慢性阻塞性肺疾病急性加重期住院患者病原菌分布及耐药分析

目的分析我院呼吸内科慢阻肺急性加重期住院患者痰细菌培养、病原菌分布及耐药情况,为临床医师经验性合理应用抗菌药物提供参考依据。方法回顾性分析我院2013年9月-2015年9月呼吸内科住院1046例AECOPD患者痰细菌培养、药敏及耐药情况。结果 1046例AECOPD患者痰培养分离出病原菌224株,阳性率21.41%。其中,革兰氏阴性菌188株,占83.93%,常见病原菌依次为:肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌;革兰氏阳性菌3株,占病原菌总分布1.35%,分别为:金黄色葡萄球菌、肺炎链球菌、草绿色链球菌;真菌33株,占14.72%,依次为:白色念珠菌、酵母样真菌、曲霉菌、丝状真菌。结论 AECOPD患者病原菌以革兰氏阴性菌为主;临床上对反复感染及病情严重的住院患者应选用广谱β-内酰胺类、氨基糖苷类、喹诺酮类敏感抗菌药物或联合用药;并高度警惕真菌感染。     

Genetic variants of chromosome 9p21.3 region associated with coronary artery disease and premature coronary artery disease in an Asian Indian population

IntroductionAsian Indians have a propensity for premature, severe, and diffuse coronary artery disease (CAD). Several single-nucleotide polymorphisms (SNPs) in the ‘core CAD’ region of the chromosomal region 9p21.3 are known to be strongly associated with CAD.ObjectivesWe aimed to study SNPs in the 9p21.3 region associated with CAD and premature CAD and identify their association with demographic and clinical characteristics in an Asian Indian population.MethodsSNP genotyping was performed for 30 SNPs of the 9p21.3 region using MassARRAY^® technology. Along with demographic and SNP data analysis, we also performed multivariate logistic regression analysis and multifactor dimensionality reduction analysis to study SNP–SNP and SNP–demographic/clinical variable interactions.ResultsOur results suggest that females are at a higher risk of premature CAD. We found that SNPs rs1333045 (CC), rs16905599 (AA), rs2383206 (GG), rs2383208 (AG), and rs4977574 (GG) were significantly associated with premature CAD. When adjusted for covariates/confounders, we found that rs2383206 showed the strongest risk association with CAD followed by rs16905599 and rs2383208. Further, SNPs rs1333049 (CC) and rs4977574 (GG) were found to be exclusively associated with premature CAD cases, suggesting their potential as genetic markers for premature CAD in the local population. Upon gender-based stratification, it was found that rs10757272 (TT and TC) is significantly associated with eightfold to ninefold CAD risk specifically among females. SNP rs7865618 (GG) is significantly associated with more than 2.5-fold CAD risk specifically among males.ConclusionOur study suggests that SNPs at the 9p21 risk locus may be used to generate a reliable genetic risk score along with markers at other loci.