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Objective To explore risk factors for healthcare-associated pneumonia (HAP) caused by carbapenemresistant Enterobacter cloacae (CREC) in patients in intensive care unit (ICU).Methods From July 2013 to June 2017, 64 patients with CREC-HAP in ICU of a hospital were collected as case group, and 64 patients with carbapenem-sensitive Enterobacter cloacae HAP (CSEC-HAP) were as control group, risk factors for the occurrence of CREC-HAP were analyzed retrospectively by 1∶1 matched case-control study.Results Univariate analysis showed that APACHE II score≥20, long length of ICU stay, use of ventilator, long length of ventilator use, use of carbapenems, long duration of antimicrobial use, and at least 2 kinds of antimicrobial agents combined use were associated with the occurrence of CREC-HAP (all P＜0.05).Multivariate logistic regression analysis showed that APACHE II score≥20, use of ventilator, long length of ventilator use, use of carbapenems, and long duration of antimicrobial use were independent risk factors for occurrence of CREC-HAP (all P＜0.05).Conclusion Risk factors for occurrence of CREC-HAP in ICU patients include the use of carbapenems, long length of ventilator use, long duration of antimicrobial use, and APACHE II score≥20.Effective preventive and control measures can be formulated and taken in view of the above risk factors.
Résumé
<p><b>OBJECTIVE</b>To study the clinical features, immunophenotypes and the significance of Epstein-Barr virus infection in primary nasal and pharyngeal non-Hodgkin's lymphomas in Shenyang.</p><p><b>METHODS</b>One hundred and fifty eight cases of primary nasal and pharyngeal non-Hodgkin's lymphomas were included in this study. The samples were stained with haematoxylin and eosin for histological examination. Immunohistochemistry studies were performed using monoclonal antibodies, including CD3 for T-lymphocytes, CD20 for B-lymphocytes, and CD56 and CD57 for NK cells. All cases were reclassified according to the new WHO classification of lymphomas (2001). In situ hybridization detection of EBV-encoded small nuclear RNA (EBER-1) was performed in 99 cases.</p><p><b>RESULTS</b>Overall, 101 (63.9%) of the 158 NHL were extranodal NK/T cell lymphomas (nasal type), 23 (14.6%) were nonspecific peripheral T cell lymphomas and the remaining 34 cases (21.5%) were B cell lymphomas. The primary sites of involvement were the nasal cavity (53.2%, 84/158), the tonsil (24.7%, 39/158) and the pharynx (22.1%, 35/158). Among 99 cases studied by EBER-1 in situ hybridization, a positive detection was seen in 70/71 cases (98.6%) of extranodal NK/T cell lymphoma (nasal type), 8/12 cases (66.7%) of T cell lymphoma, and 7/16 cases (43.8%) of B cell lymphoma.</p><p><b>CONCLUSIONS</b>Among primary nasal and pharyngeal NK lymphomas, extranodal NK/T cell lymphoma (nasal type) is the most common type and is strongly associated with EBV infection. The pathological diagnosis of nasal and pharyngeal lymphomas should take considerations of the anatomic sites and immunophenotypical features.</p>