[Analysis of risk factors of ventilator-associated pneumonia in an intensive care unit].

OBJECTIVE: To explore the risk factors of ventilator-associated pneumonia (VAP) in patients admitted in an intensive care unit (ICU) for pulmonary tuberculosis (TB). METHODS: The clinical data of 143 patients admitted in the ICU at our center between January, 2014 and June, 2015 were reviewed. The patients with VAP and those without VAP were analyzed for risk factors of VAP in the setting of an ICU for pulmonary TB and compared for the duration of ventilation and hospital stay. RESULTS: The patients with pulmonary TB showed a significantly higher incidence of VAP in the ICU than those without TB. Univariate analysis suggested that the occurrence of VAP was significantly correlated with the duration of mechanical ventilation, invasive examination, pulmonary tuberculosis, lung structure changes, use of multiple antibiotics, diabetes, tracheal incision, indwelling gastric tube, APACHE II score, and coma (P<0.05). Multivariate logistic regression analysis showed that pulmonary TB, duration of mechanical ventilation, APACHE II score, invasive operation, and use of multiple antibiotics were independent risk factors for VAP (P<0.05). The patients who developed VAP had a prolonged duration of mechanical ventilation and ICU stay (P<0.05). CONCLUSION: Patients admitted in tuberculosis ICU are exposed to a high risk of VAP with a high mortality rate as the result of multiple interacting risk factors. Pulmonary TB, prolonged mechanical ventilation, an APACHE II score >15, invasive operation, and use of multiple antibiotics are all independent risk factors for VAP in tuberculosis ICU.

[A retrospective study of one case of X-linked agammaglobulinemia].

OBJECTIVE: To investigate the clinical manifestations, diagnostic methods and treatment of X-linked agammaglobulinemia (XLA). METHODS: Flow cytometric analysis of the peripheral monocytes using the anti-BTK antibody was used to characterize the expression of BTK in a 21 year old male patient and his mother. The patient suffered from frequent pneumonia, and was found to be complicated with lymphocytopenia in the B cell populations, hypogammaglobulinemia (IgG 1.38 g/L, IgA 0.25 g/L, IgM 0.17 g/L) and angiotelectasis (which had not been reported in XLA patients). Sequencing of the BTK cDNA obtained from the peripheral monocytes of the patient and his mother was performed to confirm the genetic defect. RESULTS: The BTK expressions in peripheral monocytes of the patient and his mother were 96.9% and 97.8% respectively. Sequencing of the BTK gene revealed a missense mutation of R525Q in exon 16, and his mother was confirmed to be an XLA carrier. The patient was treated with immunoglobulin replacement therapy (2 g/kg). One month later, the serum IgG level of the patient was elevated to 5.79 g/L, and the clinical symptoms (included angiotelectasis), lung function and the CT scan results significantly improved. CONCLUSION: Genetic diagnosis was made for one Chinese XLA adult patient complicated with angiotelectasis. This case suggests that some XLA cases may present angiotelectasis. High dose intravenous immunoglobulin given at 2 g/kg may be of efficacy in severe XLA cases. More attention should be paid to the disease in China.