A novel procalcitonin-based score for detecting sepsis among critically ill patients.

BACKGROUND: Procalcitonin (PCT) has been widely investigated as an infection biomarker. The study aimed to prove that serum PCT, combining with other relevant variables, has an even better sepsis-detecting ability in critically ill patients. METHODS: We conducted a retrospective cohort study in a regional teaching hospital enrolling eligible patients admitted to intensive care units (ICU) between July 1, 2016, and December 31, 2016, and followed them until March 31, 2017. The primary outcome measurement was the occurrence of sepsis. We used multivariate logistic regression analysis to determine the independent factors for sepsis and constructed a novel PCT-based score containing these factors. The area under the receiver operating characteristics curve (AUROC) was applied to evaluate sepsis-detecting abilities. Finally, we validated the score using a validation cohort. RESULTS: A total of 258 critically ill patients (70.9±16.3 years; 55.4% man) were enrolled in the derivation cohort and further subgrouped into the sepsis group (n = 115) and the non-sepsis group (n = 143). By using the multivariate logistic regression analysis, we disclosed five independent factors for detecting sepsis, namely, "serum PCT level," "albumin level" and "neutrophil-lymphocyte ratio" at ICU admission, along with "diabetes mellitus," and "with vasopressor." We subsequently constructed a PCT-based score containing the five weighted factors. The PCT-based score performed well in detecting sepsis with the cut-points of 8 points (AUROC 0.80; 95% confidence interval (CI) 0.74-0.85; sensitivity 0.70; specificity 0.76), which was better than PCT alone, C-reactive protein and infection probability score. The findings were confirmed using an independent validation cohort (n = 72, 69.2±16.7 years, 62.5% men) (cut-point: 8 points; AUROC, 0.79; 95% CI 0.69-0.90; sensitivity 0.64; specificity 0.87). CONCLUSIONS: We proposed a novel PCT-based score that performs better in detecting sepsis than serum PCT levels alone, C-reactive protein, and infection probability score.

Most commensally bacterial strains in human milk of healthy mothers display multiple antibiotic resistance.

Recent reports have shown that food-borne or commensal bacteria can function as reservoirs of antibiotic resistance. However, the antibiotic susceptibility of bacterial isolates of most milk samples or the total bacterial counts (TBC) in human milk from healthy donors, are not fully understood in Taiwan. Thus, five healthy mothers were randomly recruited each month, and totally 30 mothers without any symptoms of infection were recruited over 6 months. Milk samples were then harvested and analyzed immediately after collection. The antibiotic susceptibility was analyzed in bacteria isolated from milk samples using nine clinically relevant antibiotics, such as oxacillin, ampicillin, cephalothin, amoxicillin, ciprofloxacin, erythromycin, clindamycin, gentamicin, and oxytetracycline. The Staphylococcus strains (48 isolates) found in milk resisted to 48.6 ± 20.1% selected antibiotics. Streptococcus-related isolates (8 isolates) exhibited resistance to 41.7 ± 26.4% selected antibiotics. Acinetobacter isolates (5 isolates) were resistant to 66.7 ± 13.6% antibiotics, and Enterococcus isolates (5 isolates) were resistant to 73.3 ± 6.1% tested antibiotics. Rothia-related isolates (4 isolates) were resisted to 58.2 ± 31.9% of tested antibiotics. In contrast, Corynebacterium isolates (5 isolates) were sensitive to 66%-100% of selected antibiotics. Furthermore, the TBC ranged from 40 to 710,000 CFU/ml, implying a wide spectrum of bacteria in milk from healthy mothers. Despite this, all milk donors were healthy during sampling, and they did not show any symptoms related to mastitis or subclinical mastitis. According to the previously described TBC criteria for the use of donated human milk, only 73% of the current milk samples could be accepted for the milk bank. In conclusion, the majority of the isolated bacterial strains from current human milk samples are multiresistant strains. In milk samples for preterm infants or milk banks, higher TBC levels or potentially antibiotic-resistant bacteria in some milk samples have supported people using approaches to disinfect human milk partially.

Profiles of commensal and opportunistic bacteria in human milk from healthy donors in Taiwan.

Recent studies indicate that milk from healthy mothers may harbor potential probiotics. Nonetheless, the distribution of bacterial profiles in human milk samples in Taiwan is not fully understood. Therefore, with the aim to address this question, in this study, milk samples were collected from 33 healthy mothers (D1 to D33) visiting our hospital during a 6-month period. The milk microbiota was analyzed by a molecular approach (Illumina MiSeq sequencing). The results indicate that the milk samples have a unique profile and patterns of bacterial abundance levels. Moreover, in colostrum and transitional-milk samples, we detected 154 and 127 bacterial species, respectively, and these sets shared 42.6% of the bacterial species. The most common bacterial species among all milk samples were Staphylococcus epidermidis, Streptococcus lactarius, and Staphylococcus hominis, suggesting that the skin contamination route plays an important role in the composition of the milk microbiota. Nevertheless, four Lactobacillus species, Lactobacillus helveticus, Lactobacillus iners, Lactobacillus zeae, and Lactobacillus gasseri, were present in only 7 samples (21% prevalence), and bifidobacterial species were quite rare taxa among the present samples. The Staphylococcus aureus was detected in a total of 15 samples (45% prevalence), suggesting that this species may be commonly present in milk samples. In conclusion, each milk sample revealed a unique profile and patterns of bacterial abundance levels, and our data do not support the idea that lactobacilli and bifidobacteria are common and abundant in modern milk samples. Because none of the donors of the milk samples showed mastitis or any discomfort during the sampling process or at follow-up inspection, the microbiota of these milk samples is not likely to negatively affect its host. This study provides new information on the proportions of commensal bacteria in human milk in Taiwan.

Antibiotic Susceptibility of Commensal Bacteria from Human Milk.

Recent studies have focused on foodborne or commensal bacteria as vehicles of antibiotic resistance. However, the antibiotic resistance of milk bacteria from healthy donors is still vague in Taiwan. For this purpose, human milk samples were obtained from randomly recruited 19 healthy women between 3 and 360 days post-partum. Antibiotic susceptibility profile of bacteria from milk samples was determined. About 20 bacterial species were isolated from milk samples including Staphylococcus (6 species), Streptococcus (4 species), Enterococcus (2 species), Lactobacillus (1 species), and bacteria belonging to other genera (7 species). Some opportunistic or potentially pathogenic bacteria including Kluyvera ascorbata, Klebsiella oxytoca, Klebsiella pneumoniae, Acinetobacter baumannii, Actinomyces bovis, and Staphylococcus aureus were also isolated. Intriguingly, Staphylococcus isolates (22 strains) were resistant to 2­8 of 8 antibiotics, while Streptococcus isolates (3 strains) were resistant to 3­7 of 9 antibiotics, and members of the genus Enterococcus (5 strains) were resistant to 3­8 of 9 antibiotics. Notably, Staphylococcus lugdunensis, S. aureus, Streptococcus parasanguinis, Streptococcus pneumonia, and Enterococcus faecalis were resistant to vancomycin, which is considered as the last-resort antibiotic. Therefore, this study shows that most bacterial strains in human milk demonstrate mild to strong antibiotic resistance. Whether commensal bacteria in milk could serve as vehicles of antibiotic resistance should be further investigated.

Purple urine bag syndrome: a community-based study and literature review.

AIM: Purple urine bag syndrome (PUBS) is considered as an uncommon phenomenon. This cohort study aimed to figure out the causative factors and the potential risks of PUBS. METHODS: We recruited 84 patients with long-term urinary catheterization from seven nursing institutions and home care centre, then compared the differences of demographic, clinical, urine test and bacteriological data between the patients with and without PUBS. RESULTS: The 2-month period prevalence of PUBS in chronic catheterized patients was 16.7%. PUBS-affecting patients had significantly higher proportion of female gender (P = 0.034), self oral intake (P = 0.036) and eating self-prepared food (P = 0.007). Otherwise, no statistical associations were found. Five different bacterial species were isolated from the urine of PUBS-affecting patients. No sequelae were found after forward follow-up for 6 months. We further discuss the associations between certain factors and PUBS according to literature review and the results of our study. CONCLUSION: PUBS is not as rare as we thought before. The causative factors of PUBS have not been clearly characterized. It may be the combination of several factors that cause the PUBS. Female gender and food content were found to be associated factors of PUBS in our study. Asymptomatic PUBS is unnecessary to be treated by antibiotics.

Long-term disability from acute childhood Japanese encephalitis in Shanghai, China.

We traced 85 Japanese encephalitis (JE) patients, 6-27 years after hospitalizations. The first control group was made up of 73 non-JE encephalitis patients 6-27 years previously, whereas the second control group was made up 78 neighborhood residents, matched to the 78 surviving JE cases by age, sex, and residence. All subjects were examined with neurologic examinations, intelligence quotient (IQ) measurement, Mini-Mental State Examinations (MMSE), and activities of daily living (ADL) assessments. At follow-up, 22% of JE patients had objective neurologic deficits compared with 3% of non-JE encephalitis patients. Moreover, 28% of JE patients had subnormal IQs, as opposed to 2% non-JE encephalitis patients. Abnormal ADL scores were only noted in 15% JE patients. All neighborhood controls had normal examination results, and one non-JE encephalitis case showed mildly reduced IQ. The study showed that significant neurologic and overall functional disability were evident in a high proportion of JE survivors many years after their index hospitalizations.

Genetic analysis of the GABRA1 gene in patients with essential tremor.

The gamma-aminobutyric acid A (GABA-A) receptor mediates inhibitory neurotransmission in the brain and as such may be involved in certain neurological movement disorders, such as tremor. GABA-A receptor alpha 1 (Gabra)(-/-) mice have been reported to exhibit postural and kinetic, alcohol-responsive, tremor that is characteristic of essential tremor (ET), the most common form of tremor. To determine whether ET is associated with the GABRA1 gene mutation, we screened 76 patients with familial ET and found a novel nucleotide variant: IVS8+24 G>T (nt 6119289) in a male patient, and a known 156T>C polymorphism (nt 6090903) in exon 4 in 41% patients, which results in a silent mutation (G52G). No significant association between 156T>C variant and disease risk was found (adjusted OR=0.95, 95% CI=0.57-1.61; p=0.858) by further analysis of 121 familial ET patients and 114 normal controls, except a novel 96A>G (Q32Q; nt 6090743) variant, found in a normal control. Since the 156T>C variant appears to be not pathogenically relevant, our results suggest that missense, nonsense or splice site mutation in the coding region of the GABRA1 gene is not a major genetic cause of ET in Caucasian subjects.

[Predictive factors on mortality and survival of elderly dementia in Shanghai].

OBJECTIVE: To study the predictive factors on mortality and survival of elderly dementia in Shanghai. METHODS: Subjects were from people who had been screened in a prevalence survey study from the selected 5 urban and 4 rural communities from 1997 to 1998. Phase I screening was carried out by a brief memory testing with mini-mental state examination. In phase II, those who scored below the cutoff points and 4% of those whose score was in the normal range were interviewed to identify dementia through a set of diagnostic examinations according to the DSM IV criteria. In phase III which was six months later, a follow-up program was conducted for all persons who were involved in phase II to identify those with Alzheimer's dementia (AD) and vascular dementia (VaD) according to NINCDS-ADRDA and NINDA-AIREN criteria and other types of dementia. RESULTS: The mortality of elderly dementia was 6.06/1000 person-years. Compared to nondementia group, the survival rate of dementia group had a decrease of 57% after 40 months of follow-up (P < 0.05). There was no statistical difference between AD and VaD groups. The relative risk of death caused by dementia, AD and VaD were 1.63 (95% CI: 1.42-1.86), 1.71 (95% CI: 1.44-2.03) and 1.45 (95% CI: 1.16-1.82), respectively. Some factors such as age (RR = 1.0685), severalty (RR = 1.5733), and high ADL (RR = 1.0368) might have increased the risk of death among those patients. CONCLUSION: The mortality of elderly dementia in Shanghai was lower than that seen in other areas in the world. There was no obvious difference between the survival rates of AD and VaD patients. Age, severalty and high ADL seemed to be the risk factors to the death outcome.

[Evaluation of effectiveness of intervention on risk factors for cerebrovascular disease in three cities of China].

OBJECTIVE: To evaluate the effects of community intervention on risk factors of cerebrovascular disease. METHODS: With cluster sampling, 2,586 and 2,723 women and men aged 35 to 74 were selected randomly as intervention cohort and control cohort, respectively, from about 300 thousand community population in Beijing, Shanghai and Changsha, during 1997 to 2000. Their blood pressure, levels of blood lipid, body mass index (BMI) were measured and status of smoking and alcohol consumption were surveyed as indices of evaluation. Health education for smoking quit, alcohol consumption restriction and reinforced treatment for diabetic and hypertensive patients were implemented in the intervention communities. And, 2,544 and 2,533 persons in the two cohorts responded three years after intervention, and then all the indices mentioned above were measure again for them. RESULTS: Average reduction in systolic blood pressure by 3.21 mm Hg and serum level of total cholesterol by 0.58 mmol/L was achieved in intervention cohort after intervention, but with 0.48 mmol/L increase in triglyceride. Average blood levels of both high density lipoprotein-cholesterol (HDL-C) and glucose increased in the two cohorts after intervention, but with 0.30 mmol/L net increase of blood glucose in control cohort. There was no significant difference in average increase of HDL-C between the two cohorts. BMI increased by 0.56 in control cohort, and no significant change in intervention cohort. Proportion of smoking decreased by 5.4% in men and 2.4% in women of intervention cohort, and no change in control cohort. CONCLUSION: Level of risk factors for cerebrovascular disease reduced significantly with community intervention.

[A case-control study on the risk factors and other socio-psychological factors of epilepsy].

OBJECTIVE: To identify the risk factors and socio-psychological condition of epilepsy in general population. METHODS: A community-based, pair-matched case-control study using the epileptic patients living in Zhujing town, Jinshan district, Shanghai was carried out. Patients were matched for age (+/-1 years) and gender to controls (81 cases and 81 controls). Data was analyzed with multiple conditional logistic regression. RESULTS: As a result of multiple logistic regression, postnatal insults (OR = 6.517), alcohol intake (OR = 10.761) and family history (OR = 5.414) were powerfully associated with epilepsy. Compared with control group, epileptic patients were significantly different in socio-psychological condition, especially in > or = 17 years adult patients. CONCLUSION: Postnatal insults, alcohol intake and family history were the risk factors of epilepsy. Psychological and psychiatric disorders were highly prevalent among epilepsy patients.