Socioeconomic Burden of Pyogenic Liver Abscess Caused by Klebsiella Pneumoniae from a Teaching Hospital in East China.

Background: The prevalence of pyogenic liver abscess (PLA) is increasing worldwide. However, evaluation on its economic burden is still lack. Methods: A retrospective study that included all patients identified PLA from 2017 to 2020 was conducted. Clinical information and hospital costs were collected through the electronic medical records. We evaluated the economic burden using disability-adjusted life years (DALYs). Differences in socioeconomic burdens between Klebsiella pneumoniae-caused liver abscesses (KPLA) and non-Klebsiella pneumoniae-caused liver abscesses (non-KPLA) were compared. Results: We found 327 patients identified PLA in the study, including 146 with KPLA and 181 with non-KPLA. The demographic characteristics, median hospital stay, severity, and in-hospital mortality were similar between the two groups. The median total in-hospital cost was higher in the non-KPLA than in the KPLA group, although no statistical difference was found ($3607.2 vs $3424.6; P = 0.446). The median DALY loss was significantly higher in the KPLA than in the non-KPLA group [1.49 (0.97-2.30) vs 1.27 (0.87-1.89); P = 0.033)], and male patients presented a higher average DALY loss than female patients. KPLA had a substantially greater median indirect economic loss than the non-KPLA group [$1442.8 (915.9-17,221.5) vs $1232.5 (764.6-15,473.0); P = 0.028], and indirect economic loss exhibited a significant increase from 2017 to 2020 in patients with PLA. No differences were found in the socioeconomic burden between the two groups [$8019.6 (4200.3-21,832.1) vs $7436.4 (4023.2-19,063.9); P = 0.172]. Conclusion: The economic burden of PLA is significant, particularly in patients with KP. Patients with KPLA experienced increased DALY loss and indirect economic loss than non-KPLA. PLA must be prioritized as the indirect economic burden rises annually.

Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016.

BACKGROUND: To explore the trends in epidemiology and the risk factors related to the prognosis of infective endocarditis in a tertiary hospital over the past ten years. METHODS: A retrospective cohort study was performed. A total of 407 consecutive patients who were admitted with infective endocarditis were included. The clinical characteristics and the risk factors related to the prognosis of infective endocarditis during this period were analyzed. RESULTS: A total of 407 patients with infective endocarditis were included, the average age was 48 ± 16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 11.3%. Among patients with underlying heart disease, congenital heart disease was the most common (25.8%), followed by rheumatic heart disease (17.0%) which showed a decreased trend during this period (P < 0.001). There were 222(54.5%) patients with positive blood cultures results and Streptococci (24.6%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 235 patients (57.7%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P < 0.001, OR = 28.594, 95% CI 5.561-148.173) and vegetation length>30 mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality. CONCLUSIONS: There were no significant changes in the overall incidence of infective endocarditis, but the clinical features of infective endocarditis had slightly changed during the past ten years. Streptococci infective endocarditis was still the predominant. Patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length>30 mm had an worse in-hospital outcome.

The clinical features and prognosis of infective endocarditis in the elderly from 2007 to 2016 in a tertiary hospital in China.

BACKGROUND: Infective endocarditis (IE) especially in the elderly is a serious disease, with a worse prognosis. METHODS: A retrospective cohort study was conducted. A total of 405 patients with definite IE were divided into three groups: 205 patients under 50 years old, 141 patients between 50 and 64 years old and 59 patients over 65 years old. RESULTS: For older patients, clinical symptoms such as fever, anemia, and heart murmur were as common as the younger patients. IE in old patients had more frequent nosocomial origin (P = 0.007) and tended to be more frequent with bad oral hygiene (p = 0.008). The most frequent isolated pathogens in the old groups was streptococci and coagulase-negative staphylococci. The old patients had a lower operation rate (40.7% vs 58.9% vs 62.4%, P = 0.012) and higher in-hospital mortality (20.3% vs 10.6% vs 8.8%, P = 0.044) compared with the younger patients. Surgical treatment was a significant predictor of one-year mortality even after adjusting for the confounders (HR = 2.45, 95% CI 1.027-10.598, P = 0.009). The one-year survival rate was higher for older patients with surgical intervention than those without (95.8% vs 68.6%, P = 0.007). CONCLUSIONS: Older patients with IE presented with more comorbidities, bad oral hygiene, more nosocomial origin and a more severe prognosis than younger patients. Streptococci was the most frequent micro-organisms in this group. Surgery were underused in old patients and those with surgical treatment had better prognosis.

A retrospective analysis of Pseudomonas aeruginosa bloodstream infections: prevalence, risk factors, and outcome in carbapenem-susceptible and -non-susceptible infections.

Background: Pseudomonas aeruginosa (PA) is a leading cause of nosocomial infections, and carbapenem non-susceptible strains are a major threat to patient safety. Methods: A single center, retrospective comparative analysis of carbapenem-non-susceptible PA (CnSPA) and carbapenem-susceptible PA (CSPA) bloodstream infections (BSIs) was conducted between January 1, 2007, and December 31, 2016. Prevalence and risk factors associated with CnSPA BSIs were examined. Results: The study enrolled 340 patients with PA BSIs; 30.0% (N = 101) of patients had CnSPA. High APACHE II scores (≥15), central venous catheterization, and delayed application of appropriate definitive therapy were independently associated with higher risk of mortality in PA BSIs. Multivariate analysis revealed that respiratory disease and exposure to carbapenems within the previous 90 days to onset of BSI were independent risk factors for acquisition of CnSPA BSIs. Overall all-cause 30-day mortality associated with PA BSIs was 26.8% (91/340). In addition, mortality was higher in patients with CnSPA than in those with CSPA (37.6% vs. 22.2%, respectively; P = 0.003). Corticosteroid therapy and delayed receipt of effective definitive therapy were independent risk factors for death from CnSPA BSIs. Conclusion: Increased incidence of CnSPA BSIs was observed during the study period, with higher mortality seen in patients with these infections. Respiratory disease and exposure to carbapenems were independent risk factors for development of CnSPA BSIs. Appropriate definitive therapy reduced mortality rates. BLBLIs were as effective as carbapenems as a treatment for PA BSIs.

A retrospective analysis of risk factors and outcomes in patients with extended-spectrum beta-lactamase-producing Escherichia coli bloodstream infections.

OBJECTIVE: Risk factors and outcomes associated with extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) bloodstream infections (BSI) are not yet fully understood. METHODS: This was a retrospective analysis of patients with E. coli BSI treated over a 4-year period. The characteristics of bacteremia caused by ESBL-producing versus non-ESBL-producing E. coli were compared. Factors influencing mortality were also assessed. RESULTS: Of 554 eligible patients, 58.9% developed ESBL-producing E. coli. Multivariate analysis showed that urinary tract infections, stomach tube catheterization, and prior cephalosporin exposure were independent risk factors for the emergence of ESBL-producing E. coli BSI. No significant differences in 30-day mortality were seen in patients with BSI caused by ESBL-producing or non-ESBL-producing E. coli (11.1% vs. 9.2%; P=0. 642). Factors independently associated with a higher risk of mortality were previous carbapenem exposure, high APACHE II score, and respiratory tract origin. CONCLUSIONS: This study showed that prior UTIs and previous cephalosporin exposure represent significant risk factors for the development of ESBL-producing E. coli BSI. Previous carbapenem exposure, high APACHE II score, and a respiratory tract origin were seen to be independent mortality risk factors in patients with E. coli BSI.

A graphene quantum dot-based method for the highly sensitive and selective fluorescence turn on detection of biothiols.

A facile assay method for the highly sensitive and selective sensing of biothiols based on graphene quantum dots (GQDs) has been developed. GQDs emitted strong blue fluorescence in an aqueous buffer solution. It was observed that mercury(II) ions could efficiently bind and quench the fluorescence of the GQDs. When a biothiol compound (glutathione, cysteine, or homocysteine) was added to the assay mixture of GQDs and mercury(II), it bound to mercury(II) ions. Hg(2+)-GQD complex dissociated, and a fluorescence turn-on signal was detected. The emission intensity changes of the GQDs could be directly related to the amount of biothiol added to the assay solution. The assay is highly sensitive, the limits of detection (LOD) for GSH, Cys and Hcy were 5 nM, 2.5 nM and 5 nM, respectively. The assay is also highly selective, a number of amino acids and proteins were tested, and little interference was observed. In addition, GSH standard recovery in serum samples was also demonstrated. We envision that our assay method could facilitate the biothiol quantification related biological and biomedical research.

Tuning the emission properties of Ru(phen)3(2+) doped silica nanoparticles by changing the addition time of the dye during the Stöber process.

A series of tris(1,10-phenanthroline)ruthenium ion (Ru(phen)(3)(2+)) doped silica nanoparticles were prepared by introducing the dye at different stages of the Stöber process. The emission properties of the doped silica particles were found to be dependent on the time (0-8 h) of the dye introduced into the reaction system. A turnover of the emission properties was identified for the doped silica particles by introducing the dye before and after 3 h of the reaction. Compared to the particles prepared by adding the dye at the beginning of the reaction (0 h doping), the particles prepared by introducing the dye before 3 h of the reaction (3 h doping) showed enhanced emission intensity and blue-shifted emission with the delayed addition time. The particles prepared by introducing the dye during the period of 3-8 h of the reaction showed decreased emission intensity and red-shifted emission with the delayed addition time compared to those prepared by introducing the dye at 3 h of the reaction. The emission intensity of the 3 h doping silica particles was about 3.3 times that of the 0 h doping particles, and the emission maximum shifted from 592 to 575 nm correspondingly. The 8 h doping particles showed emission maximum at 581 nm, and their emission intensity was only 15% of that of the 3 h doping particles. However, both the emission intensity and maximum of the 8 h doping particles would be similar to those of the 3 h doping particles after further deposition of silica protection layer. The switching of the emission properties of the doped silica particles prepared by introducing the dye before and after 3 h is attributed to the suppressed aggregation of the dye molecules and decreased thickness of the silica protection layer, respectively.