外周血CD4+CXCR5+Tfh水平对肺炎克雷伯菌感染者预后的影响

目的　检测肺炎克雷伯菌感染者外周血CD4+CXCR5+滤泡辅助性T细胞（T follicular helper cell, Tfh）水平，探讨其对患者预后的影响。方法　选取2017年7月—2019年5月于本院ICU住院治疗的147例患者为研究对象，根据患者入院后是否出现肺炎克雷伯菌感染，将其分为感染组（69例）和未感染组（78例）。采用流式细胞术检测147例患者外周血CD4+CXCR5+Tfh水平。采用单因素分析肺炎克雷伯菌感染的影响因素；采用单因素分析和多因素Logistic回归分析肺炎克雷伯菌感染者预后的影响因素。结果　感染组的住院时间、入住ICU时间、入住ICU时APACHE II评分、机械通气时间及心血管疾病、多器官功能障碍综合征、接受手术、恶性肿瘤患者比例均高于未感染组，差异均有统计学意义（P均＜0.05）。感染组外周血CD4+CXCR5+Tfh水平、死亡患者比例均高于未感染组（P均＜0.05）。感染组中死亡患者外周血CD4+CXCR5+Tfh水平高于生存患者（P＜0.05）。CD4+CXCR5+Tfh、碳青霉烯类耐药、入住ICU时APACHE II评分是影响肺炎克雷伯菌感染者死亡的独立危险因素（P均＜0.05）。结论　外周血CD4+CXCR5+Tfh水平在肺炎克雷伯菌感染者中显著升高，CD4+CXCR5+Tfh可能通过参与机体免疫应答影响感染者的预后。检测CD4+CXCR5+Tfh水平不仅对判断感染者的免疫状态有重要意义，也可为肺炎克雷伯菌感染者治疗提供依据。     

Transfusion‐transmitted CMV infection – current knowledge and future perspectives

Transmission of human cytomegalovirus (CMV) via transfusion (TT‐CMV) may still occur and remains a challenge in the treatment of immunocompromised CMV‐seronegative patients, e.g. after stem cell transplantation, and for low birthweight infants. Measures to reduce the risk of TT‐CMV have been evaluated in clinical studies, including leucocyte depletion of cellular blood products and/or the selection of CMV‐IgG‐negative donations. Studies in large blood donor cohorts indicate that donations from newly CMV‐IgG‐positive donors should bear the highest risk for transmitting CMV infections because they contain the highest levels of CMV‐DNA, and early CMV antibodies cannot neutralise CMV. Based on this knowledge, rational strategies to reduce the residual risk of TT‐CMV using leucoreduced blood products could be designed. However, there is a lack of evidence that CMV is still transmitted by transfusion of leucoreduced units. In low birthweight infants, most (if not all) CMV infections are caused by breast milk feeding or congenital transmission rather than by transfusion of leucoreduced blood products. For other patients at risk, no definitive data exist about the relative importance of alternative transmission routes of CMV compared to blood transfusion. As a result, only the conduction of well‐designed studies addressing strategies to prevent TT‐CMV and the thorough examination of presumed cases of TT‐CMV will achieve guidance for the best transfusion regimen in patients at risk.     

Nephrotoxicity in isoxazolylpenicillin prophylaxis in hip surgery

In 789 courses of antibiotic prophylaxis in hip arthroplasty surgery, either dicloxacillin (Diclocil®) or cloxacillin (Ekvacillin®) was used during two different time periods. The surgical methods, anesthesia, preoperative and postoperative care of the patients, and laboratory procedures were the same all the time. Changes in creatinine values were used as a method for evaluating the impact on renal function. When using dicloxacillin, a pathologic increase of creatinine was noted in 12 and 13 percent by two different calculation methods. Sixteen patients (4.2 percent) had a severe creatinine increase during the first postoperative week after dicloxacillin prophylaxis, requiring dialysis in 2 patients. Cloxacillin had only a marginal impact on renal function. Patients above aged 70 years were more vulnerable as regards renal function than younger persons, and the impairment was slightly dose related in all ages. In the dicloxacillin group, preoperative use of antiphlogistic drugs was correlated with reduced postoperative renal function.     

Coccidioidomycosis Infection of a Total Knee Arthroplasty in a Nonendemic Region

Fungal prosthetic joint infections are rare and difficult to treat. There is an ongoing discussion about the type and duration of antifungal treatment and the necessity of prosthesis removal. We report the first European case of an infected total knee arthroplasty with Coccidioides immitis. Treatment consisted of lifelong treatment with oral fluconazole at a dose of 400 mg/d, without total knee arthroplasty removal. After 6 months, the initial complaints of pain and swelling were completely resolved. This case report clearly states that a travel history and culturing for fungi are helpful in patients with persisting complaints after joint arthroplasty.     

护理干预对消化道手术切口感染的预防效果分析

目的探讨护理干预措施对预防消化道手术后切口感染的效果。方法 280例接受消化道手术治疗者随机分为观察组与对照组,各140例。对照组实施常规护理,观察组则在此基础上实施个性化护理干预,比较两组的切口愈合效果以及感染率。结果观察组的切口甲级愈合率为72.9%,显著高于对照组的48.6%(P0.05);观察组的切口感染率为1.4%,显著低于对照组的12.14%(P0.05);观察组的护理满意度为100.0%,显著高于对照组的89.3%(P0.05)。结论在消化道手术后实施个体化综合护理干预有利于降低切口感染率,促进切口的愈合。     

Unusual high rate of asymptomatic maternal parvovirus B19 infection associated with severe fetal outcome

Objective.?To study the role of asymptomatic maternal parvo B19 infection in severe fetal outcome in Province of Vojvodina.

Methods.?One hundred seventy-six pregnant women (13–25 weeks of gestation) were divided in two groups – patients with symptoms of imminent spontaneous abortion and poor pregnancy outcome and patients with normal course of pregnancy. Double serum samples were analyzed to quantify IgM and IgG to parvovirus B19.

Results.?Among pregnant women with symptoms of spontaneous abortion, we found significantly higher percentage of acute parvovirus B19 infection.

Conclusions.?Asymptomatic parvo B19 infection is associated with poor fetal outcome much more than we presumed previously.     

Chlamydia pneumoniae and Atherosclerosis

Chlamydia pneumoniae, a human respiratory pathogen, has been linked to atherosclerotic disease based on sero-epidemiologic studies, direct detection of the organism in atherosclerotic lesions, animal experiments and tissue culture. In this review paper we propose to interprete results in line with the biology of Chlamydia with persistence of Chlamydia pneumoniae antigens in the pathogenesis of atherosclerosis rather than viable bacteriae.