Résumé
Objective To evaluate the clinical application of the whole blood interferon γ(IFN-γ) release assay of QuantiFERON TB Gold in tube (QFT-GIT) in diagnosis of tuberculosis. Methods From October 2014 to October 2015, 109 patients with tuberculosis (45 cases of confirmed patients and 64 cases of clinically diagnosed patients) and 70 patients with non-tuberculosis were enrolled in Tianjin Medical University General Hospital. In order to evaluate diagnosis value between two kinds of tests, and to compare the differences between two groups, QFT-GIT test and colloidal gold anti tuberculosis antibody (TB-Ab) were employed to detect in two groups of patients. The ROC curve of IFN-γrelease quantity was analyzed in two groups. Results The sensitivity and specificity of QFT-GIT were 93.58% and 85.71% respectively. The positive rate was significantly higher in QFT-GIT than that of TB-Ab (χ2=43.68,P<0.01). The sensitivity of combined detection of the two methods decreased to 52.3% (57/109), but the specificity increased to 90.0% (63/70). The release quantity of IFN-γwas significantly higher in tuberculosis group than that in the non-tuberculosis group (U=330,P<0.05). The area under the ROC curve of IFN-γrelease quantity was 0.913 (95%CI:0.864-0.963). Conclusion The whole blood IFN-γrelease assay of QFT-GIT is a sensitive and specific assay for detecting tuberculosis infection. The combination QFT-GIT with TB-Ab can improve the specificity further, which could be a useful tool for the diagnosis of tuberculosis .
Résumé
Objective To assess the risk factors of carbapenem -resistant Acinetobacter baumannii (CRAB) infection.Methods Clinical data of patients with positive bacterial culture in Tianjin Medical University General Hospital during January 2011 and December 2015 were retrospectively analyzed, including 68 patients with carbapenem resistant Acinetobacter baumannii (CRAB) bacteremia, 68 patients with carbapenem sensitive Acinetobacter baumannii ( CSAB) bacteremia, and 68 patients with positive culture of other bacteria (control group).The risk factors of Acinetobacter baumannii infection were analyzed by univatiate and multivariate Logistic regression analyses .Results Univariate analysis showed that bacteremia /sepsis,use of carbapenems,β-lactamase inhibitor compound,tigecycline,combined antibiotics, glucocorticoids,surgery within one month, mechanical ventilation, central venous catheters ( CVCs ), arteriopuncture,indwelling catheter≥3 days and indwelling gastric tube were risk factors of CRAB infection (CRAB vs.control: χ2 =4.96,15.56,7.64,9.22,5.89,6.80,17.00,11.83,18.22,8.24,25.24 and 7.70, P <0.05 or P <0.01, respectively); while use of third-generation cephalosporin,CVCs,length of hospital stay were risk factors of CSAB infection (CSAB vs.control: χ2 =11.93 and 6.94,U =1555, P <0.05).Multivariate logistic analysis showed that bacteremia /sepsis (OR =4.01, 95%CI:1.13 ~14.20), use of carbapenems (OR =4.17, 95%CI :1.79 ~9.73), CVCs (OR =2.93, 95% CI: 1.22 ~7.08), indwelling catheter≥3 days (OR =6.08,95%CI:2.39 ~15.46) were independent risk factors of CRAB infection; use of third-generation cephalosporin (OR =3.98, 95% CI :1.88 ~8.43 ),CVCs(OR =3.40, 95% CI:1.48 ~7.81) were independent risk factors of CSAB infection .Conclusions Long-term use of carbapenems and invasive procedures are associated with CRAB infection , strict control of invasive procedures and rational use of antibiotics may reduce CRAB infection .