ABSTRACT
Objective:To analyze the clinical characteristics, therapeutic options and risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection, and to provide evidence for clinical treatment option and prognosis evaluation of CRAB bloodstream infections. Methods:A retrospective study was carried out in 224 patients with confirmed diagnosis of CRAB bloodstream infection during the period from January 2012 to December 2017 in West China Hospital, Sichuan University. The patients were divided into the death group and the survival group according to the survival status 28 days after collecting blood samples. The clinical features and therapeutic options of antibacterial drugs were reviewed. Student′s t test was used for analyzing normally distributed data and Mann-Whitney U test for non-normal data.Chi-square test was used for categorical variables. Univariate and multivariate logistic analysis were used to analyze the risk factors of mortality associated with CRAB bloodstream infection. Results:Among 224 cases of CRAB bloodstream infection, 121 cases died (54.02%). These patients were mainly in intensive care unit (ICU) and hematology department. The common underlying diseases were severe acute pancreatitis and severe cardiovascular events. The interleukin (IL)-6 level (median (interquartile range)) in the death group (480.40 ng/L (1 432.95 ng/L)) was higher than that of the survival group (107.05 ng/L (263.08 ng/L)), the difference was statistically significant ( Z=4.526, P<0.01). The procalcitionin (PCT) levels in the death group and the survival group were 3.81 μg/L (17.26 μg/L) and 2.12 μg/L (12.74 μg/L), respectively, with no difference between the two groups ( P>0.05). The death rate of empirical treatment with a single or more non-active antimicrobial agents was 57.14% (64/112), that of monotherapy with active agent was 45.68% (37/81), and that of combination therapy with at least one active drug was 64.52% (20/31). The differences had no statistical significance ( P=0.130). The logistic regression analysis showed that the risk factors of mortality associated with CRAB bloodstream infection were renal dysfunction (odds ratio ( OR)=2.181, P=0.024) and multiple organ dysfunction syndrome (MODS; OR=20.376, P<0.01). Conclusions:The fatality rate of patients with CRAB bloodstream infection is high. These patients with renal dysfunction or MODS have poor prognosis. In addition to early effective antibacterial therapy, individual comprehensive treatment should be implemented in order to improve the curative effect.
ABSTRACT
Objective To evaluate the value of peripheral blood Mycobacterium tuberculosis interferon-γ release assay(TB-IGRA )in early adjuvant diagnosis of tuberculous meningitis(TBM).Methods 56 patients with TBM (trial group) and 56 patients with non-TB meningitis (control group) admitted to West China Hospital of Sichuan University in January-December 2015 were analyzed, results of TB-IGRA, cerebrospinal fluid(CSF) Mycobacterium tuberculosis(MT) culture, and CSF TB-DNA testing of two groups of patients were analyzed, the sensitivity and specificity of each diagnostic method were calculated.Results The sensitivity of TB-IGRA, CSF MT culture, and CSF TB-DNA for diagnosis of TBM were 87.5％(49/56), 19.6％(11/56), and 60.7％(34/56) respectively,specificity were 89.3％(50/56), 100.0％(56/56), and 76.8％(43/56)respectively.The sensitivity of TB-IGRA for diagnosing TBM was higher than that of CSF TB-DNA and CSF MT culture, specificity of TB-IGRA was higher than that of CSF TB-DNA(89.3％>76.8％), pairwise comparison showed a significant difference(all P<0.01).Among 11 cases confirmed by CSF culture, 10 (90.9％[10/11])were positive for TB-IGRA;among 45 cases with clinical diagnosis and effective anti-tuberculosis treatment, 39 (86.7％[39/45])were positive for TB-IGRA.Conclusion TB-IGRA is highly sensitive and specific in the early adjuvant diagnosis of TBM, it is convenient, rapid, effective, and worthy to be popularized in clinical practice.