ABSTRACT
Objective:To investigate the prognosis of intensive care unit(ICU)patients with carbapenem-resistant Klebsiella pneumoniae(CR-KP)infection.Methods:Clinical data of 86 elderly patients with KP infection admitted to our hospital from August 2017 to July 2019 were retrospectively analyzed.All patients were identified by the VITEK system and were tested by using the Kirby-Bauer paper diffusion method for drug susceptibility.Based on the existence of CR-KP, patients were divided into the non-resistance group(n=40)and the resistance group(n=46). The number of ventilator days, ICU days and clinical prognosis were compared between the two groups.Results:Specimens from sputum had the highest rate of KP isolation(46/86, 53.49%), followed by specimens from drainage fluid(16/86, 18.60%), blood(12/86, 13.95%), puncture wound fluid(3/86, 3.50%)and the tip of deep vein catheters(9/86, 10.46%). KP had high drug resistance to meropenem, and the drug-resistance rate was 53.49%(46/86). Compared with the non-resistance group, ventilator days and ICU days increased in the drug-resistance group[(60.75±72.86)d vs.(26.11±41.10)d, (73.41±63.32)d vs.(38.96±50.75)d, t=2.660 and 2.756, P=0.003 and 0.004]. The clinical effectiveness rate was higher in the non-resistance group than in the drug-resistance group(57.50% or 23/40 vs.23.91 % or 11/46, χ2=10.097, P=0.001). Conclusions:ICU patients with CR-KP have a higher number of ventilator days and longer ICU stays than those without CR-KP.In clinical practice, it is necessary to strictly follow the indications for antibiotic use, regularly perform bacterial identification and drug susceptibility tests, and diagnose KP infection as early as possible, in order to provide evidence for clinical diagnosis and treatment.
ABSTRACT
Objective To describe the chnical, neuroimagine, pathological and genetic features in a case with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS)/Leigh overlap syndrome.Methods The ease was a 22-year-old woman with recurrent headache, loss of visual acuity and general seizures over 11 years.MRI demonstrated symmetrical high T2-weighted signals in occipital and parietal lobes, in the late stage of the disease, the above imagine changes on MRJ were also shown in the bilateral basal ganglion and brainstem.She died of status epilepticus at age of 22.Brain autopsy and mitochondrial DNA (mtDNA) analysis were performed in the patient.Results The main neuropathological findings were muhifocal and lamilar spongiform in the cortex of the whole brain, the basal ganglion and middle brain.Gliosis, macrophagie reaction and capillary endothelial proliferation were observed in these areas.All 6 layers of the cortex and subcortical white matter in occipital and parietal lobes were severely affected.GI3513A mutation was found in the gene of mitochondria encoded NADH dehydrogenase subunit 5 (MTNDS).Conclusions MELAS/Leigh overlap syndrome presents the symptoms predominantly affecting the cerebral cortex.Neuroimagines suggested that the lesion initially involves the cerebral cortex and in the late stage implicates the basal ganglion and the brainstem, possibly caused by pathological changes of spongiform with capillary proliferation in these areas.