Antimicrobial Resistance and Molecular Epidemiology of Escherichia coli From Bloodstream Infection in Shanghai, China, 2016-2019.

Background: Bloodstream infections are recognized as important nosocomial infections. Escherichia coli (E. coli) is the most prevalent Gram-negative bacillary pathogen causing bloodstream infections (BSIs). This retrospective study investigated drug susceptibility and molecular epidemiology of E. coli isolated from patients with BSI in Shanghai, China. Methods: We collected E. coli isolated from the blood cultures of patients with BSI between January 2016 and December 2019. We randomly selected 20 strains each year to investigate antimicrobial resistance, resistance genes, and molecular epidemiological characteristics. Antimicrobial susceptibility testing was performed by the disk diffusion method. PCR was performed to detect extended-spectrum ß-lactamases (ESBLs), carbapenemase genes, and housekeeping genes, and phyloviz was applied to analyze multilocus sequence typing (MLST). Results: Penicillins, first- and second-generation cephalosporins and fluoroquinolones have high resistance rates (>60%). Among the 80 randomly selected strains, 47 (58.8%) produced ESBLs, and one produced carbapenemase. Sequencing of resistance genes identified bla CTX-M-14 (34%, 16/47), bla CTX-M-15 (23.4%, 11/47) and bla CTX-M-27 (14.8%, 7/47) as the most prevalent genotypes of ESBLs. ST131 (14/80) was the most prevalent sequence type (ST), followed by ST1193 (10/80), ST648 (7/80). Conclusions: Our findings suggest that amikacin, carbapenems, and piperacillin-tazobactam have relatively low resistance rates and may be the preferred antibiotic regimens for empiric therapy. ST131 and bla CTX-M-14 are still the main prevalent in Shanghai with a rapid increase in the occurrence of ST1193 is rapidly increasing and more diverse bla CTX genes.

Upper gastrointestinal mucosal injury associated with ticagrelor plus aspirin, ticagrelor alone, or aspirin alone at 1-year after coronary artery bypass grafting.

BACKGROUND AND AIM: The presence and severity of upper gastrointestinal mucosal lesions have not been evaluated using esophagogastroduodenoscopy (EGD) in patients receiving ticagrelor plus aspirin or alone after myocardial revascularization. We assessed upper gastrointestinal mucosal injury and the use of proton pump inhibitors (PPIs) in patients receiving 1 year of antiplatelet therapy after coronary artery bypass grafting (CABG). METHODS: In this single-center prospective substudy of a randomized trial, 231 patients completing 1-year antiplatelet therapy (ticagrelor 90 mg twice daily plus aspirin 100 mg once daily, ticagrelor 90 mg twice daily, or aspirin 100 mg once daily, in 81, 80, and 70 patients, respectively) after CABG underwent 13 C urea breath testing and EGD. Gastroduodenal lesions were assessed by modified Lanza score, and reflux esophagitis was evaluated according to Los Angeles classification. Additionally, at least one ulcer ≥ 5 mm was separately analyzed. RESULTS: Among 231 patients, EGD showed 28 (12.1%) with ulcers ≥ 5 mm, which were detected in 13.6% (11/81) of ticagrelor plus aspirin recipients, 8.8% (7/80) of ticagrelor recipients, and 14.3% (10/70) of aspirin recipients, and 24 (10.4%) had reflux esophagitis. Eighty-eight (38.1%) patients had a positive 13 C urea breath testing after 1 year of treatment, and one patient received eradication therapy during follow up. Nineteen (8.2%) patients received a PPI for ≥ 6 months. CONCLUSIONS: Severe upper gastrointestinal mucosal lesions were more frequently observed in patients treated with ticagrelor plus aspirin and aspirin monotherapy than in patients treated with ticagrelor monotherapy for 1 year post-CABG. Prophylactic use of PPIs might be inadequate.

Predictors of early vein graft failure after off-pump coronary artery bypass grafting: angiocomputed tomographic results of 233 patients.

OBJECTIVES: Low saphenous vein graft (SVG) patency has become the bottleneck in surgical revascularization. This study aimed to identify the predictors of early vein graft failure (VGF) after off-pump coronary bypass grafting (OPCAB). METHODS: A total of 233 patients who had OPCAB were postoperatively evaluated by coronary computed tomography angiography. Logistic regression analyses were performed to detect the predictors of early VGF (FitzGibbon-B/O) at both the patient and the graft level. RESULTS: Overall FitzGibbon-A patency of SVG at 1 week after OPCAB was 94.1% (659/700). At the patient level, a patient who had at least 1 VGF was regarded as an event, and increased preoperative platelet count [odds ratio (OR) 9.848], quantity of perioperatively transfused red blood cells (RBC) (U, OR 1.544) and creatinine clearance rate (CCr) (ml/min, OR 1.037) were predictors of early VGF, whereas use of a left internal mammary artery graft was a protective factor (OR 0.348). At the graft level, when VGF was regarded as an event, increased preoperative platelet count (OR 17.450), CCr (ml/min, OR 1.034), quantity of perioperatively transfused RBC (U, OR 1.505) and endarterectomy (OR 5.499) were predictors of early VGF. Under the same circumstances, dual antiplatelet therapy (OR 0.419), recipient vessel diameter (mm, OR 0.052), graft run-off (ml/min, OR 0.949), preoperative RBC count (×1012, OR 0.576) and a side-to-side (when compared with end-to-side) anastomosis (OR 0.276) were protective factors. The patency of SVGs sutured to vessels with a larger diameter (>1.5 mm) was significantly higher than that of the others (96.6% vs 91.1%). SVGs with greater run-off (>25 ml/min for each anastomosis) were significantly more patent than others (95.1% vs 88.7%). CONCLUSIONS: Early SVG patency after OPCAB was satisfactory. Increased preoperative platelet count, more perioperative RBC transfusions and higher CCr were predictors of patients with early VGF, whereas use of a left internal mammary artery graft was a protective factor. Increased preoperative platelet count, higher CCr, more perioperative RBC transfusions and endarterectomy were predictors of VGF, whereas dual antiplatelet therapy, larger recipient vessel diameter, greater graft run-off, higher preoperative RBC count and side-to-side anastomosis were protective factors. Recipient diameter >1.5 mm and graft run-off >25 ml/min were cut-off values for detecting VGF.

The influence of marital status on the survival of patients with esophageal cancer: a population-based, propensity-matched study.

BACKGROUND AND AIMS: Multiple studies have shown that marital status is associated with the survival of various types of cancer patients. However, there has not been adequate evidence of the association between marital status and the survival of patients with esophageal cancer (EC). We aimed to investigate the effect of marital status on survival of EC patients. METHODS: We identified 15,598 EC patients from the Surveillance, Epidemiology, and End Results (SEER) database. Meanwhile, propensity scores for marital status, which were calculated for each patient using a nonparsimonious multivariable logistic regression model, were used to match 6,319 unmarried patients with 9,279 married patients. We performed Kaplan-Meier analysis and multivariate Cox regression to analyze the association between marital status and the overall survival (OS) and EC cause-specific survival (CSS) of EC patients before matching and after matching. RESULTS: We matched 2,986 unmarried patients with 2,986 married patients. Unmarried patients had poorer OS than married patients before matching (hazard ratio [HR]: 1.22; 95% confidence interval [CI]: 1.18-1.27; P < 0.0001) and after matching (HR: 1.20; 95% CI: 1.13-1.27; P < 0.0001) and poorer CSS than married patients before matching (HR: 1.21; 95% CI: 1.16-1.26; P < 0.0001) and after matching (HR: 1.17; 95% CI: 1.10-1.24; P < 0.0001). Further analysis showed that among different unmarried patients, widowed patients had the poorest OS (HR: 1.46; 95% CI: 1.38-1.55; P < 0.0001) and CSS (HR: 1.43; 95% CI: 1.34-1.52; P < 0.0001) compared with married patients. CONCLUSIONS: Unmarried EC patients had poorer survival rates than married EC patients. Meanwhile, widowed patients with EC had the highest risk of death compared with single, married, and divorced patients.