD; seven developed interstitial pneumonitis, with four deaths; and five relapsed between three and 12 months after transplantation, with three deaths. Fifty-nine per cent (13/22) of patients who received a transplant during remission remain in continuous complete remission and 68% (15/22) have survived for a median of 18 months (range, four to 73 months). Bone-marrow transplantation that is undertaken during remission of disease offers a prolonged disease-free survival in selected childhood malignancies.     

Successful treatment of invasive burn wound infection with sepsis in patients with major burns

Objective To investigate the clinical characteristics of invasive burn wound infection wit h sepsis in patients with major burns and to summarize the successful experience s in the treatment of such patients. Methods Eight patients with major burns, complicated by invasive burn wound infection an d sepsis were consecutively admitted to our hospital from September 1997 to Octo ber 1998.Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock.The plasma concentrations of IL-6, IL-8, TNFα and lypopolysaccharide (LPS) were assayed before and after surgical inter vention, as well as when the patient’s vital signs became stable.Results The patients’ conditions usually deteriorated abruptly when extensive invasive b urn wound infection emerged.While multi-microbial infection was usually found , Pseudomonas aeruginosa was the predominant bacteria isolated from the sube schar tissue.The plasma concentrations of IL-6, IL-8, TNFα and LPS before s urgical intervention were significantly higher than those after surgical interve ntion (P<0.05).The lowest levels of the inflammatory mediators were obser ved when the patients’ conditions became stable, and the values were signifi cantly lower than those before surgical intervention (P<0.001). Conclusion Since the main cause of burn wound sepsis is the presence of a large area of i nfected burn wound, they should be excised and covered as early as possible.LP S and pro-inflammatory mediators play an important role in the pathogenesis of burn sepsis.Although favorable results should be attributed to comprehensive t reatment, we believe that early, aggressive and thorough surgical excision of in fected burn wounds, followed by sound and complete coverage of the area, play a crucial role.     

绿脓杆菌败血症43例临床分析

本文报道绿脓杆菌败血症43例,均经血培养证实,35例的致病菌为单菌种绿脓杆菌,余8例为复数菌,其中绿脓杆菌与葡萄球菌3例;绿脓杆菌与肺炎杆菌2例;绿脓杆菌与变形杆菌、肺炎杆菌和变形杆菌、表皮葡萄球菌和类酵母菌各1例。院内感染34例(79％)。起病均急骤,伴畏寒、发热,严重者有休克、神态改变、颅内出血、弥漫性血管内凝血、下颌弥漫性蜂窝组织炎、肺迁徙性病灶、多脏器功能衰竭,病情凶险。病死率高达83.7％。     

机械通气的严重胸外伤患者铜绿假单胞菌感染的流行病学和危险因素分析

目的 铜绿假单胞菌逐渐成为院内感染的主要菌株,且耐药性较高。本文旨在探讨机械通气的严重胸外伤患者铜绿假单胞菌感染的流行病学和危险因素,为临床上防治机械通气相关性铜绿假单胞菌感染提供依据。 方法 前瞻性收集2012年1月-2016年1月温州医科大学附属第五医院收治的机械通气的严重胸外伤患者218例,主要观察指标为铜绿假单胞菌感染的流行病学和危险因素,次要观察指标为铜绿假单胞菌的耐药性。 结果 共21例(9.63%)患者发生铜绿假单胞菌感染,在机械通气后3~47 d确诊,平均在机械通气后(19.57±7.38)d确诊为铜绿假单胞菌感染。与对照组比较,研究组患者机械通气时间显著延长、开放性损伤率、APACHEⅡ评分、抗菌素使用种类 ≥ 3种率、开胸手术率、血气胸发生率和多发伤率显著增高(P<0.05)。单因素和多因素回归分析显示机械通气时间、APACHEⅡ评分和开胸手术是机械通气的严重胸外伤患者铜绿假单胞菌感染的危险因素(P<0.05)。21株铜绿假单胞菌中,18例为多重耐药菌,2例为泛耐药菌,对亚胺培南和美罗培南耐药率较低(14.29%)。 结论 机械通气的严重胸外伤患者铜绿假单胞菌感染率和耐药性较高,机械通气时间、APACHEⅡ评分和开胸手术是机械通气的严重胸外伤患者铜绿假单胞菌感染的危险因素,对这类患者加强铜绿假单胞菌的防治或可改善临床预后。      

感染性心内膜炎的临床观察与治疗分析

目的:观察与分析感染性心内膜炎的临床表现、病原菌、治疗效果等,以期早期诊断、早期治疗、促进患者康复。方法:选取60例感染性心内膜炎患者且对其临床表现、治疗方法和效果及生存质量等进行观察与相关数据记录和统计分析。结果:感染性心内膜炎临床表现多样、而以发热为首发症状最为常见,病原菌为草绿色链球菌、表皮葡萄球菌、金黄色葡萄球菌、大肠杆菌、白色念珠菌、铜绿假单胞菌且本次治疗死亡率为3.33%。结论:感染性心内膜炎的诊断应综合患者临床症状、体征、辅助检查等及早做出判断,从而早期给予合理治疗,方能降低死亡率和致残率、改善患者生存质量。     

2014年老年病房内铜绿假单胞菌感染状况及其耐药性分析

目的 分析老年病房内铜绿假单胞菌的感染状况及耐药情况。方法 收集2014年1~12月安徽省立医院老年内分泌科临床感染患者的痰、尿或血标本,采用法国梅里埃公司的VITEK2 Compact进行细菌鉴定及药敏实验。结果 共检出63株细菌,其中铜绿假单胞菌共29株,占46.03%。29株铜绿假单胞菌中,痰培养阳性26株（89.66%）,尿培养阳性3株（10.34%）。多重耐药的铜绿假单胞菌16株,占55.17%,耐药率低于10%的药物有阿米卡星、庆大霉素和妥布霉素,耐药率超过80%的有哌拉西林、头孢唑林、头孢曲松、头孢替坦、复方新诺明和呋喃妥因,对亚胺培南的耐药率为13.79%。结论 老年患者是铜绿假单胞菌的易感人群,临床多表现为肺部感染,细菌耐药率高。     

Short-course ceftriaxone therapy in spontaneous bacterial peritonitis

Forty patients with spontaneous bacterial peritonitis, three of whom had complicating acute hepatitis syndrome, eight late-onset hepatic failure, and 29 with cirrhosis, were treated with ceftriaxone 2 g intravenously once daily for 5 days. Ascitic fluid culture was positive in 28 patients, with Escherichia coli and Klebsiella as common isolates. All the bacteria isolated were sensitive to ceftriaxone except Enterococcus faecalis, which was isolated in a cirrhotic patient. All culture-positive patients sensitive to ceftriaxone showed bacteriological cure and 26 (65%) patients showed cytological cure after 48 hours of treatment. A total of 95% were cured of their infection after 5 days of treatment. Twelve (30%) patients died during hospitalisation after documented cure of their spontaneous bacterial peritonitis (renal failure, gastrointestinal bleed and cerebral oedema were the primary causes of death). Infection-related mortality due to Pseudomonas septicaemia was seen in one cirrhotic patient.     

Complications associated with central venous catheters in a haematology unit.

The use of central venous catheters in patients suffering from haematological disorders has brought enormous benefits, but has been associated with an increase in septicaemia. We have reviewed septic and other complications in 43 patients who received one of three different forms of central venous catheters (type A-Hickman, type B-Portacath, type C-Pasport) during 1991. All complications were reviewed up to 18 months following insertion. The total complication rate was 31% (0.97 per 100 catheter days), and the total sepsis complication rate was 18.8% (0.49 per 100 catheter days). Type A catheters had the greatest sepsis complication rate of 29.5% (0.84 per 100 catheter days), with type B 15% (0.39 per 100 catheter days) and type C 9.9% (0.32 per 100 catheter days). Prophylactic antibiotics on the day of catheter insertion did not reduce the sepsis rate or prolong catheter survival.     

铜绿假单胞菌oprI基因的反向斑点杂交检测法

目的 建立一种早期快速检测铜绿假单胞菌的方法。方法 根据铜绿假单胞菌特异的oprI基因设计引物,聚合酶链反应合成特异探针,光敏生物素标记细菌DNA,应用反向斑点杂交法检测铜绿假单胞菌。结果 所合成的探针具有高度特异性,能鉴别铜绿假单胞菌,与其他细菌、病毒、真菌间无交叉反应。该方法能检测出100 ng细菌DNA。结论 反向斑点杂交法具有快速、特异的优点,对铜绿假单胞菌的早期检测具有重要意义。