45例老年人洋地黄中毒临床分析

洋地黄治疗充血性心衰４２８例，≥６０岁组１４８例，中毒４５例（３０．４％），＜６０岁组２８０例，中毒２０例（７．１４％）（Ｐ＜０．０１）。中毒原因可能为：（１）低血钾１０例、低血镁３例（２８．９％）。（２）肾功能不全１２例（２６．７％）。（３）肺部感染９例（２０％）。（４）药物影响５例（１１％）。（５）心肌衰竭４例（８％）。（６）原因不明４例（８％）。显示老年人洋地黄中毒多数可以找到原因。     

系统性红斑狼疮并发细菌及真菌感染的临床研究

目的 研究近年系统性红斑狼疮（ＳＬＥ）患者发生细菌与真菌感染的临床特点。方法 选择１９９０年１月至１９９８年５月确诊为ＳＬＥ并发细菌和真菌感染的病例９６例,统计分析有关资料。结果 ９６例ＳＬＥ患者共发生１５１例次感染,其中医院感染占４８．３％;革兰氏阴性（Ｇ＾－）杆菌和革兰氏阳性（Ｇ＾＋）球菌感染分别占４０．４％和３０．５％,真菌占１８．５％,其他细菌占１０．６％;２７例次（１７．９％）感染由细胞     

345株下呼吸道感染革兰阴性杆菌的分布及耐药

目的了解院内下呼吸道感染革兰阴性杆菌的状态，供临床用药借鉴。方法院内下呼吸道感染患者痰菌分离，经培养鉴定共取得３４５株革兰阴性杆菌。抗生素敏感性测定采用ＫＢ纸片法，最低抑菌浓度（ＭＩＣ）采用琼脂二倍稀释法。β内酰胺酶的测定采用Ｎｉｔｒｏｃｅｐｈｉｎ纸片法，超广谱β内酰胺酶（ＥＳＢＬｓ）测定采用Ｅｔｅｓｔ法。结果（１）克雷伯菌属及铜绿假单胞菌在３４５株细菌中分别占３９７％、１７４％。（２）头孢噻肟耐药率由４２９％（６年前）降至８２％。（３）ＥＳＢＬｓ检测结果为阴性。结论（１）克雷伯菌属及铜绿假单胞菌构成院内下呼吸道感染主要致病菌。（２）尚未发现ＥＳＢＬｓ的存在，但今后应加强监测     

1277例消化性溃疡内镜检查分析

一、临床资料：我院１９７５年５月至１９８９年５月共作胃镜８９３３例，检出消化性溃疡１２７７例，占１４．３％，年龄１２～８３岁，平均４７．５岁。其中十二指肠球部溃疡７８２例（８．７５％），胃溃疡４９５例（５．５４％），所有病例均以初诊时内镜检查为准。二、发病年龄：十二指肠球部溃疡以２０～２９岁发病率最高，共３１７例（２４．８％），其次３０～３９岁２１６例（１６．９％），４０岁以后发病逐渐下降，１９岁以下及６０岁以上最少。在检出４９５例胃溃疡病人中，５０～５９岁为发病高峰，共１４３例（１１．２％），…     

78例恶性血液病医院感染分析

本文调查了１９８６～１９９１年恶性血液病住院人７８例，发生医院感染３７例，感染率４７．７％，３７例医院感染病人死亡率高达５６．８％。感染部位以下呼吸道最常见；感染病原菌主要为Ｇ－杆菌及真菌。化疗、激素和抗菌素的运用及白细胞数减少（＜１．０×１０９／Ｌ）是感染增加的危险因素。建议今后要加强对这类病人院内感染的监测和预防。     

98例老年肺结核误诊分析

我院于１９８５年１月至１９９７年１２月，９８例６０岁以上肺结核患者误诊为呼吸科其他疾病而收住院，为了对老年肺结核早期诊断及时治疗，控制传染，现将误诊情况回顾性分析，从中吸取教训，以提高对本病诊断的正确率。１临床资料１．１一般情况：男６８例，女３０例，年龄６０～８１岁，平均年龄６５．７岁。１．２临床表现：咳嗽９６例（９７．９％），咯血２５例（２５．５％），咯痰９５例（９５．９％），发热７２例（７３．４％），纳差６８例（６９．３％），消瘦２０例（２０．４％），胸痛１８例（１８．３％），盗汗４０例（４…     

绿脓杆菌性败血症临床探讨

本文报告１９７３～１９９２年同济医院绿脓杆菌性败血症８７例临床资料。医院感染７９例次（８６．８％）、社会感染１２例次（１３．２％）。新生儿、恶性肿瘤、严重烧伤、与医疗操作有关的感染６２例（７１．３％）。下呼吸道、皮肤软组织、齿龈、口腔粘膜、泌尿道及消化道是常见的原发病灶（９１．２％）。危险因素有抗菌药物、皮质激素、免疫抑制剂的应用、外科手术及各类插入性操作。死亡６３例（７３．３％），其中发病３天内死亡３９例（６１．９％），４～７天死亡１３例（２０．６％）。对本病临床过程的特点，绿脓杆菌多种因子与致病的关系，早期临床诊断、治疗与预防作简要讨论。     

医院内外下呼吸道感染171例次分析

作者对收治的１７１例次细菌学阳性的医院内外下呼吸道感染进行回顾性对比分析，结果发现院内组８６例，共分离到致病菌１２４株，革兰氏阴性菌占８１．９％；院外组８５例，分离出致病菌１０５株，革兰氏阳性菌占５５．３％。治愈率：院内组３１．６％，院外组８０．３％（Ｐ＜０．０１）。院内组死亡率为９．１％，院外组２．４％（Ｐ＜０．０１）。并分析了两组在抗生素敏感性、耐药性方面的差异。     

14962 例急性心肌梗塞患者临床特征──中国心脏研究-Ⅰ 专题报告之五

目的分析１４９６２例急性心肌梗死（ＡＭＩ）患者的临床特征。方法用ＳＡＳ６０４软件统计分析１４９６２例ＡＭＩ患者的４周总病死率和并发症。结果１４９６２例ＡＭＩ患者临床特征为：男性病人７３．９％；平均年龄６１．２±１０．７岁；有心肌梗死、高血压、糖尿病病史者分别占１２．２％，４０．４％，９．４％；基础血压１２６．６±２４．３／８１．３±１４．６ｍｍＨｇ；基础心率７９．３±１８．８ｍｉｎ－１。试验４周期间主要并发症心力衰竭为１７．９％，休克４．６％，心室颤动３．２％，其他类型的心跳骤停２．３％，Ⅱ～Ⅲ度房室传导阻滞５．２％，室性心动过速３．６％，梗塞扩展４．８％，脑卒中１．２％，心脏破裂０．５％。总病死率（２８ｄ）为９．４３％，死于泵衰竭为３．２５％，死于心律失常为４．５６％。     

应用Etest法监测下呼吸道革兰阴性杆菌的耐药性

目的监测下呼吸道革兰阴性杆菌的耐药性。方法应用Ｅｔｅｓｔ法测定１７４株革兰阴性杆菌的ＭＩＣ,并根据ＮＣＣＬＳ（美国全国临床实验室标准委员会）的完全敏感折点判定其耐药比率。结果１９９６年分离株前５位的革兰阴性杆菌是硝酸盐阴性不动杆菌、绿脓杆菌、肺炎克雷伯菌、阴沟杆菌和大肠杆菌,抗菌药物耐药覆盖率较高的是头孢呋辛５６７％,阿莫西林加克拉维酸３７８％,氨曲南３３３％,氧氟沙星３２２％,庆大霉素３２２％。１９９７年分离株前５位的革兰阴性杆菌是硝酸盐阴性不动杆菌、绿脓杆菌、阴沟杆菌、肺炎克雷伯菌和荧光假单胞菌,抗菌药物耐药覆盖率较高的是头孢呋辛７８６％,头孢三嗪６７９％,替卡西林加克拉维酸４４０％,头孢哌酮４０５％,头孢噻肟４０５％。结论革兰阴性杆菌的耐药率普遍较高,临床上须根据细菌药敏结果合理应用抗菌药物。Ｅｔｅｓｔ是目前较为理想的一种药敏试验,其准确性高可靠性强,值得在临床上推广。     

Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factor for mortality and the impact of capsular serotypes as a herald for community-acquired infection

BACKGROUND: Although several epidemiological surveys of Klebsiella clinical isolates have been performed, few studies have correlated the clinical isolate with disease. OBJECTIVE: To compare the clinical and bacteriological characteristics of Klebsiella pneumoniae bacteremia acquired as community or nosocomial infections. METHODS: We prospectively enrolled 158 consecutively hospitalized patients with K pneumoniae bacteremia. Clinical data were reviewed. Antimicrobial susceptibility testing and capsular serotyping were performed. We used the chi(2) test, the Fisher exact test, or the t test for statistic analysis. RESULTS: Underlying diabetes mellitus was more common in community-acquired than in nosocomial infection (46/94 [49%] vs. 8/64 [12%]; P<.001). On the other hand, neoplastic disease (34/64 [53%] vs. 13/94 [14%]; P<.001) and antibiotic resistance (P<.01) were more frequent in patients with nosocomial compared with community-acquired infections. Klebsiella pneumoniae liver abscesses, which were all community acquired, accounted for the source of 22 (23%) of 94 community-acquired K pneumoniae infections. No attributable source of infection was found for 37 (58%) of the 64 nosocomial infections vs. 15 (16%) of the 94 community-acquired infections. Only 58 isolates (36.7%) could be serotyped; of these, capsular serotypes K1, K2, and K28 accounted for 37 (23.4%), 8 (5.1%), and 6 (3.8%), respectively, of all strains. However, typeable isolates were significantly more common among community-acquired than nosocomial isolates (42/94 [45%] vs. 16/64 [25%]; P =.01), especially for serotype K1 (28/94 [30%] vs. 9/64 [14%]; P =.02). Significant risk factors for mortality included nosocomial infection, lung infection, thrombocytopenia, leukopenia, ceftazidime resistance, inappropriate antimicrobial therapy, and septic shock. CONCLUSIONS: Significant differences were identified between community-acquired and nosocomial K pneumoniae bacteremia. Ceftazidime resistance in nosocomial K pneumoniae bacteremia carried a high risk for mortality, and serotype K1 in K pneumoniae was more prevalent in community-acquired infection, suggesting more virulence.     

Epidemiology of ciprofloxacin resistance and its relationship to extended-spectrum beta-lactamase production in Klebsiella pneumoniae isolates causing bacteremia.

A prospective study of Klebsiella pneumoniae bacteremia was performed in 12 hospitals in 7 countries. Of 452 episodes of bacteremia, 25 (5.5%) were caused by K. pneumoniae that was resistant in vitro to ciprofloxacin. Extended-spectrum beta-lactamase (ESBL) production was detected in 15 (60%) of 25 ciprofloxacin-resistant isolates, compared with 68 (16%) of 427 ciprofloxacin-susceptible strains (P=.0001). Multivariate analysis revealed that risk factors for ciprofloxacin resistance in K. pneumoniae included prior receipt of a quinolone (P=.0065) and an ESBL-producing strain (P=.012). In all, 18% of ESBL-producing isolates were also ciprofloxacin-resistant. Pulsed-field gel electrophoresis showed that 11 of the 15 ciprofloxacin-resistant ESBL-producing strains belonged to just 4 genotypes, suggesting that patient-to-patient transmission of such strains occurred. The close relationship between ESBL production and ciprofloxacin resistance is particularly worrisome because the first reported instance of plasmid-mediated ciprofloxacin resistance has been in an isolate of K. pneumoniae also possessing an ESBL.     

我院近3年下呼吸道革兰阴性杆菌耐药性监测

目的 调查我院近3年下呼吸道革兰阴性杆菌的耐药情况.方法 使用MIC法对我院下呼吸道感染住院患者的痰液标本中临床分离的926株革兰阴性杆菌进行药敏试验,并用WHONET 5.4软件进行数据分析.结果 926株革兰阴性杆菌中最常见的菌种依次为大肠埃希菌(29.7%)、肺炎克雷伯菌(23.7%)、铜绿假单胞菌(14.3%)、鲍曼不动杆菌(12.1%).大肠埃希菌、肺炎克雷伯菌对多黏菌素B、亚胺培南、美罗培南和咪诺环素保持高度敏感,耐药菌率在10%以内,对阿米卡星、哌拉西林/三唑巴坦、头孢哌酮/舒巴坦、头孢他啶及头孢匹肟的耐药率为30%以内,对其余所检测药物的耐药率均在30%以上.铜绿假单胞菌对多黏菌素B和咪诺环素;而亚胺培南,美罗培南、哌拉西林/三唑巴坦,头孢哌酮/舒巴坦和阿米卡星耐药率低于30%{鲍曼不动杆菌耐药情况比较严重,只有多黏菌素B、头孢哌酮/舒巴坦高度敏感,耐药率在10%以内,对亚胺培南和美罗培南的耐药率在20%以内,对其余所检测药物的耐药率均在30%到60%以上.结论 本研究结果对我院革兰阴性杆菌感染的经验用药治疗有重要参考价值.     

Recent Trend of Necrotizing Fasciitis in Taiwan: Focus on Monomicrobial Klebsiella pneumoniae Necrotizing Fasciitis

Background.?Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft-tissue infection that is traditionally caused by group A Streptococcus (GAS) or mixed aerobic/anaerobic bacteria. Monomicrobial Klebsiella pneumoniae NF (KP-NF) has been reported since 1996 but has not yet been systematically studied. Methods.?We retrospectively studied consecutive NF cases treated at a university hospital in Taiwan during 1997-2010 and investigated the clinical characteristics and outcomes associated with monomicrobial KP-NF, using monomicrobial GAS-NF as a reference. We also analyzed the virulence gene profiles of the isolated K. pneumoniae strains. Results.?Of 134 NF cases, 88 were monomicrobial, of which the most common pathogens were GAS (n?=?16) and K. pneumoniae (n?=?15). Monomicrobial KP-NF entailed a moderate risk of limb loss (20% vs 25%; P?=?1.000) and high mortality (47% vs 19%; P?=?.135), and it was more likely to involve bacteremia (80% vs 31%; P?=?.011), concomitant distant abscesses (27% vs 0%; P?=?.043), and underlying immunocompromising conditions (100% vs 63%; P?=?.018), compared with GAS-NF. The isolated K. pneumoniae strains (n?=?10) were of capsular polysaccharides genotype K1 (n?=?4), K54/K20/K5 (n?=?4), K2 (n?=?1), and K16 (n?=?1). All strains carried rmpA, iucABCDiutA, and iroA. Genotype K1 strains had a significantly higher risk of concomitant distant abscesses, compared with non-K1 strains (75% vs 0%; P?=?.033). Conclusions.?K. pneumoniae has become a common pathogen of monomicrobial NF in Taiwan. Physicians treating patients with monomicrobial KP-NF should be aware of the risk of concomitant distant abscesses, particularly in cases caused by genotype K1.     

Antibody response to the 60-kDa heat-shock protein of Chlamydia pneumoniae in patients with coronary artery disease

Serum specimens from 752 individuals undergoing coronary arteriography were examined for antibodies to Chlamydia pneumoniae. Patients with coronary artery disease (CAD) were more likely to have IgG antibodies to C. pneumoniae than were individuals without CAD (60% vs. 52%; P=.007; odds ratio, 1.8; 95% confidence interval, 1. 17-2.77). Antibodies to recombinant hsp60 of C. pneumoniae were found with nearly the same frequency in patients with CAD and individuals without CAD (29% vs. 30%; P=.751). There was no association between chlamydial hsp60 antibodies and the severity of CAD or a previous myocardial infarction. Patient sera reacted most frequently to C. pneumoniae proteins of 17, 38, 40, 58, and 60/62 kDa. Reactivity to these proteins was not different between patients with and without CAD. Study results indicate that neither antibodies to chlamydial hsp60 nor antibodies to other C. pneumoniae proteins are useful for discriminating between seropositive patients with and without CAD.     

No serological evidence of association between chlamydia pneumonia infection and acute coronary heart disease.

Today's medical literature shows more and more evidence that Chlamydia pneumoniae plays a role in coronary atherosclerotic disease. This cross-sectional study examines the serostatus for C. pneumoniae of patients with an acute cardiovascular event. A total of 58 patients with acute myocardial infarction or with proven unstable angina (occlusion > or = 70% of at least 1 vessel at coronary angiography) ('patients') were compared with 58 age- and sex-matched patients without a cardiovascular event ('controls'). Serological testing for C. pneumoniae was performed by a microimmunofluorescence test during the first week of the event and 4-6 weeks later. Although more patients from the cardiovascular event group showed a positive history of a respiratory tract infection during 6 weeks preceding hospitalization (18/58 patients, 8/58 controls, p = 0.03), there was no significant difference between the two groups for an acute, chronic or past infection by C. pneumoniae (19/58 patients, 24/58 controls, p = 0.93). In conclusion, contrary to previous published papers, this study could not confirm an association of C. pneumoniae infection with an acute coronary event. Serological testing alone may not be the best way to demonstrate this association. An acute infection by C. pneumoniae, which should have been detected by serological testing, is probably not the origin of the rupture of an atheromatous plaque.     

A comparison of moxifloxacin and amoxicillin in the treatment of community-acquired pneumonia in Latin America: results of a multicenter clinical trial

Since community-acquired pneumonia (CAP) is a common disease with a high morbidity rate, it is important to obtain information concerning its etiology and susceptibility to antibiotics across different geographic areas. This study presents data obtained in 5 Latin American counties in the course of an international clinical trial that evaluated the efficacy and safety of treatment with either moxifloxacin or amoxicillin administered for 10 days to patients suspected of having CAP caused by a pneumococcal infection. Details are given of the pathogens identified, the patterns of sensitivity to antibiotics observed, and the clinical and microbiological results obtained.A total of 84 patients were studied, of whom 70 (83.3%) were evaluated at the end of the trial to determine the efficacy and safety of the treatment received. Gram-positive bacteria were found in samples from 29 patients (80.5%). The pathogen was Streptococcus pneumoniae in 28 of those cases (77.7%). Gram-negative bacteria were found in 7 patients (19.4%), the most common being Haemophilus influenzae in 3 patients (8.3%). The presence of atypical microorganisms was detected in 18 of the 70 patients (25%), mainly Mycobacterium pneumoniae (n=11), and in 6 cases (8.5%) the infection was mixed. Ten strains of S. pneumoniae (35.7%) were shown to be susceptible to penicillin, 2 (7.1%) were highly resistant, and 16 (57.1%) showed moderate resistance. The clinical success rate at the final visit after treatment was 94.1% for moxifloxacin and 91.7% for amoxicillin. The results of this trial demonstrate a high prevalence of S. pneumoniae with reduced susceptibility to penicillin in patients with CAP in Latin America. It also revealed a high incidence of atypical pathogens and mixed infection in 8.6% of patients. This information should be taken into account when establishing protocols for empirical treatment of CAP in Latin America.     

Pneumococcal infections in children after transplantation.

Bacterial infections in recipients of bone marrow and solid-organ transplants remain a major cause of morbidity and death. The cases of 42 children who had undergone transplantation and developed an infection with Streptococcus pneumoniae were retrospectively reviewed. Thirty-four patients had 1 episode of infection, whereas 7 had 2 episodes and 1 had 3 episodes of infection. Solid-organ recipients were more likely to have recurrent invasive disease (P<.02). A total of 31 (74%) of 42 patients were on immunosuppressive therapy, and 74% had been on antimicrobial therapy within 30 days before diagnosis of S. pneumoniae infection. Only 33% of eligible patients had received a pneumococcal vaccine. Twenty-six percent of isolates recovered were not susceptible to penicillin, and 18% were not susceptible to ceftriaxone. Two patients experienced infection-related deaths; one of these had a penicillin-nonsusceptible isolate. The antimicrobial susceptibilities and outcome of infections with S. pneumoniae in patients who have undergone transplantation are similar to those in the general pediatric population.     

Etiology of pneumonia and host defense]

To investigate the relationship of efficacy of chemotherapy to host defense, we reviewed the clinical features, treatment and outcome in 648 patients with acute pneumonia (424 males and 224 females; mean age, 65 years) treated between 1984 and 1989. Pneumonia complicated pulmonary disease in 336 patients (52%) and complicated systemic disease in 258 (40%). Pneumonia pathogens were diagnosed in 346 patients (53%); the five major pathogens were S. pneumoniae (19%), H. influenzae (16%), S. aureus (14%), K. pneumoniae (14%) and P. aeruginosa (11%). The incidence of K. pneumoniae infection were decreased from 18% to 3.5% and that of S. aureus increased from 10.9% to 26.3% during the study period. The incidence of S. aureus and of P. aeruginosa infection was much higher in patients with nosocomial pneumonia, systemic disease, or serum protein concentration under 6.5 g/dl. beta-lactamase antibiotics were administered to 70% of all patients, with an efficacy rate of 74.9% of after the first course of antibiotics therapy. The efficacy rate was decreased in patients with nosocomial pneumonia, systemic or pulmonary disease, or malnutrition. The data presented in this study indicate that the risk of pneumonia must be taken into careful consideration in patients with compromising complications.     

Efficacy and safety of ten day moxifloxacin 400 mg once daily in the treatment of patients with community-acquired pneumonia. Community Acquired Pneumonia Study Group

Community-acquired pneumonia (CAP) remains a common and serious illness with approximately 2-4 million cases reported annually. Management of CAP is therapeutically challenging due to the increasing prevalence of penicillin- and macrolide-resistant pneumococci and beta-lactamase producing Haemophilus influenzae, as well as the increased recognition of 'atypical' pathogens, such as Chlamydia pneumoniae and Mycoplasma pneumoniae, and the frequent need for empiric therapy. We aimed to evaluate the safety and efficacy of moxifloxacin in the treatment of patients with CAP. To do this we carried out a prospective, uncontrolled, non-blind, Phase III clinical trial, in 27 U.S. centers. Patients included in the study were over 18 years of age with signs and symptoms of CAP confirmed by evidence of a new or progressive infiltrate on chest radiograph. The intervention used was moxifloxacin 400 mg PO once daily for 10 days. Sputum samples were collected pretherapy for Gram stain and culture for typical organisms. Culture and serological testing for Chlamydia pneumoniae and Mycoplasma pneumoniae was also performed. Susceptibility to moxifloxacin was determined by disk diffusion and MIC. Clinical and bacteriological responses were determined at the end of therapy (0-6 days post-therapy), follow-up (14-35 days post-therapy) and overall (end of therapy plus follow-up). Analyses were performed on both valid for efficacy and intent-to-treat populations. The primary efficacy variable was overall clinical resolution. Of 254 patients enrolled in the Study, 196 patients were included in the efficacy analyses. The majority of patients were male (58%) and Caucasian (85%) with a mean age of 49 years (range: 18 to 85 years). Only 3% of patients were hospitalized pretherapy. The most common pretherapy organisms identified, by culture or serology, in the valid for efficacy population (i.e. 147 organisms among 116 patients), were: Chlamydia pneumoniae (n=63; 54%), Mycoplasma pneumoniae (n=29; 25%), Streptococcus pneumoniae (n=14; 12%) and Haemophilus influenzae (n=13; 10%). End of therapy, follow-up and overall clinical resolution rates for the valid for efficacy population were 94%, 93% and 93%, respectively. The 95% CI for the overall clinical resolution rate was 88.1%, 95.9%. The overall bacteriological response for patients diagnosed by culture or serological criteria, was 91% (95% CI=84%, 96%). For patients who only met serological criteria for infection, the overall bacteriological response was 94% (60/64). Bacterial response rates for the four most commonly isolated pathogens were: 89% (56/63) for C. pneumoniae, 93% (27/29) for M. pneumoniae, 93% (13/14) for S. pneumoniae and 85% (11/13) for H. influenzae. Drug-related adverse events were reported in 33% (85/254) of moxifloxacin-treated patients. Nausea (9%), diarrhea (6%) and dizziness (4%) were the most commonly reported adverse events. Atypical organisms were isolated in high frequency among patients with CAP. Moxifloxacin 400 mg once daily for 10 days was effective and well-tolerated in the treatment of these adult patients with CAP. Moxifloxacin offers an effective treatment alternative for CAP due to both typical and atypical bacterial pathogens.