Death-Related Factors in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease Treated by Sequential Mechanical Ventilation / 中国医学科学院学报

Objective To analyze the death-related factors of elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) treated by sequential mechanical ventilation,so as to provide evidence for clinical practice. Methods The clinical data of 1204 elderly patients (≥60 years old) with AECOPD treated by sequential mechanical ventilation from June 2015 to June 2021 were retrospectively analyzed.The probability and influencing factors of death were analyzed. Results Among the 1204 elderly patients with AECOPD treated by sequential mechanical ventilation,167 (13.87%) died.Multivariate analysis showed that plasma procalcitonin ≥0.5 μg/L (OR=2.762, 95%CI=1.920-3.972, P<0.001),daily invasive ventilation time ≥12 h (OR=2.202, 95%CI=1.487-3.262,P<0.001),multi-drug resistant bacterial infection (OR=1.790,95%CI=1.237-2.591,P=0.002),oxygenation index<39.90 kPa (OR=2.447,95%CI=1.625-3.685,P<0.001),glycosylated hemoglobin >6% (OR=2.288,95%CI=1.509-3.470,P<0.001),and acute physiology and chronic health evaluation Ⅱ score ≥25 points (OR=2.126,95%CI=1.432-3.156,P<0.001) were independent risk factors for death in patients with AECOPD treated by sequential mechanical ventilation.Oral care>twice/d (OR=0.676,95%CI=0.457-1.000,P=0.048) and sputum excretion>twice/d (OR=0.492, 95%CI=0.311-0.776, P=0.002) were independent protective factors for death in elderly patients with AECOPD treated by sequential mechanical ventilation. Conclusions The outcomes of sequential mechanical ventilation in the treatment of elderly patients with AECOPD are affected by a variety of factors.To reduce the mortality,we put forward the following measures:attaching great importance to severe patients,restoring oxygenation function,shortening unnecessary invasive ventilation time,controlling blood glucose,preventing multidrug resistant bacterial infection,oral care twice a day,and sputum excretion twice a day.

Relationship between Stress Hyperglycemia and Catheter-related Urinary Tract Infection in Stroke Patients / 中国医学科学院学报

Objective To verify the relationship between catheter-related urinary tract infection(CAUTI)and stress hyperglycemia during catheter retention in stroke patients. Methods We used nosocomial infection monitoring system to track the status of CAUTI in stroke patients in a hospital.The study cohort was all the patients who received retention catheterization from January 2016 to March 2020.According to the nested case-control design,multivariate logistic regression analysis was performed to explore the relationship between stress hyperglycemia and CAUTI in stroke patients with indwelling catheter. Results A total of 322 cases of CAUTI and 644 cases of non-CAUTI were enrolled in this study.The length of stay in the case group was(20.68 ± 3.73)d,significantly longer than that[(13.00 ± 4.01)d]in the control group(t=29.473,P <0.001).Compared with non-stress hyperglycemia,stress hyperglycemia posed a higher risk of CAUTI in the stroke patients with indwelling catheter(OR=2.020,95% CI=1.447-2.821,P=0.000)and led to the higher incidence of CAUTI in one thousand days(P<0.001). Conclusion Stress hyperglycemia in the stroke patients with indwelling catheter can significantly increase the risk of CAUTI.

Risk Factors for Postoperative Recurrence of Chronic Suppurative Otitis Media / 中国医学科学院学报

To analyze the risk factors for postoperative recurrence of chronic suppurative otitis media(CSOM) and explore the intervention measures to prevent postoperative recurrence of CSOM. A total of 1066 patients with CSOM who underwent concurrent surgical treatment and achieved clinical cure in our hospital from January 2012 to December 2018 were enrolled.The clinical data and laboratory findings were reviewed by using an electronic medical record system and the patients were followed up for 1 year.The patients were divided into the non-recurrent group and the recurrent group.Chi-square test and multivariate logistic regression were used to compare the factors may contribute to the postoperative recurrence. The recurrence rate of CSOM was 6.38%.Multi-drug-resistant(MDR) infection before surgery(=16.338,=0.000),aged ≥60 years(=5.182,=0.023),frequency of occurrence ≥3 times/year(=4.388,=0.036),duration of active period>7 d(=4.729,=0.030),repeated upper respiratory tract infection>3 times/year(=11.913,=0.001),accompanied by chronic sinusitis(=11.077,=0.001),blood glucose>6.11 mmol/L(=15.327,=0.000),postoperative serum procalcitonin(PCT)>0.5 μg/L(=8.337,=0.004) were the risk factors for postoperative recurrence.The use of snorkel was a protective factor for postoperative recurrence(=5.308,=0.021).Multivariate analysis showed that MDR infection(=3.373,95%:1.825-6.234,=0.000),repeated upper respiratory tract infection>3 times/year(=2.727,95%:1.479-5.030,=0.001),accompanied by chronic sinusitis(=2.980,95%:1.654-5.369,=0.000),blood glucose>6.11 mmol/L(=3.219,95%:1.741-5.953,=0.000),and postoperative serum PCT>0.5 μg/L(=2.085,95%:1.106-3.931,=0.023) were independent risk factors for postoperative recurrence in CSOM patients. Effective prevention and control of MDR infection,control of blood sugar,prevention of upper respiratory tract infection,and lowering the recurrence of chronic sinusitis are the main measures to reduce postoperative recurrence of CSOM.Monitoring of the infection marker PCT can help to achieve early intervention.

Prognostic Factors of Central Venous Catheter-related Bloodstream Infections / 中国医学科学院学报

Objective To explore the prognostic factors of central venous catheter-related bloodstream infection(CR-BSI)and provide reference for clinical practice. Methods The clinical data of 346 CR-BSI patients from February 2014 to July 2019 were retrospectively reviewed,and the prognostic factors were analyzed. Results Of the 346 CR-BSI patients,62 died,yielding a case-fatality rate of 17.92%.Univariate analysis showed that 18 factors including age(

Correlation between Asymptomatic Bacteriuria and Surgical Site Infection in Middle-aged and Elderly Patients Undergoing Open Hysterectomy / 中国医学科学院学报

Objective To explore the correlation between asymptomatic bacteriuria(AB)and surgical site infection(SSI)in middle-aged and elderly women undergoing open hysterectomy.Methods The clinical data of 1469 middle-aged and elderly women undergoing open hysterectomy in the Third Affiliated Hospital of Guizhou Medical University from June 2011 to August 2018 were retrospectively analyzed.Factors associated with SSI after operation were analyzed by univariate and multivariate regression models to identify the relationship of AB with SSI after open hysterectomy.Results Of these 1469 patients,101(6.88%)had SSI and 124 had AB[including 14 patients(11.29%)with infections].In addition,1345 patients had no AB,among whom 87(6.47%)had infections.Thus,the infection rate in patients with AB was significantly higher than that in patients without AB(=4.123,=0.042).Univariate analysis showed AB,history of diabetes mellitus,surgical procedure,length of stay(>15 d),season(summer and autumn),body mass index(≥25 kg/m ),nature of lesions(malignant tumors),ASA grade(>grade Ⅱ),incision length(≥10 cm),and operative time(≥3 h),bleeding volume(≥1000 ml),serum albumin concentration(grade Ⅱ)were risk factors for SSI in these patients(all <0.05). Conclusions AB is one of the risk factors for SSI in middle-aged and elderly women undergoing open hysterectomy.Screening and treatment of AB before surgery can reduce the risk of SSI.ASA grading shall be performed before surgery before corresponding preparation was offered.Effective control of blood glucose,improved surgical skills,and shorter operative time are helpful for lowering postoperative SSI.

Logistic Regression Analysis of the Risk Factors for Multidrug-resistant Bacterial Infections in Chronic Rhinosinusitis / 中国医学科学院学报

Objective To analyze the risk factors of multidrug-resistant bacterial infections in patients with chronic rhinosinusitis.Methods The clinical data of 221 patients with chronic rhinosinusitis who were treated in our center from January 2010 to January 2017 were collected retrospectively. Specimens were collected for bacterial culture and antibiotic susceptibility testing. The risk factors for multidrug-resistant bacterial infections were analyzed.Results Univariate analysis showed that combined use of 3 or more antibiotics,high visual analogue scale score,high Lund-Kennedy score,long disease course(>5 years),high frequency of acute infections(more than 3 times a year),long duration of acute infection(>7 days),recurrent upper respiratory tract infections(>3 times per year),chronic otitis media,smoking history,allergic rhinitis,poor drainage,high frequency of antimicrobial use(≥3 times/year),use of multiple antibiotics(more than 3 types),aged over 60 years,and use of antibacterial drugs for over 7 days were the risk factors for production of multi-drug-resistant organism(MDRO) in patients with chronic sinusitis(all P3 times per year),smoking history,allergic rhinitis,poor drainage,and high frequency of antimicrobial use(≥3 times/year) remained the risk factors for MDRO in patients with chronic sinusitis(all P<0.05).Conclusions Multidrug-resistant bacterial infections in patients with chronic sinusitis can be caused by a variety of factors. In the clinical practice,by focusing on the major risk factors,a comprehensive management strategy should be adopted to reduce the production of MDRO and improve the therapeutic outcomes.

Logistic regression analysis on postoperative pulmonary infection in hospitalized patients undergoing spinal surgery / 中国感染控制杂志

Objective To understand the risk factors for postoperative pulmonary infection in patients undergoing spinal surgery,and put forward the intervention measures.Methods Patients who underwent spinal surgery in a hospital from May 2008 to June 2016 were analyzed retrospectively,they were divided into non-pulmonary infection group and pulmonary infection group according to whether they had postoperative pulmonary infection,clinical data of two groups were compared.Results A total of 612 patients who underwent spinal surgery were monitored,43 had postoperative pulmonary infection,incidence of postoperative pulmonary infection was 7.03％.Univariate analysis showed that 14 risk factors for pulmonary infection in patients after spinal surgery were as follows:length of hospital stay≥30 days,long-term smoking,chronic pulmonary disease,diabetes,number of surgical level≥2,general anesthesia,duration of operation≥4 hours,bleeding≥500mL,time of bed rest≥7 days,use of glucocorticoid,indwelling urinary catheter,mechanical ventilation,serum albumin＜30 g/L,blood glucose≥1 1mmol/L,and hemoglobin＜90 g/L(P＜0.05);while atomization inhalation was a protective factor(P＜0.05).Multivariate logistic regression analysis showed that 6 independent risk factors for pulmonary infection in patients after spinal surgery were as follows:length of hospital stay≥30 days,long-term smoking,chronic pulmonary disease,general anesthesia,time of bed rest≥7 days,and use of glucocorticoid(all P＜0.05),while atomization inhalation was a independent protective factor(P＜0.05).Conclusion Patients with pulmonary infection after spinal surgery is related to multiple factors,comprehensive and effective preventive measures should be taken according to the risk factors of postoperative pulmonary infection,so as to reduce the incidence of postoperative pulmonary infection in spinal surgery patients.

Epidemiological characteristics and antimicrobial resistance of 91 strains of Pseudomonas putida / 中国感染控制杂志

Objective To analyze the epidemiological characteristics and antimicrobial resistance of clinically isolated Pseudomonas putida (P.putida),and provide basis for rational prevention and treatment of P.putida infection.Methods P.putida isolated between January 2010 and December 2015,as well as clinical data of patients infected with P.putida were collected,antimicrobial susceptibility of isolates was determined by Kirby-Bauer disk diffusion susceptibility testing of Clinical and Laboratory Standards Institute (CLSI) of America,susceptibility testing results of isolated strains were analyzed by WHONET 5.5 software.Results A total of 91 strains of P.putida were isolated from clinical specimens,most were from elderly patients aged ＞60 years(70.33％);the major underlying disease was community-acquired pneumonia (23.08％),followed by chronic pulmonary heart disease (15.38％);the main specimen was sputum(57.14％),followed by urine(27.47％);P.putida mainly distributed in department of respiratory medicine (28.57 ％),followed by department of cardiovascular medicine (13.19 ％).P.putida had high resistance rate to aztreonam (52.75 ％),while resistance rates to gentamicin,imipenem,levofloxacin,ceftazidime,meropenem,and ciprofloxacin were 7.78％,9.89％,2.20％,9.89％,7.69％,and 2.22％ respectively,resistance rates to amikacin and polymyxin were both 0.Conclusion P.putida infection mainly occurs in elderly patients with underlying diseases,mainly respiratory tract infection,resistance rates to most antimicrobial agents were ＜ 10 ％.