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Objective:To explore the related indexes of coagulation and thrombosis and their clinical significance in patients with severe fever with thrombocytopenia symptoms (SFTS) during the onset and recovery period after novel bunyavirus infection.Methods:A total of 36 patients diagnosed with SFTS (SFTS onset group) and 18 convalescent SFTS patients, who were hospitalized in the First Affiliated Hospital of Anhui Medical University from April 12, 2020, to October 12, 2020 were recruited in this study. Thirty-six healthy controls were recruited from volunteers. Plasma was collected and prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time(TT), antithrombin-Ⅲ (AT-Ⅲ), fibrin degradation product (FDP) and D-dimer (D-D) were determined by automatic blood coagulation analyzer. Thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasminase-α2 plasminase inhibitor complex (PIC) and tissue plasminogen activator-plasminogen activator inhibitor 1 complex (t-PAIC) were determined by an automatic chemiluminescence analyzer.Results:Compared with the healthy control group, PT was significantly prolonged (12.5 [12.1, 13.6] s, vs 10.8 [10.5, 11.5] s, P<0.05) in SFTS onset group, but was still within the reference range (14.0-21.0 s), and APTT (49.1 [42.0, 58.2]s vs 28.5 [26.6, 30.4]s, P<0.05) was also significantly prolonged in SFTS onset group. Compared with healthy control group, FDP (6.07 [2.67, 8.64] μg/ml vs 1.00 [0.80, 1.87] μg/ml, P<0.001), D-D (2.27 [1.04, 2.98] μg/ml vs 0.30 [0.21, 0.47] μg/ml, P<0.001), TAT (16.05 [8.05, 26.58] ng/ml vs 3.55 [2.60, 4.85] ng/ml, P<0.001), PIC (4.44 [2.52, 5.54] μg/ml vs 0.84 [0.60, 1.35] μg/ml, P<0.001), TM ([19.41±8.29] TU/ml vs [9.33±1.89] TU/ml, P<0.001), and t-PAIC ([37.52±21.10] ng/ml vs [7.06±3.37] ng/ml, P<0.001) values were all significantly higher in the SFTS onset group (all P<0.001). The level of TAT in the SFTS recovery group (9.10 [3.95, 18.40] ng/ml) was still out of the reference range (<4 ng/ml), while the level of PIC in the SFTS recovery group was lower than in SFTS onset group (1.91 [1.45, 2.93] μg/ml vs 4.44 [2.52, 5.54] μg/ml, P<0.05). Compared with SFTS onset group, the levels of TM and t-PAIC were lower in the SFTS recovery group ( P<0.05). Conclusions:Coagulation system activation and vascular endothelial injury are evidenced in SFTS patients. In the convalescence period, the vascular endothelial injury is recovered, however, there is still a certain degree of coagulation dysfunction, therefore, it is necessary to monitor the coagulation indicator of discharged patients post SFTS.
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OBJECTIVE@#To investigate the characteristics of immunophenotypes and expressions of non-myeloid differentiation antigens in acute myeloid leukemia (AML) and their value in diagnosis and prognostic evaluation of AML.@*METHODS@#We examined the immunophenotypes of 109 patients with AML using BD FACSCalibur flow cytometry and analyzed the association of the immunophenotypes and expressions of non-myeloid differentiation antigens with the prognosis and complete remission (CR) rate of the patients.@*RESULTS@#Immunophenotype analysis showed that the positivity rates of the myeloid differentiation antigens of AML cells decreased in the order of CD13, CD117, CD33, MPO and CD15; the positivity rates of CD117, CD13, CD33 and MPO did not differ significantly (@*CONCLUSIONS@#Immunophenotyping and analysis of non-myeloid differentiation antigens can be of great clinical significance for the diagnosis and prognostic evaluation of AML, and serve also as one of the important bases for the diagnosis and treatment of AML.
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Humans , Cell Count , Flow Cytometry , Immunophenotyping , Leukemia, Myeloid, Acute , PrognosisABSTRACT
Objective To investigate the expression and the clinical function of exosomal miR-122 in patients with hepatitis C (HCV). Methods Forty HCV patients (28 HCV-1b and 12 non-HCV-1b) were enrolled in this study, serum and exosomal miR-122 and other conventional biomarkers reflecting liver function were measured.20healthy subjects were enrolled as control.ResultsThe expressions of exosomal miR-122 in HCV-1b and nonHCV-1b groups were higher than that in healthy group, but the former was slightly higher than the latter.Exosomal miR-122 in HCV group was weakly negatively related to AST and ALT levels.The expression of exosomal miR-122was consistent with that of serum miR-122.Besides, the serum miR-122 in sustained virological response (SVR) group was higher than that in non-sustained virological response (NR) group (P＜0.05), but statistical difference of exosomal miR-122 between SVR and NR groups was not found. Conclusion In HCV patients, exosomal miR-122 may be useful in evaluating hepatic impairment, but it cannot be used to evaluate the therapeutic effect.
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Objective To explore the value of Epstein-barr virus(EBV) antibody detection in diagnosis of nasopharyngeal carcinoma (NPC ) and infectious mononucleosis (IM). Methods ELISA and CLIA were used to evaluate the EBV 5 antibody in 535 hospitalized and outpatients. The results of the combined detection of EBV virus were analyzed by clinical pathological diagnosis. Results There was no statistical difference between the results of antibody tests in NPC and IM. The positive pattern of EB antibody spectrum in NPC was the highest in EBV-IgA, EBNA-IgG, EBVCA-IgG, EA-IgG mode, accounting for 84. 48％ of the positive rate, and IM was relatively more in EBVCA-IgG, EBVCA-IgM, EA-IgG mode, accounting for 54. 16％ of the total positive rate. The sensitivity of EB-NA-IgG and EBVCA-IgG in diagnosis of NPC was 100. 0％, and the specificity was 11. 3％ and 8. 5％ respectively. The specificity of EBVCA-IgM to NPC was as high as 95. 8％, while the sensitivity was only 1. 7％. In the IM, the sensitivity, specificity, accuracy and negative predictive value of the EBVCA-IgM single test were more than 90. 0％. The specificity and accuracy of EA-IgG reached 94. 5％ and 93. 1％, and the sensitivity was 70. 8％. Compared with the positive rate, the EBV-IgA and EA-IgG in NPC group were statistically significant(P <0. 05). EBVCA-IgM and EA-IgG was significantly higher than other children's disease group in IM group, the difference was statistically significant (P <0.05). Conclusion The positive rates of EBNA-IgG and EBVCA-IgG in adult diseases were higher than that in children, and the positive rate of EBVCA-IgM was significantly higher in children with IM than that in adult diseases and other children's diseases.
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Objective To investigate the antibiotic resistance of clinical isolates in the First Affiliated Hospital of Anhui Medical University during 2017. Methods Antimicrobial susceptibility testing was carried out according to a unified protocol using automated system or Kirby-Bauer method. Results were interpreted according to the breakpoints of CLSI 2017. The data were analyzed by WHONET 5.6 software. Results A total of 6 495 non-duplicate clinical isolates were collected in 2017. There were 1 727 strains (26.6％) of gram-positive bacteria and 4 768 strains (73.4％) of gram-negative bacteria. The most frequently isolated microorganisms were E. coli (19.8％), followed by Klebsiella pneumoniae and Acinetobacter baumannii. The strains were mainly isolated from respiratory tract (37.0％) and urine (23.1％). The prevalence of MRSA and MRCNS in Staphylococcus aureus and coagulase-negative Staphylococcus was 50.1％ and 82.1％, respectively. No Staphylococcus strains were found resistant to vancomycin or linezolid. E. faecalis and E. faecium accounted for 49.9％ and 40.4％ of total Enterococcus isolates. The prevalence of ESBLs-producing strains was 57.6％ in E. coli, 27.1％ in Klebsiella spp. and 33.0％ in Proteus mirabilis. Enterobacteriaceae strains were still highly susceptible to carbapenems antibiotics. The Klebsiella pneumoniae isolates in 2017 showed significantly higher resistance rate to imipenem and meropenem than the strains in 2016. However, Pseudomonas aeruginosa and Acinetobacterbaumannii strains showed lower resistance rates to carbapenems than the strains in 2016. Conclusions The bacterial isolates in 2017 pose serious threat to clinical antibiotic therapy. More attention should be paid to rational use of antimicrobial agents and infection control measures.
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Objective To report the distribution and antibiotic resistance of bacterial strains isolated in the First Affiliated Hospital of Anhui Medical University during 2016 for improving clinical treatment of bacterial infections. Methods Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. The results were interpreted according to the clinical and laboratory standards institute (CLSI) 2015 breakpoints, and analyzed using WHONWT 5.6. Results A total of 5 406 clinical isolates were collected during 2016, of which gram positive organisms accounted for 25.6％ (1 386/5 406) and gram negative organisms 74.4％ (4 020/5 406). The strains were mainly isolated from respiratory tract (35.4％, 1 913/5 406) and urine (26.7％, 1 441/5 406). The most frequently isolated microorganisms were E. coli (23.1％, 1 247/5 406), followed by K. pneumoniae (12.1％,654/5 406). The prevalence of MRSA was 52.2％ (166/318). The prevalence of MRCNS was 80.3％ (462/575). Of the ESBLs producers, E. coli accounted for 59.7％ (745/1 247), and K. pneumoniae accounted for 30.6％(200/654). ESBLs-producing strains showed significantly higher resistance rates to most antibiotics than non-ESBLs-producing strains. All the E. faecalis strains were susceptible to vancomycin. A few (0.2％) of the E. faecium strains were resistant to vancomycin, which were all from urine specimens. A total of 1 046 (19.3％, 1 046/5 406) carbapenemresistant strains were isolated. Most Enterobacteriaceae isolates were still highly sensitive to carbapenems. Carbapenem-resistant isolates were mainly A. baumannii (41.1％, 430/1 046), P. aeruginosa (17.4％, 182/1 046)) and K. pneumoniae (12.0％, 126/1 046). Most Acinetobacter strains were resistant to most of the antibiotics tested. Conclusions Antimicrobial resistance is increasing in the clinical isolates in this hospital. We should continue to strengthen antimicrobial stewardship, prescribe antibiotics for strict indications, and improve rational antibiotic use.
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Objective To investigate the antimicrobial resistance profile of the clinical isolates collected from selected hospitals across China. Methods Twenty-nine general hospitals and five children's hospitals were involved in this program. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to CLSI 2017 breakpoints. Results A total of 190 610 clinical isolates were collected from January to December 2017, of which gram negative organisms accounted for 70.8％ (134 951/190 610) and gram positive cocci 29.2％ (55 649/190 610). The prevalence of methicillin-resistant strains was 35.3％ in S. aureus (MRSA) and 80.3％ in coagulase negative Staphylococcus (MRCNS) on average. MR strains showed much higher resistance rates to most of the other antimicrobial agents than MS strains. However, 91.6％ of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 86.2％ of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains showed much lower resistance rates to most of the drugs tested (except chloramphenicol) than E. faecium. Vancomycin-resistant Enterococcus (VRE) was identified in both E. faecalis and E. faecium. The identified VRE strains were mainly vanA, vanB or vanM type based on phenotype or genotype. The proportion of PSSP or PRSP strains in the non-meningitis S.pneumoniae strains isolated from children decreased but the proportion of PISP strains increased when compared to the data of 2016. Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, less than 10％ of these strains (excluding Klebsiella spp.) were resistant to carbapenems. The prevalence of imipenem-resistant K. pneumoniae increased from 3.0％ in 2005 to 20.9％ in 2017, and meropenem-resistant K. pneumoniae increased from 2.9％ in 2005 to 24.0％ in 2017, more than 8-fold increase. About 66.7％ and 69.3％ of Acinetobacter (A. baumannii accounts for 91.5％) strains were resistant to imipenem and meropenem, respectively. Compared with the data of year 2016, P. aeruginosa strains showed decreasing resistance rate to carbapenems. Conclusions Bacterial resistance is still on the rise. It is necessary to strengthen hospital infection control and stewardship of antimicrobial agents. The communication between laboratorians and clinicians should be further improved in addition to surveillance of bacterial resistance.
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Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS)is a powerful tool for routine identification of a variety of microorganisms,including bacteria,yeast and filamentous fungi.Fast,accurate, high-throughput and low-cost characteristics,and gradually used for filamentous fungal infection in the laboratory diagnosis. In the MALDI-TOF MS analysis of filamentous fungi,from sample preparation to obtaining accurate identification results, each step determines whether the medical technician can provide accurate results for the clinician.This review will provide a systematic overview of the applications and prospects of filamentous fungal analysis (including identification,typing,and an-tifungal susceptibility testing)from preparation of the test sample to the MALDI-TOF MS technique,as well as a review of some of its future developments.
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Objective To investigate the distribution and the antibiotic resistance profile of clinical isolates in the First Affiliate Hospital of Anhui Medical University during 2015.Methods Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method and automated systems.Results A total of 5 524 nonduplicate clinical isolates were collected during 2015,including gram-negative bacteria (3 882,70.3 ％),gram-positive bacteria (1 642,29.7 ％).The prevalence of methicillin-resistant isolates in Staphylococcus aureus (MRSA) and coagulase-negative Staphylococcus (MRCNS) was 57.6％ and 83.0 ％,respectively.All staphylococcal isolates were susceptible to vancomycin and linezolid.E.faecalis and E.faecium accounted for 46.1％ and 46.8 ％ of enterococcal isolates.Some E.faecalis and E.faecium strains were nonsusceptible to vancomycin or linezolid.The prevalence of extended-spectrum lactamases (ESBLs) positive strains was 62.0 ％ in E.coli,32.2 ％ in Klebsiella and 18.8 ％ in Proteus mirabilis.Enterobacteriaceae strains were still highly susceptible to carbapenem antibiotics,evidenced by lower resistance rate of Enterobacteriaceae strains to ertapenem,imipenetn and meropenem (a11＜22 ％).Conclusions It seems that antibiotic resistance still poses a serious threat to clinical antimicrobial therapy.More attention should be paid to resistance surveillance and rational use of antibiotics.
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Objective@#To investigate the comparative study of serum hepatitis B virus (HBV) large protein (HBV-LP) , HBV-DNA, and Pre S1 antigen (Pre S1-Ag) detection in the evaluation of serum HBV replication in patients with chronic hepatitis B.@*Methods@#A total of 482 patients infected with chronic hepatitis B virus (CHB) were enrolled and the serums were collected in a hospital of Hefei city in Anhui province from June 2013 to March 2015. The serum HBV-LP, HBV markers(HBV-M) and Pre S1-Ag were detected using ELISA, and HBV-DNA were quantified using quantitative real-time PCR. The positive detection rate difference of HBV-DNA, HBV-LP and Pre S1-Ag were compared, the correlation between the logarithm of HBV-DNA copies number and the absorbance value of HBV-LP was analyzed using Spearman rank correlation.@*Results@#The positive rates of HBV DNA, HBV-LP, and Pre S1-Ag were 67.22% (324/482), 73.86% (356/482), and 37.34% (180/482), respectively (P<0.01). The positive rates of the three markers were 54.57% (185/339), 64.90% (220/339), and 27.73% (94/339), respectively, in 339 HBeAg-negative CHB patients (P<0.01). In HBeAg negative patients, the positive rate of HBV-LP in 185 cases of HBV-DNA positive samples was 90.81% (168/185), which was higher than that of Pre S1-Ag with rate of 39.46% (73/185) (P<0.01).The positive rate of HBV-LP was 33.77% (52/154) in 154 cases of patients with negative HBV-DNA whose positive rate was higher than Pre S1-Ag with positive rate of 13.64% (21/154)(P<0.01). The positive rates of HBV-DNA, HBV-LP and Pre S1-Ag in HBsAg, HBeAg and HBcAb positive groups were 97.04% (131/135), 94.81% (128/135), and 60.00% (81/135), (P<0.01); The positive rates of three indexes of HBsAg, HBeAb, HBcAb positive group were 53.74% (122/227), 63.88% (145/227), and 27.31% (62/227); The positive rates of three indexes of HBsAg and HBcAb positive group were 55.79% (53/95), 67.37% (64/95), and 28.42% (27/95) (P<0.01). The absorbance value of HBV-LP was positively related with the logarithm of HBV-DNA copies number (Spearman rank correlation coefficient was 0.908, P<0.01).@*Conclusion@#There was a good correlation between HBV-LP and HBV-DNA load value, and could be used as an effective complement for the detection of HBV-DNA and HBV-M. Compared with Pre S1-Ag.
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Objective To detect the effects of miR-143 on proliferation, migration and invasion of human nasopharyngeal cancer CNE-2Z cells.Methods The expression of miR-143 in NP69 cells, CNE-1 cells and CNE-2Z cells were detected by using real-time PCR.The overexpression of miR-143 in CNE-2Z cells was constructed through infecting lentivrius, and the level of miR-143 was determined by using real-time PCR.Cell viability was detected by using a CCK-8 kit according to the manufacturer's instruction at indicated time points.The effectiveness of overex-pression of miR-143 on migration and invasion of CNE-2Z cells were detected by using Transwell cell migration and invasion assay.Results The expression level of miR-143 in CNE-2Z was significantly lower than those in NP69 and CNE-1 (P<0.01).The miR-143 over-expressed CNE-2Z cell was successfully established.The cell viability in CNE-2Z/ miR-143 group was significantly decreased compared with CNE-2Z and CNE-2Z/miR-NC (P<0.01).Overexpression of miR-143 inhibited cell migration and invasion of CNE-2Z cells significantly(P<0.01).Conclusion miR-143 might inhibit cell proliferation, migration and invasion in human nasopharyngeal cancer CNE-2Z cells, indicating its important role in diagnosis, treatment and prognosis of nasopharyngeal cancer.
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Objective To explore the diagnosis and treatment of bronchogenic cyst in the abdomen.Methods Clinical data of 7 cases with abdominal bronchogenic cyst in the First Affiliated Hospital of China Medical University from October 2001 to February 2016 were retrospectively analyzed.Results Of the 7 patients,5 were male and 2 were female aging from 36 to 50 years with a median age of 37 years.Two cases were complaining for upper abdominal pain,5 cases were asymptomatic.Ultrasonography revealed hypoechoic or anechoic mass.Color doppler flow imaging showed no blood flow.Contrast-enhanced CT scans showed no obvious enhancement in 6 out of 7 cases,all patients underwent cystectomy successfully.Cysts were of unilocular in 6 cases and multilocular in one.Bronchogenic cysts were diagnosed by pathology in all 7 cases.Six patients were followed up from 1 month to 6 years with no recurrence.Conclusions Abdominal bronchogenic cyst is benign and postoperative prognosis is very good.
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Objective:To investigate the correlation between NKG2A+NK cells and regulatory T cells in peripheral blood of patients with chronic hepatitis B virus infection, and explore the clinical significances.Methods: Forty-six patients with chronic hepatitis B virus infection and 17 health individuals were included in this study.HBV DNA levels were measured by Real-time quantitative PCR ( FQ-PCR) .NKG2A+NK cells and Treg in PBMC were quantitatively analyzed by flow cytometry.Results:According to HBV DNA levels,the CHB patients were divided into two groups:Low HBV DNA group(Low viral load group,300-104 U/ml)and High HBV DNA group( High viral load group,105-108 U/ml).We found that ALT levels of High HBV DNA group were obviously higher than Low HBV DNA group(P<0.05).The frequenies of CD56dim NK cells of High HBV DNA group were obviously higher than low HBV DNA group ( P<0.05 ), and similarly the percentages of NKG2A+CD56dim NK cells of High HBV DNA group were significantly higher than Low HBV DNA and control groups ( P<0.05).We also found that the percentages of regulatory T cells ( Treg) of High HBV DNA group were significantly higher than Low HBV DNA and control groups ( P<0.05).In addition,the proportions of NKG2A+CD56dim NK cells were positively correlated with High HBV DNA levels (r=0.59,P<0.05) and the percentages of Treg(r=0.53,P<0.05) in CHB patients.Conclusion:NKG2A+CD56dim NK cells may closely relate to the HBV-related immune escape and the progress of CHB.
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Objective To explore the clinical value of five methods commonly used for the detection of clinical syphilis antibody.Methods A total of 160 confirmed syphilis cases were chosen as the experimental group while 200 non-syphilis cases were set as the control group.Serum specimens were detected by methods as Treponema pallidum particle agglutination assay (TPPA),chemiluminescent microparticle immune assay (CMIA),enzyme linked immunosorbent assay (ELISA),emulsion method (TP-AD) and toluidine red unheated serum test (TRUST).Sensitivity and specificity were evaluated on five methods.Titers of syphilis antibody in different stages and pre/post on treament among syphilis patients were compared and analyzed under the five methods.Results The sensitivity vs.specificity of TPPA,CMIA,ELISA,TP-AD and TRUST appeared as 100.00％ vs.99.50％,99.38％ vs.99.00％,98.12％ vs.99.00％,94.38％ vs.94.50％ and 85.62％ vs.95.50％,respectively.Among the patients at primary or latent stages,the syphilis antibody positive rate detected by TRUST appeared lower than that detected by ELISA,TPPA,CMIA or TP-AD,and the differences were statistically significant (P＜0.01).There were no statistical differences in the syphilis antibody positive rate of syphilis patients in the secondary or tertiary stages detected by five methods (P＞0.05).In each stage of the syphilis patients,the syphilis antibody positive rate detected by ELISA or of CMIA combined with TRUST both reached 100.00％.Before and after treatment in 121 cases of confirmed syphilis,there was statistically significant difference in the syphilis antibody positive rate detected by TRUST method (P＜0.05).There was no statistical significance in the syphilis antibody positive rate detected by other four methods (P＞0.05).Conclusions The sensitivity and specificity of TPPA,CMIA and ELISA methods were better.Methods as ELISA or as CMIA combined with TRUST both appeared reliable for syphilis screening in every stage of the disease.TRUST was suitable for the determination of active stage syphilis and monitoring the effects after treatment.
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Objective To explore the clinical value of five methods commonly used for the detection of clinical syphilis antibody.Methods A total of 160 confirmed syphilis cases were chosen as the experimental group while 200 non-syphilis cases were set as the control group.Serum specimens were detected by methods as Treponema pallidum particle agglutination assay (TPPA),chemiluminescent microparticle immune assay (CMIA),enzyme linked immunosorbent assay (ELISA),emulsion method (TP-AD) and toluidine red unheated serum test (TRUST).Sensitivity and specificity were evaluated on five methods.Titers of syphilis antibody in different stages and pre/post on treament among syphilis patients were compared and analyzed under the five methods.Results The sensitivity vs.specificity of TPPA,CMIA,ELISA,TP-AD and TRUST appeared as 100.00％ vs.99.50％,99.38％ vs.99.00％,98.12％ vs.99.00％,94.38％ vs.94.50％ and 85.62％ vs.95.50％,respectively.Among the patients at primary or latent stages,the syphilis antibody positive rate detected by TRUST appeared lower than that detected by ELISA,TPPA,CMIA or TP-AD,and the differences were statistically significant (P＜0.01).There were no statistical differences in the syphilis antibody positive rate of syphilis patients in the secondary or tertiary stages detected by five methods (P＞0.05).In each stage of the syphilis patients,the syphilis antibody positive rate detected by ELISA or of CMIA combined with TRUST both reached 100.00％.Before and after treatment in 121 cases of confirmed syphilis,there was statistically significant difference in the syphilis antibody positive rate detected by TRUST method (P＜0.05).There was no statistical significance in the syphilis antibody positive rate detected by other four methods (P＞0.05).Conclusions The sensitivity and specificity of TPPA,CMIA and ELISA methods were better.Methods as ELISA or as CMIA combined with TRUST both appeared reliable for syphilis screening in every stage of the disease.TRUST was suitable for the determination of active stage syphilis and monitoring the effects after treatment.
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Objective To investigate the clinical features and prognostic factors of nosocomially acquired candidemia.Methods A retrospective analysis was conducted for hospitalized patients with nosocomial candidemia between January 2012 and December 2014 at the First Affiliated Hospital of Anhui Medical University.The univariate and multivariate Logistic regression analyses were used to determine the prognostic factors of candidemia.Results A total of 92 patients were diagnosed with nosocomially acquired candidemia.The most common pathogen was Candida glabrata (C.glabrata,39/92,42.4％),followed by Candida albicans (C.albicans,30/92,32.6％),then Candida krusei (C.krusei,7/92,7.6％),Candida tropicalis (C.tropicalis,5/92,5.4％),Candida parapsilosis (C.parapsilosis,4/92,4.4％) and other Candida spp.(7/92,7.6％).The sensitivity rates of Candida spp.strains against flucytosine,amphotericin B,voriconazole,fluconazole and itraconazol were 100.0％,98.9％,92.4％,82.6％oo and 77.2％,respectively.The 30-day attributable case fatality rate was 13.0％(12/92).Multivariate Logistic regression analyses indicated that presence of central venous catheter (OR=4.833,95％CI:1.010-23.125,P=0.049),invasive mechanical ventilation (OR=6.075,95％CI:1.144-32.257,P=0.034),and receiving hemodialysis (OR =8.367,95 ％ CI:1.390-50.364,P =0.020)were factors independently correlated with increased mortality.Conclusions The pathogens causing nosocomially acquired candidemia are mainly C.glabrata,C.albicans and C.krusei.The drug susceptibility of Candida spp.varies among fluconazole,itraconazol voriconazole.The resistant rates of Candida spp.against voriconazole,fluconazole and itraconazol are different.The presence of central venous catheter,invasive mechanical ventilation and receiving hemodialysis are factors independently correlated with increased mortality.
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Objective To evaluate the changing pattern of antibiotic resistance inKlebsiella strains isolated from the patients in 19 hospitals across China based on the data from CHINET Antimicrobial Resistance Surveillance Program during the period from 2005 through 2014.Methods Kirby-Bauer disk diffusion and automated susceptibility testing methods were used to test the susceptibility ofKlebsiella isolates to the commonly used antibiotics. The results were interpreted according to the criteria of the Clinical and Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing (CLSI-2014).Results A total of 61 406Klebsiella strains were identified between 2005 and 2014, includingK. pneumoniae (56 281 strains), K. oxytoca(4 779),Klebsiella pneumoniae subsp.Ozaenae (300) and otherKlebsiella species (46). Most (89.0%, 54 664/61 406) of theKlebsiella strains were isolated from inpatients, and 60.0% (36 835/61 406) were from respiratory tract speciems. About 16.7% (10 248/61 406) of the strains were isolated from pediatric patients aged 0-17 years and 83.3% (51 158/61 406) from adult patients. The prevalence ofKlebsiella spp. increased with time from 10.1% in 2005 to 14.3% in 2014. Based on the surveillance data during the 10-year period, we found a marked increase of resistance to imipenem (2.9% to 10.5%) and meropenem (2.8% to 13.4%) inKlebsiella spp. The prevalence of ESBLs-producing isolates inK. pneumoniae andK. oxytoca decreased from 39.0% in 2005 to 30.1% in 2014. The resistance to amikacin, ceftazidime, ciprolfoxacin, pipracillin-tazobactam and cefoperazone-sulbactam was on decline. The resistance rate to cefotaxime remained high about 49.5%. Carbapenem resistantance was identiifed in 5 796 (9.4%) of the isolates, including 5 492 strains ofK. pneumoniae and 280 strains ofK. oxytoca. Overall, 4 740 (7.8%) strains were identiifed as extensively-drug resistant (XDR), including 4 520 strains ofK. pneumoniae and 202 strains ofK. oxytoca. The carbapenem-resistant strains showed high (>60%) resistance rate to majority of the antimicrobial agents tested, but relatively low resistance to tigecycline (16.8%), amikacin (54.4%), and trimethoprim-sulfamethoxazole (55.5%).Conclusions During the 10-year period from 2005 through 2014, carbapenem resistance amongKlebsiella isolates has increased dramatically in the hospitals across China. The level of resistance to other antibiotics remains stable.
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Objective To investigate the distribution and antibiotic resistance proifle of clinicalEnterobacter isolates using the data from CHINET during the period from 2005 through 2014.Methods A total of 20 558 clinical strains ofEnterobacter spp. were collected from 2005 to 2014 in CHINET Antimicrobial Resistance Surveillance Program. Antimicrobial susceptibility testing was performed with Kirby-Bauer or minimum inhibitory concentration method. The results were analyzed according to CLSI 2014 breakpoints.ResultsEnterobacter cloacae andEnterobacter aerogenes accounted for 71.1% (14 617/20558) and 20.1% (4 129/20 558) of all theEnterobacterisolates, respectively. The proportion ofEnterobacter spp. increased with time from 3.5% in 2005 to 4.3% in 2014. The main source of the isolates was respiratory tract, accounting for 55.2% (11 358/20 558). More than 90% of theEnterobacterisolates were resistant to cefazolin and cefoxitin, but less than 30% of the strains were resistant to cefepime, piperacillin-tazobactam, cefoperazone-sulbactam, amikacin, gentamicin, ciprolfoxacin, meropenem, imipenem and ertapenem. TheEnterobacterisolates showed a trend of declining resistance to most antibiotics except ertapenem and meropenem. The resistance proifle ofEnterobacterisolates varied with departments where they were isolated. The strains from ICU and Department of Surgery were relatively more resistant to antibiotics. The prevalence of multi-drug resistant (MDR) strains was decreasing, but the prevalence of carbapenem-resistantEnterobacter (CRE, resistant to any of imipenem, meropenem or ertapenem) was increasing. The MDR and CRE strains were primarily isolated from ICU and Department of Surgery. At least 30% of the MDREnterobacter strains were resistant to any of the antimicrobial agents tested except meropenem, imipenem and ertapenem and at least 35% of the CRE strains were resistant to any of the antimicrobial agents tested except amikacin and ciprolfoxacin.Conclusions TheEnterobacter isolates in CHINET Antimicrobial Resistance Surveillance Program showed decreasing resistance to most of the antimicrobial agents tested since 2011, but the prevalence of CRE strains increased progressively. Effective measures should be carried out to prevent the spread of CRE strains in hospitals.
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Objective To understand the changing resistance proifle ofProteus,Serratia,Citrobacter,Morganella andProvidencia in hospitals across China according to the data from CHINET Antimicrobial Resistance Surveillance Program 2005-2014.Methods Antimicrobial susceptibility was tested by using Kirby-Bauer method or automatic minimum inhibitory concentration determination according to a uniifed protocol.Results A total of 21 663 clinical isolates were collected from January 2005 to December 2014. The proportion ofProteus andSerratia isolates increased with time from 1.41% in 2005 to 2.09% in 2014, and from 0.99% in 2005 to 1.28% in 2014 among all the isolates. No change was found for the proportion ofCitrobacter,Morganella, orProvidencia. Less than 10% of theProteus isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, ceftazidime, cefoxitin, amikacin and tigecycline. Less than 10% of theSerratia isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, amikacin and tigecycline. Less than 20% of theCitrobacter isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, amikacin and tigecycline. Less than 10% of theMorganella isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, amikacin and tigecycline. Less than 20% of theProvidencia isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, cefoxitin and tigecycline.Conclusions The antibiotic resistance ofProteus,Serratia, Citrobacter,Morganella andProvidencia isolates in hospitals across China is growing during the period from 2005 to 2014. Strengthening infection control and rational antibiotic use are effective to slow the growth of drug resistance.
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Objective To investigate the distribution and changing resistance proifle ofSalmonella isolates in hospitals across China during the period from January 2005 to December 2014.Methods Seventeen general hospitals and two children’s hospitals were involved in this program. Antimicrobial susceptibility testing was carried out by means of a unified protocol using Kirby-Bauer method or MIC determination. The results were analyzed according to CLSI 2014 breakpoints.Results The proportion ofSalmonella isolates increased with time from 0.2% in 2005 to 0.7% in 2014. A total of 3 478Salmonella strains were collected from 19 hospitals. The proportion ofSalmonella typhimurium andSalmonella enteritidis was 27.4% and 24.4%, respectively. During the 10-year period, theSalmonella strains showed highest resistance rate to ampicillin (33.3%-64.8%), but low resistance to cefoperazone-sulbactam (0-5.3%) and ciprofloxacin (2.4%-14.3%).S. typhimurium showed higher resistance rate thanS. typhi,S. paratyphi andS. enteritidis. About 76.8% and 50.5% ofS. typhimurium were resistant to ampicillin and trimethoprim-sulfamethoxazole. The average prevalence of multi-drug resistantSalmonellawas 3.9% in the ten-year period, the highest (7.5%) was in 2005, the lowest (1.5%) in 2013.Conclusions During the period from 2004 to 2015, majority of theSalmonella isolates in hospitals across China wasS. typhimurium andS. enteritidis. Ampicillin and trimethoprim-sulfamethoxazole are no longer appropriate for empirical treatment ofS. typhimurium infection due to high resistance rate.Salmonella isolates are relatively more susceptible to third-generation cephalosporins and quinolones. Ongoing monitoring is necessary to identify multi-drug resistant strains ofSalmonella.