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OBJECTIVE：To provide reference for clinical empirical treatme nt of non-fermentative Gram-negative bacilli （NFGNB）infection. METHODS ：All kinds of clinical specimens were collected from Jan. 2010 to Dec. 2019 in a tertiary hospital from Hanzhong city of Shaanxi province ；the distribution and drug resistance of NFGNB were analyzed retrospectively. RESULTS ： A total of 26 386 strains of pathogenic bacteria were detected in the hospital during 2010-2019，including 4 077 strains of NFGNB （15.45％），mainly from patients ≥60 years old （1 836 strains，45.05％）. During the 10 years，the detection rate of NFGNB decreased from 20.14％ in 2010 to 15.36％ in 2019 （P＜0.001）. Acinetobacter baumannii （1 359 strains），Pseudomonas aeruginosa （1 269 strains），Stenotrophomonas maltophilia （447 strains） and Burkholderia cepacia （351 strains） were main pathogens. The detected NFGNB mainly came from hospitalized patients （4 001 strains），and most of them were found in ICU （17.05％），neurosurgery department （14.52％），respiratory department （12.41％），and respiratory tract （66.69％），secretion （7.80％）specimens. The detection rates of A. baumannii and P. aeruginosa in oncology department ，blood specimens and urine specimens showed an overall upward trend ，while the detection rates in ICU of the hospital showed a downward trend （P＜0.05）； the detection rate of P. aeruginosa in neurosurgery department showed an upward trend （P＜0.05），and that of A. baumannii in respiratory department showed an upward trend （P＜0.05）. The resistance rate of A. baumannii to carbapenems increased from about 10％ in 2010 to about 75％ in 2019，and the guyh3201@163.com resistance rate to cephalosporins exceeded 78％. The resistance rates of P. aeruginosa to imipenem and me ropenem were lower than 35％ and 30％ respectively，and the trend of drug resistance did not change significantly （P＞0.05）；the resistance rates to 12 kinds of clinically commonly used antibiotics as piperacillin and aztreonam were lower than 40％. The resistance rate of S. maltophilia to compound sulfamethoxazole showed a decreasing trend （P＜0.001），and the resistance rate to ceftazidime was high （54.70％-74.10％）. The resistance rates of B. cepacia to compound sulfamethoxazole，meropenem and ceftazidime showed a downward trend （P＜0.01），and were lower than 15％ after 2014. CONCLUSIONS：Although the detection rate of NFGNB in our hospital showed a downward trend ，the multi-drug resistance and pan-drug resistance of A. baumannii are serious ，and the resistance rate to carbapenems is increased. Sensitive drugs such as cefoperazone/sulbactam，amikacin，levofloxacin and ceftazidime should be selected for NFGNB infection according to the results of drug sensitivity tests.
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Objective To investigate the role of early detecting macrophage inflammatory protein‐1β(MIP‐1β) and proealcitonin (PCT ) level for the diagnosis of spontaneous bacterial peritonitis (SBP) in the decompensated stage of liver cirrhosis .Methods 384 cases of decompensated stage of liver cirrhosis complicating SBP collected in the Affiliated 3201 Hospital of Xi ′an Jiaotong Univer‐sity from May 2011 to February 2015 were included into the SBP group ,while other 377 cases of decompensated stage of liver cir‐rhosis complicating ascites were included into the control group .The serum and ascites samples were collected for detecting PCT by using electrochemical luminescence method and MIP‐1β by using the enzyme‐linked immunoassay .The significance of these two in‐dicators was compared between the serum detection and ascites detection .At the same time the clinical application value of these two indicators was analyzed by using the receiver operating characteristic curve .Results The serum and ascites PCT and MIP‐1βlevels in the SBP group were significantly higher than those in the control group ,the difference was statistically significant (P<0 .05) ;the serum PCT level in the SBP group had statistical difference between the patients with Gram‐negative bacteria infection and the patients with Gram positive bacteria infection (P< 0 .05) ;the ascites MIP‐1β level in the patients with Gram‐negative bacte‐ria infection of the SBP group was higher than that with Gram positive bacteria infection ,the difference was statistically significant (P< 0 .05) .Conclusion The serum and ascites PCT and MIP‐1β detection can help to the differentiation diagnosis of early decom ‐pensated stage of liver cirrhosis complicating SBP ;the serum PCT detection is superior to the MIP‐1β detection ,while ascites MIP‐1β detection is superior to the PCT detection .
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Objective Previous studies have shown that genetic variants in the interferons regulatory factor 5 (IRF5) gene are associated with rheumatoid arthritis (RA) in European and Japanese, but not found in Han Chinese. We conducted this study to investigate whether genetic variants in the IRF5 gene are associated with RA in ShaanXi Han Chinese population. Methods This study was collected 576 RA patients and 768 normal controls. Six IRF5 gene polymorphisms (rs729302, rs2004640, rs752637, rs3807306, rs10954213 and rs2280714) were genotyped by the SNaPshot method. T-test and χ2 test were used for statistic analysis. The genotype and allele frequencies were evaluated using the chi square tests. Genotyping data were adjusted by Logistic regression method by age and gender. The linkage disequilibrium (LD) block structure was examined using Hapview 4.2 software. Results Six SNPs inspected complied with Hardy-weinberg equilibrium (P>0.05). Two SNPs were significantly associated with RA: rs729302 A risk allele [OR=1.29, 95%CI (1.10, 1.50), P=5.57×10-3];dominant model [OR=1.58, 95%CI (1.10, 2.27), P=0.024], recessive model [OR=1.31, 95%CI (1.17, 1.64), P=0.028]. rs2004640 T risk allele [OR=1.28, 95%CI (1.08, 1.54), P=0.039]; dominant model [OR=1.27, 95%CI (1.03, 1.58), P=0.036]. In addition, there was no significant difference in rs752637, rs3807306, rs10954213 and rs2280714 SNPs between RA group and control and genotyped polymorphisms were significantly associated with RA susceptibility. Conclusion The present study confirm that rs729302 and rs2004640 in the IRF5 gene is significantly associated with increased risk of RA in ShaanXi Han Chinese population.
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Objective To investigate the significance of procalcitonin(PCT),C-reactive protein(CRP),white blood cell(WBC) and other inflammatory markers in the diagnosis of pediatric patients with HFMD.Methods 138 cases of pediatric patients with foot and mouth disease(study group)and 50 cases of healthy children(control group)were recruited in the study.Procalcitonin (PCT),white blood cell(WBC),neutrophil count(NC),lymphocyte count(Ly),immunoglobulins,C-reactive protein and other indi-cators were determined and compared.Results PCT,CRP,WBC,NC,Ly% and IgM levels were higher in study group than those in control group,the differences were all statistically significant(P <0.05 );IgG,IgA levels in control group were lower than that in control group,the differences were statistically significant(P <0.05).Conclusion PCT,WBC,NC,Ly,CRP and IgA,IgG,IgM can provide experimental evidence for diagnosis of children with hand foot and mouth disease.
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Objectives To investigate characterization of imipenem resistance among imipenem non susceptible Pseudomonas aeruginosa isolated from patients who treated without imipenem and explore risk factors of imipenem resistance.Methods From April,2006 to March,2008,a total of 37 non-susceptible to imipenem without imipenem therapy isolates were collected from affiliated 3201st Hospital of Medical College of Xi'an Jiaotong University.The minimum inhibition concentration (MIC) to 11 antimicrobial agents were determined by the broth dilution method.We also tested imipenem MIC combined with efflux pump inhibitor PAβN.PCR was performed to check for the presence of carbapenem-hydrolylzing MBL genes and oprD gene.The expression level of oprD2 and ampC were evaluated by qRT-PCR.Molecular typing was performed using PFGE.Results There is significant difference ( t =- 2.9004,P ＜ 0.01 ) of the average number days of therapy between with two or more antibiotics in the 16 patients (20.0 ± 9.5 ) d and that with only one antibiotic in the other 21 patients ( 12.6 ± 4.4 ) d before imipenem-non-susceptible strains were isolated.In all 37 strains,32 strains showed resistance to more than three antibiotics.The MBL gene ( IMP-9 ) was only found in one strain,but its phenotype is negative,oprD2 gene from the 29 strains were found forward inserted by ISpa1328.Thirty-five isolated were considered to have no oprD expression.The patterns of the total DNA of 37 strains appeared six PFGE types.The 26 strains belonged to C2 PFGE type.In the presence of PAβN,all 37 strains increased sensitivity to meropenem.Conclusion Fluoroquinolones and cephalosporins treatment could play an important role in imipenem non-susceptible production in the research isolates.
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Objective To evaluate accuracy of cefoxitin disk testing for detecting oxacillin resistance coagulase-negative staphylococci (MRCNS). Methods 139 clinical coagulase-negative staphylococci (CNS) were detected with ID32 STAPH. Cefoxitin disk and oxacillin disk testing were used to detect MRCNS. PBP2a was tested by latex agglutination us a reference method. Results 139 CNS isolates were identified to 8 species: Staphylococcus haemolyticus , S. epidermidis , S. hominis , S. xylosus , S. saprophyticus , S. auricularis , S. simulans and S. warneri. The sensitivity and specificity for cefoxtin disk and oxacillin disk testing were 99.0% vs. 86.0% and 91.7% vs. 74.4%, respectively. One S. epidermidis strain was identified to affect the sensitivity of cefoxitin disk testing. S. xylosus, S. warned, and S. saprophyticus were major species related to the decrease of specificity of cefoxitin disk testing. S. haemolyticus, S. hominis, S. simulans and S. auricularis were major species related to the decrease of sensitivity of oxacillin disk testing. And the decrease of specificity of oxacillin disk testing were mainly related to S. hominis , S. simulans , S. xylosus , S. auricularis , S. saprophyticus and S. warneri. Conclusions The accuracy of MRCNS detection by cefoxitin disk testing is varied due to different CNS species. So it is necessary to test PBP2a or mecA gene according to CNS species, especially for S. xylosus, S. warned and S. saprophyticus.