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Objective To describe the clinical characteristics of hypervirulent Klebsiella pneumoniae (hvKP) infection.To analyze the antibiotic susceptibility of hvKP to provide the empiric antibiotic options.To investigate capsule serotype and sequence type (ST) of hvKP and their correlation with clinical profiles.Methods hvKP was defined as bacteria isolated from patients with community-acquired pyogenic liver abscess (CA-PLA) with co-infection sites outside liver or a bloodstream infection in a host without underlying biliary tract diseases.Patients with CA-PLA hospitalized in the First Hospital of China Medical University were retrospectively analyzed from January 2011 to December 2017.Antibiotic susceptibility was detected by automatic bacterial identification and antibiotic susceptibility analysis system in vitro.Polymerase chain reaction method and gene sequencing were used to detect the main capsule serotype and ST.Results A total of 140 cases with hvKP infection were enrolled.The co-infections outside liver abscess included 98 bloodstream infections,53 pneumonia,11 perianal abscess,10 urinary system infections,3 subphrenic abscess,3 endophthalmitis,2 spleen abscess,and other miscellaneous infections including 1 peritonitis,1 skin and soft tissue infection,1 myelitis,1 colitis,1 psoas major abscess and 1 myocardial abscess.Among the 140 cases,106 presented with single co-infection site,32 with 2 sites,and 2 with 3 sites.HvKP manifested high antibiotic susceptibility up to 80％ for most commonly used antibiotics.Capsule serotyping of 4,3 revived isolates indicated that K1 serotype accounted for 53.49％ (23/43),K2 34.88 (15/43),K54 2.33％ (1/43),K57 2.33％ (1/43),and other serotypes 6.98％(3/43).There was no significant distribution among K1,K2,K54,and K57 of hvKP capsule serotypes in patients with or without diabetes mellitus (P＞0.05).Multilocus sequence typing (MLST) suggested that ST23 and ST65 were predominant accounting for 39.53％ (17/4.3) and 25.58％ (11/4.3) respectively.No serotype or ST predominance was seen in any of the clinical infections.Conclusion HvKP is related to a wide spectrum of infectious diseases,including multiple extrahepatic sites and bloodstream infections besides CA-PLA with high antibiotic susceptibility.K1 and K2 are the predominant capsule serotypes,and ST 23 and ST65 are the predominant sequence types.
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Objective To investigate the clinical features of SAPHO syndrome.Methods Clinical data of 22 cases of SAPHO syndrome were analysed.Results There were 7 males and 15 females among the 22 patients.The average age at onset of cutaneous and osteoarticular lesions was 45 years and 44 years, respectively.Of the 22 patients,21 had palmoplantar pustulosis and 1 had acne fulminans.Anterior chest wall (ACW) was involved in 19 patients,peripheral joints in 4 patients and sacroiliac joints in 2 patients.Osteoarticular manifestations occurred prior to the onset of skin lesions in 10 cases.after that in 9 cases,and simultaneously in 3 cases.The mean interval between the onset of cntaneous and osteoarticular lesions was 2.7 years and the longest interval was 20 years.Conclusions Middle-aged females predominate in patients with SAPHO syndrome seen in dermatological clinics.Palmoplantar pustulosis and ACW involvement are the most common clinical manifestations of SAPHO syndrome.
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Objective To explore the effects of different initial treatment protocols on the prognosis of pneumonia in the kidney transplant recipients. Methods Sixty-seven cases of pneumonia following kidney transplantation were divided into case group (34 cases) and control group (33 cases).The patients in case group were treated with Imipenem and Cilastatin, SMX/TMP and ganciclovir,and those in control group received routine treatments. Mortality and length of stay in hospital (LOS)were analyzed. Results Mortality (5.9 % ) and LOS (15 days) in case group were reduced as compared with those in control group ( 18. 2 %, 23 days, respectively) (P＜ 0. 05). Among the patients without severe pneumonia, the mortality and incidence of LOS beyond 21 days in case group (3. 4 %, 1/29; 3. 4 %, 1/29) were lower than those in control group (17. 2 %, 5/29; 37. 9 %, 11/29, respectively) (P＜0. 05). Whether the patients were admitted to hospital sooner or later, the incidence of LOS beyond 21 days in case group was lower than that in control group (P＜0. 05).Whether the etiologies were determined or undetermined, the incidence of LOS beyond 21 days in case group was lower than that in control group (P＜0. 05). The incidence of LOS beyond 21 days in case group was lower than that in control group among the patients with cardiopulmonary disease (P＜0. 05). Conclusion The initial appropriate treatment would improve the prognosis of pneumonia in the kidney transplant recipients.
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Objective To explore the relationship between pulmonary arterial hypertension (PAH)associat-ed with chronic obstructive pulmonary disease (COPD) and inflammatory reaction(inflammatory cell, bs CRP, IL-8 and TNF-α). Methods According to echocardiography results, the patients (systolic pulmonary artery pressure, SPAP>30 mm Hg) were divided into PAH group(n=36), single COPD group(n=32). All of the patients and 30 healthy subjects (control group) were recruited into the study. Lung function, arterial blood gases, cell differentials in induced sputum, and the levels of serum high sensitivity CRP(hs-CRP), IL-8, TNF-α were determined. Results The incidence of PAH associated with COPD were 53% (36/68),including 27% (3/11) of mild PAH,38% (5/13) of moderate PAH and 64% (28/44) of severe PAH and there were significantly differences in the severity of the spirometric abnormality (χ26.020, P<0.05). The mean PASP and right ventricle wall thickness (RVWT) in PAH group were significantly greater in the patients compared to single COPD[PASP: (52±15)mmHg in PAH group and (23±12) mm Hg in single COPD group, t=3.32,P<0.01 ; PVWT: (5.03±1.04 )mm in PAH group and (3.78±0.57)nun in single COPD group, t=2.36, P<0.05]. The levels of total cell count and neutrophils in induced sputum,hs-CRP,IL-8 and TNF-α in PAH group were higher than those in single COPD group and healthy subjects[toal cell count: (2.84±0.56)×109/L in PAH group and (1.73±0.42)×109/L in single COPD group and (0.68±0.21)×109/L in control group; neutrophils: (2.78±0.52)×109/L in PAH group and (2.57± 0.26)×109/L in single COPD group and (0.63±0.21 )×109/L in control group; hs CRP: (32±12) mg/L in PAH group and (23±11)mg/L in single COPD group and (11±4)mg/L in control group; IL-8: (113±34) ng/L in PAH group and (69±24) ng/L in single COPD group and (38±11) ng/L in control group; TNF-α: (206±63)ng/L in PAH group and (153±54)ng/L in single COPD group and (75±26)ng/L in control group (P<0.05)]. PASP in PAH group was negatively correlated with FEV<,1>% (r=-0.48,P<0.01) and was positively correlated with the levels of serium IL-8 and TNF-α, neutrophils in induced sputum respectively(r=0.43,0.56,0. 47,P<0.01). Conclusion Inflammation reaction is responsible for PAH associated with COPD.
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Objective To study the relationship between inflammation and malnutrition in patients with stable chronic obstructive pulmonary disease (COPD).Methods A total of 85 patients with stable COPD and 30 healthy subjects were recruited .All patients were divided into the lower body mass index (BMI,BMI<18.5 kg/m~2) group and normal BMI (BMI=18.5-23.9 kg/m~2) group.Lung function,arterial blood gall,cell differenti-als in induced sputum,and the levels of serum C-reactive protein (CRP),interleukin-8(IL-8),interleukin-6 (IL-6),interleukin-10 (IL-10),and tumor necrosis factor-α(TNF-α) were determined.Results The levels of total cell count and neutrophils in induced sputum were significantly higher in lower BMI group than in normal BMI group and healthy subjects (P<0.05).The forced expiratory volume in 1 second percentage,forced expiratory volume in 1 second/forced vital capacity,and arterial oxygen tension were significantly lower in lower BMI group than in normal BMI group,and the arterial carbon dioxide tension was significantly higher in lower BMI group than in normal BMI group (P<0.05).The levels of serum CRP,IL-8,IL-6,and TNF-α were significantly higher in lower BMI group than those in normal BMI group and healthy subjects (P<0.05).In lower BMI group,BMI was negatively correlated with total cell count (r=-0.492,P=0.0038) and neutrophils (r=-0.501,P=0.0032) in induced sputum and the levels of serum CRP (r=-0.473,P=0.0083),IL-8(r=-0.382,P=0.0421),IL-6(r=-0.422,P=0.0147),and TNF-α(r=-0.416,P=0.0156),respectively.Conclu-sion Local and systemic inflammatory reaction is responsible for malnutrition associated with COPD.