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Objective To discuss the clinical application value of serum procalcitonin(PCT) in patients with Candida bloodstream infection.Methods The data of 783 hospitalized patients of Tianjin Medical University General Hospital including blood culture and serum PCT test were retrospectively analyzed,and the medical records of patients with Candida or bacterial bloodstream infection were evaluated by univaxiate and multivariate logistic regression analysis.The comparison of PCT value were carried out among the different blood culture groups using the Mann-Whitney U test.A receiver operating characteristic(ROC) curve was used to determine the diagnostic performance of the PCT.Results The PCT was 0.21 (0.06,1.02) ng/mL in the 510 patients with negative blood culture,but in 121 patients with Candida infection and 152 patients with bacteria infections,the PCT levels were 1.15 (0.38,6.85) ng/ mL and 2.34 (0.77,15.12) ng/mL,respectively.There were statistically significant differences in PCT levels among three groups(P＜0.05).According to ROC,when the value of PCT was 0.355 ng/mL,the sensitivity was 76.9％,and the specificity was 60.8％ with 0.726 area under the curve (AUC) (P＜0.01) for the identification of Candida infection by blood cultures.Conclusions Serum PCT levels have a certain diagnostic value for Candida bloodstream infection.In critically ill patients with factors associated with candidemia,the combination of clinical symptoms with PCT as an adjuvant diagnostic marker and other laboratory findings can be used to make a prompt and effective initiation of antifungal therapy.
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Objective To investigate the resistance mechanism and virulence genes of clinical strains of carbapenem-resistant Klebsiella pneumonia ( CRKP ) .Methods Twenty clinical CRKP strains were collected from Tianjin Medical University General Hospital during May 2014 and May 2015.Vitek-2 Compact system was used for identification of the strains and antibiotic susceptibility test .Modified Hodge Test and EDTA double disk phenotypic test were performed for screening of drug -resistant phenotypes .Drug-resistant genes , capsular serotypes and associated virulence genes were amplified by PCR , and positive products were sequenced and analyzed by DNA sequencing .Results Resistance to beta-lactam antibiotics including cephalosporins and carbapenems was observed in 80.0%and above strains , but more than 70.0%strains were sensitive to tigecycline , amikacin and levofloxacin .KPC gene and NDM gene were found in 7 strains (35.0%) and 8 strains (40.0%), respectively.SHV, the most common extended-spectrumβ-lactamases ( ESBLs ) gene, was found in 16 strains ( 80.0%). DHA plasmid-mediated AmpCβ-lactamase was found in 2 strains (10.0%).Deletions of porin-coding genes OmpK35 and OmpK36 were found in 8 stains ( 40.0%) and 13 strains ( 65.0%), respectively.Carbapenem-resistant genes in combination with ESBLs genes and/or variation of porin was found in 14 strains (70.0%), and ESBLs genes in combination with variation of porin was found in 4 strains (30.0%).Three strains were of capsular serotype K1 and 1 was of K57, and all of them carried KPC genes .Virulence gene rmpA was found in 8 strains and all carried carbapenemases , among which 5 strains with KPC, 2 strains with NDM, 1 strain with both KPC and NDM .Six strains were aerobactin gene positive , among which 4 strains carried KPC genes . FimH-1 was positive in all strains .Conclusions KPC and NDM genes mainly account for resistance in CPKP, and ESBLs with OmpK gene deletion may also be an important cause .Strains with capsular serotypes K1 and K57 carrying KPC genes are common .
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Objective To analyze Klebsiella pneumoniae by DiversiLab system, providing scientific evidence for the control of nosocomial infection. Methods Eight strains of non-duplicated clinical Klebsiella pneumoniae isolated from the surgical ward in a hospital in 2010 were typed by rep-PCR-based DiversiLab system. The results were compared with those of pulsed-field gel electrophoresis (PFGE). Results Antimicrobial susceptibility test showed that 7 clinical strains were the same sensitivity to 11 antimicrobial agents, except the strain K8-02. And these 7 clinical strains were all multi-drug re-sistant. The result of PFGE showed that 7 strains were the same pattern. The result of DiversiLab also showed that 7 strains were the same pattern, and the strain K8-02 was another pattern. Conclusion DiversiLab system is simple, quick, good re-peatability and accurate, which is a kind of standardization and automation system. DiversiLab system and PFGE method could get the same result.
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OBJECTIVE To study the drug resistance,drug-resistant genes and(disinfectant)-resistant genes of(MRS)A.METHODS The drug resistance and mecA gene of the ?-lactamase and aac(6′)/aph(2″),aph(3′)-Ⅲ,ant(4′,4″) genes of aminoglycoside and qac(A/B) disinfectant-resistant genes were(detected) in 47 strains of MRSA.(RESULTS) In all 47 strains of MRSA,46 MRSA isolates were mecA positive,39 MRSA isolates were aac(6′)/aph(2″) positive,30 MRSA isolates were aph(3′)-Ⅲ positive,6 MRSA isolates were ant(4′,4″) positive,and 19 MRSA isolates were qac(A/B) positive.CONCLUSIONS MRSA is multiple-drug resistant.The main resistant mechanisms of MRSA to aminoglycosides and disinfectant are related to the drug-resistant genes of aminoglycoside and disinfectant-resistant genes.Clinic physician must pay attention to the diagnosis and(therapy) of MRSA,and control the hospital infection.