BACKGROUND Thrombocytopenia is common in patients with sepsis and septic shock.AIM To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in th...BACKGROUND Thrombocytopenia is common in patients with sepsis and septic shock.AIM To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in the intensive care unit.METHODS A retrospective analysis of patients admitted with sepsis and septic shock in Xingtai People Hospital was revisited.Patient population characteristics and laboratory data were collected for analysis.RESULTS The study group consisted of 85(39%)inpatients with bloodstream infection,and the control group consisted of 133(61%)with negative results or contamination.The percentage decline in platelet counts(PPCs)in patients positive for pathogens[57.1(41.3-74.6)]was distinctly higher than that in the control group[18.2(5.1–43.1)](P<0.001),whereas the PPCs were not significantly different among those with gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.Using receiver operating characteristic curves,the area under the curve of the platelet drop rate was 0.839(95%CI:0.783-0.895).CONCLUSION The percentage decline in platelet counts is sensitive in predicting bloodstream infection in patients with sepsis and septic shock.However,it cannot identify gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.展开更多
BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to death.However,limited information is available regarding the prediction ...BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to death.However,limited information is available regarding the prediction of patients with high risk of death.METHODS:The Emergency Bloodstream Infection Score(EBS)for CABSIs was developed to visualize the output of a logistic regression model and was validated by the area under the curve(AUC).The Mortality in Emergency Department Sepsis(MEDS),Pitt Bacteremia Score(PBS),Sequential Organ Failure Assessment(SOFA),quick Sequential Organ Failure Assessment(qSOFA),Charlson Comorbidity Index(CCI),and McCabe–Jackson Comorbid Classification(MJCC)for patients with CABSIs were computed to compare them with EBS in terms of the AUC and decision curve analysis(DCA).The net reclassification improvement(NRI)index and integrated discrimination improvement(IDI)index were compared between the SOFA and EBS.RESULTS:A total of 547 patients with CABSIs were included.The AUC(0.853)of the EBS was larger than those of the MEDS,PBS,SOFA,and qSOFA(all P<0.001).The NRI index of EBS in predicting the in-hospital mortality of CABSIs patients was 0.368(P=0.04),and the IDI index was 0.079(P=0.03).DCA showed that when the threshold probability was<0.1,the net benefit of the EBS model was higher than those of the other models.CONCLUSION:The EBS prognostic models were better than the SOFA,qSOFA,MEDS,and PBS models in predicting the in-hospital mortality of patients with CABSIs.展开更多
Objective: Pseudomonas aeruginosa bloodstream infection presents a severe challenge to hospitalized patients. To investigate the clinical characteristics, risk factors and drug resistance of Pseudomonas aeruginosa blo...Objective: Pseudomonas aeruginosa bloodstream infection presents a severe challenge to hospitalized patients. To investigate the clinical characteristics, risk factors and drug resistance of Pseudomonas aeruginosa bloodstream infection. Methods: Clinical data and laboratory results of patients with Pseudomonas aeruginosa bloodstream infection in the First Affiliated Hospital of Yangtze University from January 2019 to December 2022 were retrospectively analyzed. The factors associated with infection and death were analyzed by univariate analysis. Results: A total of 55 patients were enrolled in this study, The 28-day mortality rate was 14.5%. Univariate analysis showed that high procalcitonin, low albumin, ICU admission, central venous catheterization, indwelling catheter, and mechanical ventilation were associated with death. Multivariate Logistic regression analysis showed that hypoproteinemia and central venous catheters were independent risk factors for death in patients with Pseudomonas aeruginosa bloodstream infection. Conclusions: The drug resistance of P. aeruginosa bloodstream infection is not high, but the fatality rate is high. The combination of hypoalbuminemia after the onset of the disease and the use of central vein catheters can lead to increased mortality, suggesting that clinical identification of high-risk patients as early as possible, reducing the use of catheters, preventing the occurrence of P. aeruginosa bloodstream infection and improving the prognosis.展开更多
Objective:To analyze the risk factors of catheter-related bloodstream infection in outpatients and propose feasible prevention and control measures.Methods:The medical records of outpatients with peripherally inserted...Objective:To analyze the risk factors of catheter-related bloodstream infection in outpatients and propose feasible prevention and control measures.Methods:The medical records of outpatients with peripherally inserted central catheter(PICC)from January 2020 to December 2021 were selected for retrospective analysis,and the factors that may be related to the occurrence of catheter-related bloodstream infection were analyzed by logistic multivariate analysis.Results:The incidence rate of catheter-related bloodstream infection among the enrolled patients was 4.78%.It was found that age,duration of catheterization,catheter site,number of punctures,and diabetes were all risk factors for catheter-associated bloodstream infection,and the differences were statistically significant.Conclusion:Age,duration of catheterization,catheterization site,and diabetes are all risk factors for catheter-related bloodstream infection,and medical personnel should fully understand and learn more about these risk factors and actively develop countermeasures to reduce the risk of catheter-related bloodstream infection.展开更多
BACKGROUND Immunosuppression is an important factor in the incidence of infections in transplant recipient.Few studies are available on the management of immunosuppression(IS)treatment in the liver transplant(LT)recip...BACKGROUND Immunosuppression is an important factor in the incidence of infections in transplant recipient.Few studies are available on the management of immunosuppression(IS)treatment in the liver transplant(LT)recipients complicated with infection.The aim of this study is to describe our experience in the management of IS treatment during bacterial bloodstream infection(BSI)in LT recipients and assess the effect of temporary IS withdrawal on 30 d mortality of recipients presenting with severe infection.AIM To assess the effect of temporary IS withdrawal on 30 d mortality of LT recipients presenting with severe infection.METHODS A retrospective study was conducted with patients diagnosed with BSI after LT in the Department of Liver Surgery,Renji Hospital from January 1,2016 through December 31,2017.All recipients diagnosed with BSI after LT were included.Univariate and multivariate Cox regression analysis of risk factors for 30 d mortality was conducted in the LT recipients with Gram-negative bacterial(GNB)infection.RESULTS Seventy-four episodes of BSI were identified in 70 LT recipients,including 45 episodes of Gram-positive bacterial(GPB)infections in 42 patients and 29 episodes of GNB infections in 28 patients.Overall,IS reduction(at least 50%dose reduction or cessation of one or more immunosuppressive agent)was made in 28(41.2%)cases,specifically,in 5(11.9%)cases with GPB infections and 23(82.1%)cases with GNB infections.The 180 d all-cause mortality rate was 18.5%(13/70).The mortality rate in GNB group(39.3%,11/28)was significantly higher than that in GPB group(4.8%,2/42)(P=0.001).All the deaths in GNB group were attributed to worsening infection secondary to IS withdrawal,but the deaths in GPB group were all due to graft-versus-host disease.GNB group was associated with significantly higher incidence of intra-abdominal infection,IS reduction,and complete IS withdrawal than GPB group(P<0.05).Cox regression showed that rejection(adjusted hazard ratio 7.021,P=0.001)and complete IS withdrawal(adjusted hazard ratio 12.65,P=0.019)were independent risk factors for 30 d mortality in patients with GNB infections after LT.CONCLUSION IS reduction is more frequently associated with GNB infection than GPB infection in LT recipients.Complete IS withdrawal should be cautious due to increased risk of mortality in LT recipients complicated with BSI.展开更多
BACKGROUND Klebsiella pneumoniae(K.pneumoniae)is an infective microorganism of worldwide concern because of its varied manifestations and life-threatening potential.Genetic analyses have revealed that subspecies of K....BACKGROUND Klebsiella pneumoniae(K.pneumoniae)is an infective microorganism of worldwide concern because of its varied manifestations and life-threatening potential.Genetic analyses have revealed that subspecies of K.pneumoniae exhibit higher virulence and mortality.However,infections with Klebsiella subspecies are often misdiagnosed and underestimated in the clinic because of difficulties in distinguishing K.pneumoniae from its subspecies using routine tests.This case study reports the rapid and fatal effects of K.pneumoniae subspecies.CASE SUMMARY A 52-year-old male patient was febrile and admitted to hospital.Examinations excluded viral and fungal causes along with mycoplasma/chlamydia and parasitic infections.Bacterial cultures revealed blood-borne K.pneumoniae sensitive to carbapenem antibiotics,although corresponding treatment failed to improve the patient’s symptoms.His condition worsened and death occurred within 72 h of symptom onset from sepsis shock.Application of the PMseq-DNA Pro high throughput gene detection assay was implemented with results obtained after death showing a mixed infection of K.pneumoniae and Klebsiella variicola(K.variicola).Clinical evidence suggested that K.variicola rather than K.pneumoniae contributed to the patient’s poor prognosis.CONCLUSION This is the first case report to show patient death from Klebsiella subspecies infection within a short period of time.This case provides a timely reminder of the clinical hazards posed by Klebsiella subspecies and highlights the limitations of classical laboratory methods in guiding anti-infective therapies for complex cases.Moreover,this report serves as reference for physicians diagnosing similar diseases and provides a recommendation to employ early genetic detection to aid patient diagnosis and management.展开更多
Objective:The clinical characteristics and microbiological data of patients with K.pneumoniae bloodstream infections(BSI)from January 2018 to December 2020 were retrospectively analyzed to study the molecular epidemio...Objective:The clinical characteristics and microbiological data of patients with K.pneumoniae bloodstream infections(BSI)from January 2018 to December 2020 were retrospectively analyzed to study the molecular epidemiology of Carbapenem-resistant Klebsiella pneumoniae(CRKP).We also aimed to identify the risk factors for the development of CRKP BSI.Methods:This retrospective study was conducted at Renmin Hospital of Wuhan University from January 2018 to December 2020.The date of non-duplicate K.pneumoniae isolates isolated from blood samples was identified using the microbiology laboratory database.The data from patients diagnosed with K.pneumoniae BSI were collected and analyzed.展开更多
The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the pre...The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the prevention and control status of CLABSI in hospitals of different grades in Guangxi is not clear. In this study, we aim to investigate central venous catheter (CVC) placement and disinfectant use in second and third-level hospitals in Guangxi. This survey was conducted on the second and third-level hospitals in Guangxi, China from 13th April 2021 to 19th April 2021. The results show that a total of 283 questionnaires were collected, including 206 secondary hospitals and 77 tertiary hospitals. In terms of the CVC, tertiary hospitals were able to place CVC entirely under the guidance of B-ultrasound, which was 24 (31.6%) and secondary hospitals were 26 (20.6%). In secondary hospitals, Most CVC placements were performed in operating rooms 94 (74.6%) and 65 (85.5%) on the third level hospital, but 32.5% of secondary hospitals and 48.7% of tertiary hospitals were selected at the bedside of patients in general wards, and 27.8% of the second-level hospital, 43.4% of third-level hospitals was done in general ward treatment rooms, only 61.9% of secondary hospitals and 64.5% of tertiary hospitals could fully achieve the maximum sterile barrier. In terms of skin disinfectants, only 36.0% of tertiary hospitals and 16.4% of second-level CVC-operators chose > 0.5% chlorhexidine alcohol. In conclusion, the prevention and control of catheter line-associated bloodstream infections (CLABSI) in Guangxi are not ideal. The prevention and control department should increase training, implement guidelines and standardize management to reduce the incidence of CLABSI.展开更多
Bloodstream infection (BSI) is an important cause of morbidity and mortality worldwide. If we can make early diagnosis and start effective antibiotic treatment in time, the hospitalization time of patients with bloods...Bloodstream infection (BSI) is an important cause of morbidity and mortality worldwide. If we can make early diagnosis and start effective antibiotic treatment in time, the hospitalization time of patients with bloodstream infection can be significantly shortened. However, the current diagnosis of bloodstream infection cannot achieve the ideal therapeutic effect to a large extent because of the matrix effect of blood and the long turnaround time of blood culture. Therefore, a new detection method with a short turnaround time and high sensitivity is needed for the early diagnosis and timely treatment to improve the prognosis of patients. Metagenomic next-generation sequencing (mNGS) is a recently developed method for the comprehensive analysis of all microorganisms and genetic materials in clinical samples and is expected to be the main method for the early diagnosis of bloodstream infections. This review discusses the clinical application of mNGS in bloodstream infections. We also discuss technical challenges that need to be addressed to improve the diagnostic applicability of mNGS.展开更多
BACKGROUND Bloodstream infection(BSI)is one of the most significantly adverse events that can occur after liver transplantation(LT)in children.AIM To analyze the profile of BSI according to the postoperative periods a...BACKGROUND Bloodstream infection(BSI)is one of the most significantly adverse events that can occur after liver transplantation(LT)in children.AIM To analyze the profile of BSI according to the postoperative periods and assess the risk factors after pediatric LT.METHODS Clinical data,collected from medical charts of children(n=378)who underwent primary LT,were retrospectively reviewed.The primary outcome considered was BSI in the first year after LT.Univariate and multivariate analyses were performed to identify risk factors for BSI and respective odds ratios(ORs).RESULTS Of the examined patients,106(28%)experienced 162 episodes of pathogen-confirmed BSI during the first year after LT.There were 1.53±0.95 episodes per children(mean±SD)among BSIcomplicated patients with a median onset of 0.4 mo post-LT.The most common pathogenic organisms identified were Coagulase-negative staphylococci,followed by Enterococcus spp.and Streptococcus spp.About half(53%)of the BSIs were of unknown origin.Multivariate analysis demonstrated that young age(≤1.3 year;OR=2.1,P=0.011),growth failure(OR=2.1,P=0.045),liver support system(OR=4.2,P=0.008),and hospital stay of>44 d(OR=2.3,P=0.002)were independently associated with BSI in the year after LT.CONCLUSION BSI was frequently observed in patients after pediatric LT,affecting survival outcomes.The profile of BSI may inform clinical treatment and management in high-risk children after LT.展开更多
BACKGROUND Gardnerella vaginalis(G.vaginalis)is a facultative anaerobic bacteria known to cause bloodstream infections.However,cases are very rare in clinics.There is very limited clinical experience in the treatment ...BACKGROUND Gardnerella vaginalis(G.vaginalis)is a facultative anaerobic bacteria known to cause bloodstream infections.However,cases are very rare in clinics.There is very limited clinical experience in the treatment of bloodstream infections caused by G.vaginalis.Therefore,there is an urgent need for effective antibacterial drugs to treat patients with bloodstream infections caused by G.vaginalis.CASE SUMMARY A woman who underwent a cesarean section presented with a sudden onset of high fever 1-d post-surgery.The blood cultures suggested an infection due to G.vaginalis,and treatment with cefoperazone-sulbactam was started.After 5 d of treatment,there was a decrease in the hemogram;however,the temperature and C-reactive protein levels remained high.Based on clinical experience and a review of literature,the treatment was modified to include ornidazole in combination with cefoperazone-sulbactam.Following a week of treatment,the temperature,hemogram and C-reactive protein levels returned to normal,and blood cultures turned negative,suggesting a therapeutic effect of the combination treatment.CONCLUSION This case highlighted the effective use of cefoperazone-sulbactam combined with ornidazole for bloodstream infection caused by G.vaginalis following a cesarean section.展开更多
Background: Intensive care units (ICUs) have an increased risk of Central line associated bloodstream infection (CLABSI) due to the prevalence of invasive procedures, devices, immunosuppression, comorbidity, frailty, ...Background: Intensive care units (ICUs) have an increased risk of Central line associated bloodstream infection (CLABSI) due to the prevalence of invasive procedures, devices, immunosuppression, comorbidity, frailty, and elderly patients. We have seen a successful reduction in Central line associated bloodstream infection related the past decade. In spite of this, Intensive care unit-Catheter related bloodstream infections remain high. The emergence of new pathogens further complicates treatment and threatens patient outcomes in this context. In addition, the SARS-CoV-2 (COVID-19) pandemic served as a reminder that an emerging pathogen poses a challenge for adjusting prevention measures regarding both the risk of exposure to caregivers and maintaining a high level of care. ICU nurses play an important role in the prevention and management of CLABSI as they are involved in basic hygienic care, quality improvement initiatives, microbiological sampling, and aspects of antimicrobial stewardship. Microbiological techniques that are more sensitive and our increased knowledge of the interactions between critically ill patients and their microbiota are forcing us to rethink how we define CLABSIs and how we can diagnose, treat, and prevent them in the ICU. The objective of this multidisciplinary expert review, focused on the ICU setting, is to summarize the recently observed occurrence of CLABSI in ICU, to consider the role of modern microbiological techniques in their diagnosis, to examine clinical and epidemiological definitions, and to redefine several controversial preventive measures including antimicrobial-impregnated catheters, chlorhexidine-gluconate impregnated sponge, and catheter dressings.展开更多
BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidit...BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.展开更多
Background: Central venous catheters (CVCs) are essential to current intensive care unit (ICU) practices as a tool for treating critically ill patients. However, the use of CVCs is associated with substantial risk of ...Background: Central venous catheters (CVCs) are essential to current intensive care unit (ICU) practices as a tool for treating critically ill patients. However, the use of CVCs is associated with substantial risk of infection. Central line associated bloodstream infection (CLABSI) is increasing in prevalence each year and is among the major causes of bloodstream infection in ICU patients. Therefore, investigating the epidemiology and risk factors of CLABSI in ICU patients is important. Objective: This study aimed to investigate the incidence rates, causative pathogens and risk factors of CLABSI in an ICU population. Methods: A retrospective observational study was performed in an ICU at Qilu Hospital of Shandong University in China from January 2016 to December 2020. Patients with at least one CVC were enrolled, and information relevant to CVC use was recorded. The prevalence was calculated, and related risk factors were analyzed. Results: A total of 1920 catheters were identified, 507 of which were eligible for analysis. For each of the years 2016-2020, the incidence rates of CLABSI were 1.91, 3.18, 1.69, 2.97 and 1.27 per 1000 catheter days, respectively. The yeast Candida albicans was the most prevalent pathogen (16 [(3.2%]), followed by Gram-positive methicillin-resistant Staphylococcus aureus (11 [2.2%]) and the Gram-negative multidrug-resistant pathogen Acinetobacter baumanii. Risk factors associated with CLABSI development were age, (p = 0.05), Charlson comorbidity index > 5 (p Conclusion: Candida albicans was the most common causative microorganism, which was followed by Gram positive methicillin resistant Staphylococcus, MDR K. pneumoniae and Acinetobacter baumanii.展开更多
Purpose:To investigate the epidemiology,causative pathogen antibiotic susceptibility,and mortality risk factors of bloodstream infection(BSI)in patients with hematological malignancies(HMs).Methods:Single-center retro...Purpose:To investigate the epidemiology,causative pathogen antibiotic susceptibility,and mortality risk factors of bloodstream infection(BSI)in patients with hematological malignancies(HMs).Methods:Single-center retrospective analysis of BSI cases in patients with HMs in a Chinese tertiary hospital from 2012-2019.Results:Among 17,796 analyzed admissions,508 BSI episodes(2.9%;95%confidence interval:2.6%-3.2%)were identified.Of 522 resulting isolates,326(62.5%)were Gram-negative,173(33.1%)were Gram-positive.The BSI incidence among patients with different HMs(severe aplastic anemia:6.7%;acute leukemia:6.2%;myelodysplastic syndrome:3.2%;multiple myeloma:1.3%;and lymphoma:1.0%)differed significantly(p<0.001).The BSI incidence was significantly higher in the hematopoietic stem cell transplantation(HSCT)group(10.2%)than in the non-HSCT group(2.5%;p<0.001).Escherichia coli(30.7%,160/522)was the most common pathogen,followed by Coagulase-negative staphylococci(19.4%,101/522)and Klebsiella pneumoniae(10.0%,52/522).,The rates of imipenem resistance for E.coli,K.pneumoniae,Pseudomonas aeruginosa,and Acinetobacter baumannii were 6.4%,15.0%,27.8%,and 79.0%,respectively.All the Gram-positive pathogens were linezolid susceptible.Three vancomycin-resistant Enterococcus species were isolated.The overall 14-day mortality was 9.8%(95%confidence interval:7.2%-12.4%).A multivariate analysis showed that HM subtype severe aplastic anemia,A.baumannii,and malignancy non-remission were independent 14-day mortality risk factors.Conclusions:Gram-negative bacteria were the most common pathogens,with E.coli as the predominant strain,causing BSIs in HM patients.A carbapenem-resistant A.baumanni with a high mortality rate in HM patients made empirical antimicrobial choice a highly challenging issue.展开更多
This study aimed to explore epidemiological information on central line-associated bloodstream infection(CLABSI).A retrospective observational study was performed in an ICU at Qilu Hospital of Shandong University in C...This study aimed to explore epidemiological information on central line-associated bloodstream infection(CLABSI).A retrospective observational study was performed in an ICU at Qilu Hospital of Shandong University in China from January 2015 to December 2020.Patients with at least one central venous catheters(CVCs)were enrolled,and recorded relative information relevant to the CVC use.The prevalence was calculated,and related factors were analyzed.A total of 507 catheters were eligible for analysis.For the years 2016~2020,the incidence rates of CLABSI were as follows,1.91,3.18,1.69,2.97 and 1.27 per 1000 catheter days,respectively.Regarding the pathogen,yeast infections with Candida albicaans were the most prevalent[16(3.2%)],followed by gram-positive methicillin-resistant Staphylococcus aureus[11(2.2%)],and the gram-negative multidrug-resistant pathogens Acinetobacter baumanii.Risk factors associated with the development of CLABSI were age,(P=0.05),Charlson comorbidity index>5(P=0.00),and duration of the central venous CVC placement(P=0.01).Our study showed that there has been a slight decrease of CLABSI rates over the period of five years.This study identifies some risk factors in our ICU that may be important in the prevention of CLABSI in ICU populations.展开更多
Objective To investigate the etiology,clinical features and outcome of hospitalized patients with bloodstream infections(BSIs)in a tertiary hospital.MethodsPositive blood cultures were obtained from the microbiologica...Objective To investigate the etiology,clinical features and outcome of hospitalized patients with bloodstream infections(BSIs)in a tertiary hospital.MethodsPositive blood cultures were obtained from the microbiological laboratory in Fuxing Hospital,Capital Medical University from January 1,2012 to December 31,2012.展开更多
Objective Recombinase-aided polymerase chain reaction(RAP)is a sensitive,single-tube,two-stage nucleic acid amplification method.This study aimed to develop an assay that can be used for the early diagnosis of three t...Objective Recombinase-aided polymerase chain reaction(RAP)is a sensitive,single-tube,two-stage nucleic acid amplification method.This study aimed to develop an assay that can be used for the early diagnosis of three types of bacteremia caused by Staphylococcus aureus(SA),Pseudomonas aeruginosa(PA),and Acinetobacter baumannii(AB)in the bloodstream based on recombinant human mannanbinding lectin protein(M1 protein)-conjugated magnetic bead(M1 bead)enrichment of pathogens combined with RAP.Methods Recombinant plasmids were used to evaluate the assay sensitivity.Common blood influenza bacteria were used for the specific detection.Simulated and clinical plasma samples were enriched with M1 beads and then subjected to multiple recombinase-aided PCR(M-RAP)and quantitative PCR(qPCR)assays.Kappa analysis was used to evaluate the consistency between the two assays.Results The M-RAP method had sensitivity rates of 1,10,and 1 copies/μL for the detection of SA,PA,and AB plasmids,respectively,without cross-reaction to other bacterial species.The M-RAP assay obtained results for<10 CFU/mL pathogens in the blood within 4 h,with higher sensitivity than qPCR.M-RAP and qPCR for SA,PA,and AB yielded Kappa values of 0.839,0.815,and 0.856,respectively(P<0.05).Conclusion An M-RAP assay for SA,PA,and AB in blood samples utilizing M1 bead enrichment has been developed and can be potentially used for the early detection of bacteremia.展开更多
BACKGROUND A previous study compared vortexing and Maki techniques for the diagnosis of catheter-related bloodstream infection(CRBSI),and concluded that vortexing was not superior to Maki method.AIM To determine wheth...BACKGROUND A previous study compared vortexing and Maki techniques for the diagnosis of catheter-related bloodstream infection(CRBSI),and concluded that vortexing was not superior to Maki method.AIM To determine whether the combined use of vortexing and Maki techniques provides profitability versus the Maki technique for the diagnosis of catheter tip colonization(CTC)and CRBSI.METHODS Observational and prospective study carried out in an Intensive Care Unit.Patients with suspected catheter-related infection(CRI)and with one central venous catheter for at least 7 days were included.The area under the curve(AUC)of the Maki technique,the vortexing technique and the combination of both techniques for the diagnosis of CTC and CRBSI were compared.RESULTS We included 136 episodes of suspected CRI.We found 21 cases of CTC of which 10 were also CRBSI cases.Of the 21 CTC episodes,18(85.7%)were diagnosed by Maki technique and vortexing technique,3(14.3%)only by the technique of Maki,and none only by technique of vortexing.Of the 10 CRBSI episodes,9(90.0%)were diagnosed by the techniques of Maki and vortexing,1(10.0%)was diagnosed only by the technique of Maki,and none only by the technique of vortexing.We no found differences in the comparison of AUC between the technique of Maki and the combination of Maki and vortexing techniques for the diagnosis of CTC(P=0.99)and CRBSI(P=0.99).CONCLUSION The novel finding of our study was that the combined use of vortexing and Maki techniques did not provide profitability to the technique of Maki alone to CRBSI diagnosis of.展开更多
Background: Peripheral venous catheter (PVC) insertion is a crucial nursing action during life support. Several factors that increase the risk of thrombophlebitis associated with PVCs have been reported. Objective: We...Background: Peripheral venous catheter (PVC) insertion is a crucial nursing action during life support. Several factors that increase the risk of thrombophlebitis associated with PVCs have been reported. Objective: We wish to evaluate the impact of a quality improvement regarding PVC treatment for patients with coronary heart diseases. Method: A longitudinal, quantitative observational study was carried out in 2008 and 2013 in a hospital in southern Sweden with 360 consecutive patients suffering from acute chest pain. New routines for PVC treatment were included in the hospital with daily inspection according to a checklist. A structured observation protocol was used to survey the prevalence of thrombophlebitis between 2008 and 2013. Also, we examined the relationship between the location and luminal diameters of PVCs. Results: The student’s t-test showed significant differences between 2008 and 2013 with respect to luminal diameter of PVCs (p = 0.002), prevalence of thrombophlebitis (p = 0.003) and number of days with PVC left in situ (p < 0.001). Conclusion: These findings emphasize the value of using systematic daily inspections and checklists to achieve quality and safety in patients with acute chest pain having PVC-based treatment.展开更多
文摘BACKGROUND Thrombocytopenia is common in patients with sepsis and septic shock.AIM To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in the intensive care unit.METHODS A retrospective analysis of patients admitted with sepsis and septic shock in Xingtai People Hospital was revisited.Patient population characteristics and laboratory data were collected for analysis.RESULTS The study group consisted of 85(39%)inpatients with bloodstream infection,and the control group consisted of 133(61%)with negative results or contamination.The percentage decline in platelet counts(PPCs)in patients positive for pathogens[57.1(41.3-74.6)]was distinctly higher than that in the control group[18.2(5.1–43.1)](P<0.001),whereas the PPCs were not significantly different among those with gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.Using receiver operating characteristic curves,the area under the curve of the platelet drop rate was 0.839(95%CI:0.783-0.895).CONCLUSION The percentage decline in platelet counts is sensitive in predicting bloodstream infection in patients with sepsis and septic shock.However,it cannot identify gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.
基金supported by the National Key Research and Development Program of China(2021YFC2501800)。
文摘BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to death.However,limited information is available regarding the prediction of patients with high risk of death.METHODS:The Emergency Bloodstream Infection Score(EBS)for CABSIs was developed to visualize the output of a logistic regression model and was validated by the area under the curve(AUC).The Mortality in Emergency Department Sepsis(MEDS),Pitt Bacteremia Score(PBS),Sequential Organ Failure Assessment(SOFA),quick Sequential Organ Failure Assessment(qSOFA),Charlson Comorbidity Index(CCI),and McCabe–Jackson Comorbid Classification(MJCC)for patients with CABSIs were computed to compare them with EBS in terms of the AUC and decision curve analysis(DCA).The net reclassification improvement(NRI)index and integrated discrimination improvement(IDI)index were compared between the SOFA and EBS.RESULTS:A total of 547 patients with CABSIs were included.The AUC(0.853)of the EBS was larger than those of the MEDS,PBS,SOFA,and qSOFA(all P<0.001).The NRI index of EBS in predicting the in-hospital mortality of CABSIs patients was 0.368(P=0.04),and the IDI index was 0.079(P=0.03).DCA showed that when the threshold probability was<0.1,the net benefit of the EBS model was higher than those of the other models.CONCLUSION:The EBS prognostic models were better than the SOFA,qSOFA,MEDS,and PBS models in predicting the in-hospital mortality of patients with CABSIs.
文摘Objective: Pseudomonas aeruginosa bloodstream infection presents a severe challenge to hospitalized patients. To investigate the clinical characteristics, risk factors and drug resistance of Pseudomonas aeruginosa bloodstream infection. Methods: Clinical data and laboratory results of patients with Pseudomonas aeruginosa bloodstream infection in the First Affiliated Hospital of Yangtze University from January 2019 to December 2022 were retrospectively analyzed. The factors associated with infection and death were analyzed by univariate analysis. Results: A total of 55 patients were enrolled in this study, The 28-day mortality rate was 14.5%. Univariate analysis showed that high procalcitonin, low albumin, ICU admission, central venous catheterization, indwelling catheter, and mechanical ventilation were associated with death. Multivariate Logistic regression analysis showed that hypoproteinemia and central venous catheters were independent risk factors for death in patients with Pseudomonas aeruginosa bloodstream infection. Conclusions: The drug resistance of P. aeruginosa bloodstream infection is not high, but the fatality rate is high. The combination of hypoalbuminemia after the onset of the disease and the use of central vein catheters can lead to increased mortality, suggesting that clinical identification of high-risk patients as early as possible, reducing the use of catheters, preventing the occurrence of P. aeruginosa bloodstream infection and improving the prognosis.
文摘Objective:To analyze the risk factors of catheter-related bloodstream infection in outpatients and propose feasible prevention and control measures.Methods:The medical records of outpatients with peripherally inserted central catheter(PICC)from January 2020 to December 2021 were selected for retrospective analysis,and the factors that may be related to the occurrence of catheter-related bloodstream infection were analyzed by logistic multivariate analysis.Results:The incidence rate of catheter-related bloodstream infection among the enrolled patients was 4.78%.It was found that age,duration of catheterization,catheter site,number of punctures,and diabetes were all risk factors for catheter-associated bloodstream infection,and the differences were statistically significant.Conclusion:Age,duration of catheterization,catheterization site,and diabetes are all risk factors for catheter-related bloodstream infection,and medical personnel should fully understand and learn more about these risk factors and actively develop countermeasures to reduce the risk of catheter-related bloodstream infection.
基金Supported by the National Key R&D Precision Medicine Program,No.2017YFC0908100Shanghai Key Clinical Specialty Grant,No.Shslczdzk05801.
文摘BACKGROUND Immunosuppression is an important factor in the incidence of infections in transplant recipient.Few studies are available on the management of immunosuppression(IS)treatment in the liver transplant(LT)recipients complicated with infection.The aim of this study is to describe our experience in the management of IS treatment during bacterial bloodstream infection(BSI)in LT recipients and assess the effect of temporary IS withdrawal on 30 d mortality of recipients presenting with severe infection.AIM To assess the effect of temporary IS withdrawal on 30 d mortality of LT recipients presenting with severe infection.METHODS A retrospective study was conducted with patients diagnosed with BSI after LT in the Department of Liver Surgery,Renji Hospital from January 1,2016 through December 31,2017.All recipients diagnosed with BSI after LT were included.Univariate and multivariate Cox regression analysis of risk factors for 30 d mortality was conducted in the LT recipients with Gram-negative bacterial(GNB)infection.RESULTS Seventy-four episodes of BSI were identified in 70 LT recipients,including 45 episodes of Gram-positive bacterial(GPB)infections in 42 patients and 29 episodes of GNB infections in 28 patients.Overall,IS reduction(at least 50%dose reduction or cessation of one or more immunosuppressive agent)was made in 28(41.2%)cases,specifically,in 5(11.9%)cases with GPB infections and 23(82.1%)cases with GNB infections.The 180 d all-cause mortality rate was 18.5%(13/70).The mortality rate in GNB group(39.3%,11/28)was significantly higher than that in GPB group(4.8%,2/42)(P=0.001).All the deaths in GNB group were attributed to worsening infection secondary to IS withdrawal,but the deaths in GPB group were all due to graft-versus-host disease.GNB group was associated with significantly higher incidence of intra-abdominal infection,IS reduction,and complete IS withdrawal than GPB group(P<0.05).Cox regression showed that rejection(adjusted hazard ratio 7.021,P=0.001)and complete IS withdrawal(adjusted hazard ratio 12.65,P=0.019)were independent risk factors for 30 d mortality in patients with GNB infections after LT.CONCLUSION IS reduction is more frequently associated with GNB infection than GPB infection in LT recipients.Complete IS withdrawal should be cautious due to increased risk of mortality in LT recipients complicated with BSI.
基金Supported by Science and Technology Fund of Guizhou Provincial Health CommissionNo. gzwjkj2019-1-067+1 种基金Doctor Foundation of Guizhou Provincial People’s HospitalNo. GZSYBS[2019]04
文摘BACKGROUND Klebsiella pneumoniae(K.pneumoniae)is an infective microorganism of worldwide concern because of its varied manifestations and life-threatening potential.Genetic analyses have revealed that subspecies of K.pneumoniae exhibit higher virulence and mortality.However,infections with Klebsiella subspecies are often misdiagnosed and underestimated in the clinic because of difficulties in distinguishing K.pneumoniae from its subspecies using routine tests.This case study reports the rapid and fatal effects of K.pneumoniae subspecies.CASE SUMMARY A 52-year-old male patient was febrile and admitted to hospital.Examinations excluded viral and fungal causes along with mycoplasma/chlamydia and parasitic infections.Bacterial cultures revealed blood-borne K.pneumoniae sensitive to carbapenem antibiotics,although corresponding treatment failed to improve the patient’s symptoms.His condition worsened and death occurred within 72 h of symptom onset from sepsis shock.Application of the PMseq-DNA Pro high throughput gene detection assay was implemented with results obtained after death showing a mixed infection of K.pneumoniae and Klebsiella variicola(K.variicola).Clinical evidence suggested that K.variicola rather than K.pneumoniae contributed to the patient’s poor prognosis.CONCLUSION This is the first case report to show patient death from Klebsiella subspecies infection within a short period of time.This case provides a timely reminder of the clinical hazards posed by Klebsiella subspecies and highlights the limitations of classical laboratory methods in guiding anti-infective therapies for complex cases.Moreover,this report serves as reference for physicians diagnosing similar diseases and provides a recommendation to employ early genetic detection to aid patient diagnosis and management.
文摘Objective:The clinical characteristics and microbiological data of patients with K.pneumoniae bloodstream infections(BSI)from January 2018 to December 2020 were retrospectively analyzed to study the molecular epidemiology of Carbapenem-resistant Klebsiella pneumoniae(CRKP).We also aimed to identify the risk factors for the development of CRKP BSI.Methods:This retrospective study was conducted at Renmin Hospital of Wuhan University from January 2018 to December 2020.The date of non-duplicate K.pneumoniae isolates isolated from blood samples was identified using the microbiology laboratory database.The data from patients diagnosed with K.pneumoniae BSI were collected and analyzed.
文摘The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the prevention and control status of CLABSI in hospitals of different grades in Guangxi is not clear. In this study, we aim to investigate central venous catheter (CVC) placement and disinfectant use in second and third-level hospitals in Guangxi. This survey was conducted on the second and third-level hospitals in Guangxi, China from 13th April 2021 to 19th April 2021. The results show that a total of 283 questionnaires were collected, including 206 secondary hospitals and 77 tertiary hospitals. In terms of the CVC, tertiary hospitals were able to place CVC entirely under the guidance of B-ultrasound, which was 24 (31.6%) and secondary hospitals were 26 (20.6%). In secondary hospitals, Most CVC placements were performed in operating rooms 94 (74.6%) and 65 (85.5%) on the third level hospital, but 32.5% of secondary hospitals and 48.7% of tertiary hospitals were selected at the bedside of patients in general wards, and 27.8% of the second-level hospital, 43.4% of third-level hospitals was done in general ward treatment rooms, only 61.9% of secondary hospitals and 64.5% of tertiary hospitals could fully achieve the maximum sterile barrier. In terms of skin disinfectants, only 36.0% of tertiary hospitals and 16.4% of second-level CVC-operators chose > 0.5% chlorhexidine alcohol. In conclusion, the prevention and control of catheter line-associated bloodstream infections (CLABSI) in Guangxi are not ideal. The prevention and control department should increase training, implement guidelines and standardize management to reduce the incidence of CLABSI.
文摘Bloodstream infection (BSI) is an important cause of morbidity and mortality worldwide. If we can make early diagnosis and start effective antibiotic treatment in time, the hospitalization time of patients with bloodstream infection can be significantly shortened. However, the current diagnosis of bloodstream infection cannot achieve the ideal therapeutic effect to a large extent because of the matrix effect of blood and the long turnaround time of blood culture. Therefore, a new detection method with a short turnaround time and high sensitivity is needed for the early diagnosis and timely treatment to improve the prognosis of patients. Metagenomic next-generation sequencing (mNGS) is a recently developed method for the comprehensive analysis of all microorganisms and genetic materials in clinical samples and is expected to be the main method for the early diagnosis of bloodstream infections. This review discusses the clinical application of mNGS in bloodstream infections. We also discuss technical challenges that need to be addressed to improve the diagnostic applicability of mNGS.
基金Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI)Ministry of Health&Welfare,Republic of Korea,No.HR21C0198。
文摘BACKGROUND Bloodstream infection(BSI)is one of the most significantly adverse events that can occur after liver transplantation(LT)in children.AIM To analyze the profile of BSI according to the postoperative periods and assess the risk factors after pediatric LT.METHODS Clinical data,collected from medical charts of children(n=378)who underwent primary LT,were retrospectively reviewed.The primary outcome considered was BSI in the first year after LT.Univariate and multivariate analyses were performed to identify risk factors for BSI and respective odds ratios(ORs).RESULTS Of the examined patients,106(28%)experienced 162 episodes of pathogen-confirmed BSI during the first year after LT.There were 1.53±0.95 episodes per children(mean±SD)among BSIcomplicated patients with a median onset of 0.4 mo post-LT.The most common pathogenic organisms identified were Coagulase-negative staphylococci,followed by Enterococcus spp.and Streptococcus spp.About half(53%)of the BSIs were of unknown origin.Multivariate analysis demonstrated that young age(≤1.3 year;OR=2.1,P=0.011),growth failure(OR=2.1,P=0.045),liver support system(OR=4.2,P=0.008),and hospital stay of>44 d(OR=2.3,P=0.002)were independently associated with BSI in the year after LT.CONCLUSION BSI was frequently observed in patients after pediatric LT,affecting survival outcomes.The profile of BSI may inform clinical treatment and management in high-risk children after LT.
文摘BACKGROUND Gardnerella vaginalis(G.vaginalis)is a facultative anaerobic bacteria known to cause bloodstream infections.However,cases are very rare in clinics.There is very limited clinical experience in the treatment of bloodstream infections caused by G.vaginalis.Therefore,there is an urgent need for effective antibacterial drugs to treat patients with bloodstream infections caused by G.vaginalis.CASE SUMMARY A woman who underwent a cesarean section presented with a sudden onset of high fever 1-d post-surgery.The blood cultures suggested an infection due to G.vaginalis,and treatment with cefoperazone-sulbactam was started.After 5 d of treatment,there was a decrease in the hemogram;however,the temperature and C-reactive protein levels remained high.Based on clinical experience and a review of literature,the treatment was modified to include ornidazole in combination with cefoperazone-sulbactam.Following a week of treatment,the temperature,hemogram and C-reactive protein levels returned to normal,and blood cultures turned negative,suggesting a therapeutic effect of the combination treatment.CONCLUSION This case highlighted the effective use of cefoperazone-sulbactam combined with ornidazole for bloodstream infection caused by G.vaginalis following a cesarean section.
文摘Background: Intensive care units (ICUs) have an increased risk of Central line associated bloodstream infection (CLABSI) due to the prevalence of invasive procedures, devices, immunosuppression, comorbidity, frailty, and elderly patients. We have seen a successful reduction in Central line associated bloodstream infection related the past decade. In spite of this, Intensive care unit-Catheter related bloodstream infections remain high. The emergence of new pathogens further complicates treatment and threatens patient outcomes in this context. In addition, the SARS-CoV-2 (COVID-19) pandemic served as a reminder that an emerging pathogen poses a challenge for adjusting prevention measures regarding both the risk of exposure to caregivers and maintaining a high level of care. ICU nurses play an important role in the prevention and management of CLABSI as they are involved in basic hygienic care, quality improvement initiatives, microbiological sampling, and aspects of antimicrobial stewardship. Microbiological techniques that are more sensitive and our increased knowledge of the interactions between critically ill patients and their microbiota are forcing us to rethink how we define CLABSIs and how we can diagnose, treat, and prevent them in the ICU. The objective of this multidisciplinary expert review, focused on the ICU setting, is to summarize the recently observed occurrence of CLABSI in ICU, to consider the role of modern microbiological techniques in their diagnosis, to examine clinical and epidemiological definitions, and to redefine several controversial preventive measures including antimicrobial-impregnated catheters, chlorhexidine-gluconate impregnated sponge, and catheter dressings.
文摘BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.
文摘Background: Central venous catheters (CVCs) are essential to current intensive care unit (ICU) practices as a tool for treating critically ill patients. However, the use of CVCs is associated with substantial risk of infection. Central line associated bloodstream infection (CLABSI) is increasing in prevalence each year and is among the major causes of bloodstream infection in ICU patients. Therefore, investigating the epidemiology and risk factors of CLABSI in ICU patients is important. Objective: This study aimed to investigate the incidence rates, causative pathogens and risk factors of CLABSI in an ICU population. Methods: A retrospective observational study was performed in an ICU at Qilu Hospital of Shandong University in China from January 2016 to December 2020. Patients with at least one CVC were enrolled, and information relevant to CVC use was recorded. The prevalence was calculated, and related risk factors were analyzed. Results: A total of 1920 catheters were identified, 507 of which were eligible for analysis. For each of the years 2016-2020, the incidence rates of CLABSI were 1.91, 3.18, 1.69, 2.97 and 1.27 per 1000 catheter days, respectively. The yeast Candida albicans was the most prevalent pathogen (16 [(3.2%]), followed by Gram-positive methicillin-resistant Staphylococcus aureus (11 [2.2%]) and the Gram-negative multidrug-resistant pathogen Acinetobacter baumanii. Risk factors associated with CLABSI development were age, (p = 0.05), Charlson comorbidity index > 5 (p Conclusion: Candida albicans was the most common causative microorganism, which was followed by Gram positive methicillin resistant Staphylococcus, MDR K. pneumoniae and Acinetobacter baumanii.
文摘Purpose:To investigate the epidemiology,causative pathogen antibiotic susceptibility,and mortality risk factors of bloodstream infection(BSI)in patients with hematological malignancies(HMs).Methods:Single-center retrospective analysis of BSI cases in patients with HMs in a Chinese tertiary hospital from 2012-2019.Results:Among 17,796 analyzed admissions,508 BSI episodes(2.9%;95%confidence interval:2.6%-3.2%)were identified.Of 522 resulting isolates,326(62.5%)were Gram-negative,173(33.1%)were Gram-positive.The BSI incidence among patients with different HMs(severe aplastic anemia:6.7%;acute leukemia:6.2%;myelodysplastic syndrome:3.2%;multiple myeloma:1.3%;and lymphoma:1.0%)differed significantly(p<0.001).The BSI incidence was significantly higher in the hematopoietic stem cell transplantation(HSCT)group(10.2%)than in the non-HSCT group(2.5%;p<0.001).Escherichia coli(30.7%,160/522)was the most common pathogen,followed by Coagulase-negative staphylococci(19.4%,101/522)and Klebsiella pneumoniae(10.0%,52/522).,The rates of imipenem resistance for E.coli,K.pneumoniae,Pseudomonas aeruginosa,and Acinetobacter baumannii were 6.4%,15.0%,27.8%,and 79.0%,respectively.All the Gram-positive pathogens were linezolid susceptible.Three vancomycin-resistant Enterococcus species were isolated.The overall 14-day mortality was 9.8%(95%confidence interval:7.2%-12.4%).A multivariate analysis showed that HM subtype severe aplastic anemia,A.baumannii,and malignancy non-remission were independent 14-day mortality risk factors.Conclusions:Gram-negative bacteria were the most common pathogens,with E.coli as the predominant strain,causing BSIs in HM patients.A carbapenem-resistant A.baumanni with a high mortality rate in HM patients made empirical antimicrobial choice a highly challenging issue.
基金Shandong Province Medical Science and Technology Fund (2017WS304)
文摘This study aimed to explore epidemiological information on central line-associated bloodstream infection(CLABSI).A retrospective observational study was performed in an ICU at Qilu Hospital of Shandong University in China from January 2015 to December 2020.Patients with at least one central venous catheters(CVCs)were enrolled,and recorded relative information relevant to the CVC use.The prevalence was calculated,and related factors were analyzed.A total of 507 catheters were eligible for analysis.For the years 2016~2020,the incidence rates of CLABSI were as follows,1.91,3.18,1.69,2.97 and 1.27 per 1000 catheter days,respectively.Regarding the pathogen,yeast infections with Candida albicaans were the most prevalent[16(3.2%)],followed by gram-positive methicillin-resistant Staphylococcus aureus[11(2.2%)],and the gram-negative multidrug-resistant pathogens Acinetobacter baumanii.Risk factors associated with the development of CLABSI were age,(P=0.05),Charlson comorbidity index>5(P=0.00),and duration of the central venous CVC placement(P=0.01).Our study showed that there has been a slight decrease of CLABSI rates over the period of five years.This study identifies some risk factors in our ICU that may be important in the prevention of CLABSI in ICU populations.
文摘Objective To investigate the etiology,clinical features and outcome of hospitalized patients with bloodstream infections(BSIs)in a tertiary hospital.MethodsPositive blood cultures were obtained from the microbiological laboratory in Fuxing Hospital,Capital Medical University from January 1,2012 to December 31,2012.
基金funded by the National Key R&D Program of China[2021YFC2301102]National Natural Science Foundation of China[82202593]Key R&D Program of Hebei Province[223777100D].
文摘Objective Recombinase-aided polymerase chain reaction(RAP)is a sensitive,single-tube,two-stage nucleic acid amplification method.This study aimed to develop an assay that can be used for the early diagnosis of three types of bacteremia caused by Staphylococcus aureus(SA),Pseudomonas aeruginosa(PA),and Acinetobacter baumannii(AB)in the bloodstream based on recombinant human mannanbinding lectin protein(M1 protein)-conjugated magnetic bead(M1 bead)enrichment of pathogens combined with RAP.Methods Recombinant plasmids were used to evaluate the assay sensitivity.Common blood influenza bacteria were used for the specific detection.Simulated and clinical plasma samples were enriched with M1 beads and then subjected to multiple recombinase-aided PCR(M-RAP)and quantitative PCR(qPCR)assays.Kappa analysis was used to evaluate the consistency between the two assays.Results The M-RAP method had sensitivity rates of 1,10,and 1 copies/μL for the detection of SA,PA,and AB plasmids,respectively,without cross-reaction to other bacterial species.The M-RAP assay obtained results for<10 CFU/mL pathogens in the blood within 4 h,with higher sensitivity than qPCR.M-RAP and qPCR for SA,PA,and AB yielded Kappa values of 0.839,0.815,and 0.856,respectively(P<0.05).Conclusion An M-RAP assay for SA,PA,and AB in blood samples utilizing M1 bead enrichment has been developed and can be potentially used for the early detection of bacteremia.
文摘BACKGROUND A previous study compared vortexing and Maki techniques for the diagnosis of catheter-related bloodstream infection(CRBSI),and concluded that vortexing was not superior to Maki method.AIM To determine whether the combined use of vortexing and Maki techniques provides profitability versus the Maki technique for the diagnosis of catheter tip colonization(CTC)and CRBSI.METHODS Observational and prospective study carried out in an Intensive Care Unit.Patients with suspected catheter-related infection(CRI)and with one central venous catheter for at least 7 days were included.The area under the curve(AUC)of the Maki technique,the vortexing technique and the combination of both techniques for the diagnosis of CTC and CRBSI were compared.RESULTS We included 136 episodes of suspected CRI.We found 21 cases of CTC of which 10 were also CRBSI cases.Of the 21 CTC episodes,18(85.7%)were diagnosed by Maki technique and vortexing technique,3(14.3%)only by the technique of Maki,and none only by technique of vortexing.Of the 10 CRBSI episodes,9(90.0%)were diagnosed by the techniques of Maki and vortexing,1(10.0%)was diagnosed only by the technique of Maki,and none only by the technique of vortexing.We no found differences in the comparison of AUC between the technique of Maki and the combination of Maki and vortexing techniques for the diagnosis of CTC(P=0.99)and CRBSI(P=0.99).CONCLUSION The novel finding of our study was that the combined use of vortexing and Maki techniques did not provide profitability to the technique of Maki alone to CRBSI diagnosis of.
文摘Background: Peripheral venous catheter (PVC) insertion is a crucial nursing action during life support. Several factors that increase the risk of thrombophlebitis associated with PVCs have been reported. Objective: We wish to evaluate the impact of a quality improvement regarding PVC treatment for patients with coronary heart diseases. Method: A longitudinal, quantitative observational study was carried out in 2008 and 2013 in a hospital in southern Sweden with 360 consecutive patients suffering from acute chest pain. New routines for PVC treatment were included in the hospital with daily inspection according to a checklist. A structured observation protocol was used to survey the prevalence of thrombophlebitis between 2008 and 2013. Also, we examined the relationship between the location and luminal diameters of PVCs. Results: The student’s t-test showed significant differences between 2008 and 2013 with respect to luminal diameter of PVCs (p = 0.002), prevalence of thrombophlebitis (p = 0.003) and number of days with PVC left in situ (p < 0.001). Conclusion: These findings emphasize the value of using systematic daily inspections and checklists to achieve quality and safety in patients with acute chest pain having PVC-based treatment.
