The analysis of related factors for multiple bacterial infection in elderly patients with health care-related pneumonia / 中华老年医学杂志

Objective:To analyze the related factors for plural bacterial infection in elderly patients with health care-associated pneumonia(HCAP), in order to provide the reference for clinical practice.Methods:A total of the 1 012 elderly patients conforming to inclusion criteria were in the age of 60-87(70.7±6.2)years, with 431 cases of males and 581 cases of females.The clinical data of elderly patients with HCAP admitted to our hospital from February 2015 to December 2018 were collected.According to the number of infected bacteria category, the patients were divided into the single bacterial infection group and the plural bacterial infection group.The distribution of pathogens was compared between the two groups, and the related factors for plural bacterial infection were analyzed.Results:There were 122 HCAP cases in the plural bacterial infection group, with 286 strains of pathogenic bacteria detected, while 890 HCAP cases were found in the single bacterial infection group, with 890 strains of pathogenic bacteria detected.Compared with the single infection group, the plural bacteria infection group showed that the proportions of Gram-positive Staphylococcus aureus and Enterococcus faecium were increased, while the proportion of Staphylococcus epidermidis was relatively decline( χ2=11.086, 8.460 and 4.056, P=0.001, 0.004 and 0.044). The proportions of Gram-negative Pseudomonas aeruginosa and Stenotrophomonas maltophilia were higher, while the proportions of Escherichia coli and Klebsiella were lower in the plural bacteria infection group than in the single bacteria infection group( χ2=7.495, 4.918, 9.011 and 4.604, P=0.006, 0.027, 0.003 and 0.032). Multivariate Logistic regression analysis showed that the independent risk factors for plural bacteria infection in elderly HCAP patients were the combined use of antibiotics within 30 days(≥3 kinds), more chronic underlying diseases(≥2 kinds), pneumonia severity index(PSI)classification being high, longer hospitalization time within 90 days(≥15 days), a history of ICU stays within 90 days, age(≥70 years old)( OR=2.389, 1.840, 1.289, 1.877, 2.089 and 1.981, P=0.001, 0.003, 0.001, 0.002, 0.001 and 0.002, respectively). Conclusions:The plural bacteria infection in elderly HCAP patients is related to many factors.The effective measure to reduce the plural bacteria infection in elderly HCAP patients are to focus on patients with severe disease, more basic diseases and advanced age, and on the shortening of the unnecessary hospitalization time, the reducing of the time of ICU stays, the reasonably selecting of antibiotics, the reducing of the unnecessary combination of antibacterial drugs.

Factors related to bloodstream infections in patients with catheter-associated urinary tract infections aged over 80 years / 中华老年医学杂志

Objective:To investigate factors related to bloodstream infections in patients with catheter-associated urinary tract infections(CAUTI)aged over 80 years.Methods:Clinical data of patients with CAUTI aged 80 years in our hospital from August 2014 to September 2019 were retrospectively analyzed.Independent and relevant factors for bloodstream infections in patients were analyzed by using univariate and multivariate methods with SPSS20.0 statistical software.Results:There were 138 patients with bloodstream infections, giving an infection rate of 9.28%.Univariate and multivariate analysis showed that the timing of catheterization(delayed or no extubation after infection), urinary tract operation, glucocorticoid use, tumor chemotherapy, serum albumin concentration reduction, blood glucose and multi-drug resistant bacterial infection were independent risk factors for bloodstream infections in patients with CAUTI aged over 80 years.Conclusions:Early extubation, blood glucose control, correction of hypoproteinemia, reduction of multi-drug resistant bacterial infection, rational use of glucocorticoids and tumor chemotherapy, and heightened attention to patients undergoing urinary tract surgery can reduce the risk of bloodstream infections in patients with CAUTI aged over 80 years.

Distribution and risk factors of multi drug resistant bacteria in nosocomial infection in Department of Neurosurgery / 中国神经精神疾病杂志

Objective To investigate the clinical features and risk factors of multidrug－resistant bacteria (multi drug resistant organisms, MDROs) infection in Department of Neurosurgery, and to provide evidence for the prevention and control of MDRO infection. Methods Data from 437 cases of infection in hospitalized patients on January 2012－2016 year in December Third Affiliated Hospital of Guizhou Medical University were retrospectively analyzed. Patients were divided into MDROs group and non MDROs group based on the results of MDROs detection. Multi factor Logistic regression analysis model was used to analyze risk factors. Results The infection rate of MDROs was 35.51%, and the detection rate of MDROs was 33.23% . ESBLs, CR－AB and MRSA were the most common bacterial species, and the infection of respiratory tract, urinary tract and wound infection were the main infection sites. Multivariate logistic regression analysis showed that hospitalization time ＞20 d, level of consciousness (coma), occupancy of ICU ≥7 d, ventilation (invasive), number of antibiotics used≥3, combined use of antibiotics≥3, mechanical ventilation Time≥7 d were possible risk factors for MDROs infection in neurosurgical patients (P＜0.05). Conclusion The situation of MDROs infection in neurosurgery is severe. To reduce MDROs infection, it is important to shorten unnecessary hospitalization time, promptly assess and transfer out of ICU as soon as possible, improve microbial examination, avoid frequent change of antibiotics or unnecessary use of use of broad－spectrum antibiotics, reduce unnecessary mechanical ventilation time, change to non－invasive ventilation as far as possible when the condition permits, focus on patients with poor consciousness, and prevent aspiration by mistake.

Influencing factors for fungal infection in hospitalized patients with ac-quired immunodeficiency syndrome / 中国感染控制杂志

Objective To analyze the influencing factors for fungal infection in hospitalized patients with acquired immunodeficiency syndrome(AIDS),and provide basis for taking preventive and control measures.Methods Clini-cal data of 112 inpatients with AIDS in a tertiary first-class hospital from January 2010 to October 2015 were ana-lyzed retrospectively,related risk factors were analyzed in patients with fungal infection,univariate analysis was performed byχ2 or t test,and multivariate analysis was performed by logistic regression analysis.Results Among 112 AIDS inpatients,41 (36.61%)had fungal infection.Candida albicans was the main pathogen (n=52, 76.74%)and was mainly isolated from lower respiratory tract (n=29,42.65%).Univariate analysis showed that invasive procedures,duration of antimicrobial use,combined antimicrobial use,and decreased CD4+ T lymphocyte count in peripheral blood were risk factors for fungal infection in AIDS inpatients(all P<0.05),while oral cleaning care and systemic antiviral therapy were protective factors for fungal infection(all P<0.05);multivariate analysis showed that decreased CD4+ T lymphocyte count in peripheral blood(OR,1.017[95% CI,1.009-1.025])and combined antimicrobial use(OR,3.975[95%CI,1.093-14.448])were independent risk factors for fungal infection in AIDS inpatients,while systemic antiviral therapy was independent protective factor for fungal infection (OR, 0.288[95%CI,0.099-0.841]).Conclusion There are many factors influencing fungal infection in AIDS patients, rational use of antimicrobial agents,systemic antiviral therapy,and increasing serum albumin concentration are main methods to prevent fungal infection,avoid unnecessary invasive procedures and application of preventive antifungal therapy for high-risk patients are also effective to prevent fungal infection.

Risk factors of mortality in neonates with severe bacterial pneumonia / 临床儿科杂志

Objective To explore the risk factors of mortality in neonates with severe bacterial pneumonia. Method The clinical data of 249 neonates with severe bacterial pneumonia from January 2011 to November 2015 were analyzed retrospectively, and the related factors of mortality were analyzed. Results Of the 249 children, 45 died and mortality rate was 18.07%. A total of 251 strains of pathogenic bacteria were detected in the bacterial culture, and the top 5 pathogens were Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae and Staphylococcus epidermidis. Univariate analysis showed that the gestational age, premature rupture of membranes, age at the time of hospital admission, birth weight, feeding, Apgar score, total bilirubin, complications, traumatic treatment, parenteral nutrition, and multidrug-resistant bacteria infection between the death group and survival group were significantly different (all P<0.05). Multivariate logistic regression analysis showed that the age at admission <7 days (OR=4.30, 95%CI: 1.74～10.64), Apgar scores <7 (OR=3.24, 95%CI: 1.23～8.49), and having complications (OR=6.81, 95%CI: 2.65～17.46), multidrug-resistant bacteria infection (OR=6.16, 95%CI: 1.90～19.99) and traumatic therapy (OR=3.82, 95%CI: 1.03～14.16) were the independent risk factors of mortality in neonatal severe bacterial pneumonia (all P <0.05). Conclusion The mortality rate of neonatal severe bacterial pneumonia is relatively high. And the main risk factors of death were the age at admission <7 days, Apgar scores <7, and having complications, multidrug- resistant bacteria infection and traumatic therapy.

Risk factors for healthcare-associated pneumonia in patients with orthopedic injury / 中国感染控制杂志

Objective To analyze the risk factors for healthcare-associated pneumonia (HAP) in patients with orthopedic injury,provide the basis for making prevention and control measures.Methods HAP occurred in patients with orthopedic injury and admitted to the department of orthopedics of a hospital from June 2011 to May 2015 were investigated retrospectively,risk factors were analyzed by univariate and multivariate logistic regression methods.Results A total of 2 578 patients with orthopedic injury were investigated,92 patients developed HAI,incidence of HAP was 3.57％.107 strains of pathogens were detected,the major were Klebsiella pneumoniae (n =22,20.56％),Escherichia coli (n =14,13.08％),and Acinetobacter baumannii (n =13,12.15％).Risk factors for HAP in patients with orthopedic injury were length of hospital stay≥15 days,smoking history≥3 years,bedridden ≥7 days,associated with underlying diseases,complications,indwelling catheter≥7 days,surgical operation,mechanical ventilation,admitted to intensive care unit,open injury,blood sugar≥11 mmol/L,plasma albumin＜30 g/ L,hemoglobin concentration＜90 g/L,and use of glucocorticoid≥4 days (all P＜0.05).Multivariate logistic regression analysis showed that smoking,bedridden,surgery,mechanical ventilation,glucocorticoid use,and anaemia were independent risk factors for HAP in patients with orthopedic injury.Conclusion The occurrence of HAP in patients with orthopedic injury is related with multiple factors,the major are surgical operation,mechanical ventilation,glucocorticoid use,long term smoking,bedridden,and anaemia.

Logistic regression analysis of risk factors of multiple drug-resistant infections in neonatal intensive care unit / 临床儿科杂志

Objective To analyze risk factors of multiple drug-resistant infections in neonatal intensive care unit (NICU). Methods The clinical data from 284 hospitalized pediatric patients were retrospectively analyzed from June 2011 to July 2015 . The differences between 59 cases with multiple drug-resistant infections and 225 cases with non-multiple drug-resistant infections were compared and analyzed by logistic regression. Results All of 284 cases were single birth. Fifty-nine cases ( 13 . 13 ± 9 . 03 days old) had multiple drug-resistant infections, in which 42 were males and 17 were females. Two hundred and twenty-ifve cases ( 14 . 21 ± 8 . 34 days old) had non-multiple drug-resistant infections, in which 175 cases of males and 50 cases of females. Single factor analysis showed that 8 factors, including gestational age, birth weight, days in hospital, Apgar score at birth, mechanical ventilation, parenteral nutrition, and the categories and duration of use of antimicrobial agents, were the risk factors of multiple drug-resistant infections (P?

Analysis of risk factors for multiple drug resistant bacterial infections in chronic obstructive pulmonary disease / 天津医药

Objective To analyze the risk factors of multiple drug resistant bacterial infections in patients with chronic obstructive pulmonary disease (COPD), and provide guidance for disease control and prevention. Methods Clinical data of 814 COPD patients were retrospectively analyzed from June 2011 to May 2015, including patient's age, gender, smoking history, age of onset, severity, aggravated frequency, duration of exacerbations, diabetes mellitus, complications, use frequency and use duration of glucocorticoid, use frequency of antimicrobial agents and use duration of each time, types of antimicrobial drugs used, combined with antibacterial drugs, plasma albumin concentration, blood glucose, bacteria culture detection of multi drug resistant bacteria infection. The risk factors of multi drug resistant bacteria infection were analyzed. Results A total of 857 pathogenic bacteria were isolated from 814 COPD patients with pulmonary infection. Multiple drug resistant bacteria infection were detected in 170 cases, and 175 strains (20.42%) were detected. The detection rate of multi drug resistant/PAN resistant pseudomonas aeruginosa (MDR/PDR-PA) was 55.38% (36/65). There were significant differences in patients with multi drug resistant bacteria infection between different clinical pathological characteristics. Logistic regression analysis showed that the acute exacerbation duration (days), long time use of antimicrobial drugs, and high frequency of corticosteroids and antibiotics use were independent risk factor of multi drug resistant bacteria infection in COPD patients. Conclusion Prevention and treatment of multiple drug resistant bacteria infection in COPD patients should pay attention to the combination of community and hospital, and take effective measures to prevent and control the risk factors.

Distribution and antimicrobial resistance of 965 pathogenic strains from wound infection / 中国感染控制杂志

Objective To analyze the distribution and antimicrobial resistance of pathogenic strains in wound infec-tion,and provide scientific evidence for rational use of antimicrobial agents in treatment of wound infection as well as reducing the emergence of drug-resistant organisms.Methods Data about pathogenic strains isolated from wound specimens of patients with wound infection in a hospital between June 2011 and April 2014 were analyzed retrospectively.Results A total of 965 pathogenic strains were isolated from wound specimens,the main infection sites were limbs(50.47%);infected patients mainly distributed in department of orthopaedic surgery(44.97%);trauma and incisional wound infection were the major infection types(47.98%,36.48%,respectively).Among iso-lated pathogens,gram-positive bacteria,gram-negative bacteria,and fungi accounted for 37.20%,59.59%,and 3.21 % respectively.The main gram-positive bacteria were highly susceptible to vancomycin,teicoplanin,and linezolid,the main gram-negative bacteria were highly resistant to most commonly used antimicrobial agents except cefoperazone/sulbactam,piperacillin/ tazobactam,imipenem,and meropenem.Conclusion Patients with wound infection are mainly distributed in department of orthopedics,the main infection types are trauma and surgical site infection,antimicrobial resistant rates of the major gram-positive and gram-negative bacteria are both high.Sur-geons,especially orthopedics surgeons,should pay attention to the culture of pathogens and monitoring of antimi-crobial susceptibility,use antimicrobial agents rationally,and strengthen the prevention and control of surgical site infection,so as to reduce the infection incidence and occurrence of drug-resistant organisms.