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Development of a Predictive Model of Tuberculosis Transmission among Household Contacts 家庭接触者间结核病传播预测模型的建立
Saibin Wang
Background Household contacts of patients with tuberculosis (TB) are at great risk of TB infection. The aim of this study was to develop a predictive model of TB transmission among household contacts. Method This was a secondary analysis of data from a prospective cohort study, in which a total of 700 TB patients and 3417 household contacts were enrolled between 2010 and 2013 at two study sites in Peru. The incidence of secondary TB cases among household contacts of index cases was recorded. The LASSO regression method was used to reduce the data dimension and to filter variables. Multivariate logistic regression analysis was applied to develop the predictive model, and internal validation was performed. A nomogram was constructed to display the model, and the AUC was calculated. The calibration curve and decision curve analysis (DCA) were also evaluated. Results The incidence of TB disease among the contacts of index cases was 4.4% (149/3417). Ten variables (gender, age, TB history, diabetes, HIV, index patient's drug resistance, socioeconomic status, spoligotypes, and the index-contact share sleeping room status) filtered through the LASSO regression technique were finally included in the predictive model. The model showed good discriminatory ability, with an AUC value of 0.761 (95% CI, 0.723–0.800) for the derivation and 0.759 (95% CI, 0.717–0.796) for the internal validation. The predictive model showed good calibration, and the DCA demonstrated that the model was clinically useful. Conclusion A predictive model was developed that incorporates characteristics of both the index patients and the contacts, which may be of great value for the individualized prediction of TB transmission among household contacts.
背景结核病患者的家庭接触者感染结核病的风险很大。本研究的目的是建立家庭接触者之间结核病传播的预测模型。方法:对一项前瞻性队列研究的数据进行二次分析,该研究于2010年至2013年在秘鲁的两个研究地点共纳入了700名结核病患者和3417名家庭接触者。记录指示病例家庭接触者中继发结核病例的发病率。采用LASSO回归方法对数据进行降维和变量过滤。采用多元逻辑回归分析建立预测模型,并进行内部验证。构造图表示模型,计算曲线下面积(AUC)。并对标定曲线和决策曲线分析(DCA)进行了评价。结果指示病例接触者结核发病率为4.4%(149/3417)。通过LASSO回归技术筛选的10个变量(性别、年龄、结核病史、糖尿病、HIV、指标患者耐药性、社会经济地位、spoligotypes、指标-接触者共用卧室状态)最终被纳入预测模型。该模型具有良好的判别能力,推导的AUC值为0.761 (95% CI, 0.723-0.800),内部验证的AUC值为0.759 (95% CI, 0.717-0.796)。预测模型显示出良好的校准,DCA证明该模型在临床上是有用的。结论建立了结合指标患者和接触者特征的预测模型,对家庭接触者间结核病传播的个体化预测具有重要价值。
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引用次数: 4
Application of kDNA Minicircle PCR-RFLP to Characterize Leishmania donovani Clinical Isolates Obtained from Post-Kala-Azar Dermal Leishmaniasis in Eastern Nepal 应用kDNA微环PCR-RFLP鉴定尼泊尔东部黑热病后皮肤利什曼原虫临床分离株
Ojesh Pokhrel, K. Rai, N. Bhattarai, S. Rijal, A. Rijal, B. Khanal
Post-kala-azar dermal leishmaniasis (PKDL) is a skin manifestation of visceral leishmaniasis (VL) which develops after apparent cure in some patients. PKDL is considered as the potential reservoir for the VL infection. Molecular epidemiological characterization of L. donovani isolates obtained from VL and PKDL isolates is essentially required in order to understand the transmission dynamics of the VL infection. To date, genetic variation among the VL and PKDL L. donovani isolates was not fully elucidated. Therefore, 14 clinical isolates from VL and 4 clinical isolates from PKDL were speciated by hsp70 and rDNA genes. Further characterization of L. donovani by haspB PCR demonstrates two different genotypes. All PKDL isolates have the same genetic structure. kDNA PCR-RFLP assay revealed 18 different genotypes; however, structural analysis showed the two distinct kDNA genotype population (k = 2). The kDNA fingerprint patterns of parasites from hilly districts were clustered separately from low-land districts. Therefore, further study with a large number of samples is urgently required for systematic characterization of the clinical isolates to track the molecular epidemiology of the Leishmania donovani causing VL and the role of PKDL as a reservoir.
黑热病后皮肤利什曼病(PKDL)是内脏利什曼病(VL)的一种皮肤表现,在一些患者明显治愈后发生。PKDL被认为是VL感染的潜在宿主。从VL和PKDL分离株中获得的多诺瓦利菌分离株的分子流行病学特征是了解VL感染传播动力学的必要条件。迄今为止,VL和PKDL L. donovani分离株之间的遗传变异尚未完全阐明。因此,14株VL临床分离株和4株PKDL临床分离株被hsp70和rDNA基因指定。通过haspB PCR进一步鉴定了多诺瓦杆菌的两种不同的基因型。所有的PKDL分离株具有相同的遗传结构。kDNA PCR-RFLP分析显示18个不同的基因型;然而,结构分析显示两个不同的kDNA基因型群体(k = 2)。丘陵区寄生虫的kDNA指纹图谱与低地区不同。因此,迫切需要进一步开展大量样本的研究,对临床分离株进行系统表征,以追踪引起VL的多诺瓦利什曼原虫的分子流行病学以及PKDL作为宿主的作用。
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引用次数: 0
Helicobacter pylori: Infection and New Perspective for the Treatment 幽门螺杆菌:感染及治疗新方向
T. Fasciana, P. Di Carlo, A. Jouini, M. Di Giulio
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引用次数: 2
Association between Elevated Serum Tau Protein Level and Sepsis-Associated Encephalopathy in Patients with Severe Sepsis 严重脓毒症患者血清Tau蛋白水平升高与脓毒症相关脑病的关系
Teng Zhao, Yan Xia, Da-wei Wang, L. Pang
Sepsis-associated encephalopathy (SAE) is a common complication of sepsis. It is imperative to recognize, diagnose, and effectively manage SAE at the early stages. The aim of this study was to evaluate the potential of using the serum tau protein level in the diagnosis of SAE and the prediction of SAE outcomes. This was a retrospective and observational study. The patients included in this study were diagnosed with severe sepsis or septic shock. The serum tau protein level was measured using a commercial enzyme-linked immunosorbent assay. The association between the level of serum tau protein and SAE was assessed by multiple logistic regression analysis. One hundred nine patients with severe sepsis were enrolled during a period of two years. Of the 109 enrolled patients, 27 developed SAE. The serum tau protein level was significantly higher in the patients with SAE than that of the non-SAE group. The serum tau protein level and the sequential organ failure assessment (SOFA) score were independent factors that were associated with SAE. The combined use of the serum tau protein level with the SOFA score improved the accuracy in distinguishing SAE from non-SAE patients. A cutoff value serum tau protein level of 75.92 pg/mL had 81.1% sensitivity and 86.1% specificity in predicting the 28-day mortality in patients with severe sepsis. We identified a close association between the serum tau protein level with the appearance of SAE in patients with severe sepsis. The serum tau protein level can be useful in the prediction of poor outcomes in patients with sepsis.
脓毒症相关脑病(SAE)是脓毒症的常见并发症。在早期阶段对SAE进行识别、诊断和有效管理势在必行。本研究的目的是评估使用血清tau蛋白水平在SAE诊断和SAE预后预测中的潜力。这是一项回顾性观察性研究。本研究纳入的患者均诊断为严重脓毒症或感染性休克。采用商用酶联免疫吸附法测定血清tau蛋白水平。采用多元logistic回归分析评估血清tau蛋白水平与SAE之间的关系。在两年的时间里,109名严重败血症患者被纳入研究。109例入组患者中,27例发生SAE。SAE患者血清tau蛋白水平明显高于非SAE组。血清tau蛋白水平和顺序器官衰竭评分(SOFA)是与SAE相关的独立因素。联合使用血清tau蛋白水平和SOFA评分提高了区分SAE与非SAE患者的准确性。血清tau蛋白水平的临界值为75.92 pg/mL,预测严重脓毒症患者28天死亡率的敏感性为81.1%,特异性为86.1%。我们发现血清tau蛋白水平与严重脓毒症患者SAE的出现密切相关。血清tau蛋白水平可用于预测脓毒症患者的不良预后。
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引用次数: 13
Sterol Carrier Protein Inhibition-Based Control of Mosquito Vectors: Current Knowledge and Future Perspectives 基于甾醇载体蛋白抑制的蚊媒控制:现有知识和未来展望
Hirunika Perera, Tharaka Wijerathna
Cholesterol is one of the most vital compounds for animals as it is involved in various biological processes and acts as the structural material in the body. However, insects do not have some of the essential enzymes in the cholesterol biosynthesis pathway and this makes them dependent on dietary cholesterol. Thus, the blocking of cholesterol uptake may have detrimental effects on the survival of the insect. Utilizing this character, certain phytochemicals can be used to inhibit mosquito sterol carrier protein-2 (AeSCP-2) activity via competitive binding and proven to have effective insecticidal activities against disease-transmitting mosquitoes and other insect vectors. A range of synthetic compounds, phytochemicals, and synthetic analogs of phytochemicals are found to have AeSCP-2 inhibitory activity. Phytochemicals such as alpha-mangostin can be considered as the most promising group of compounds when considering the minimum environmental impact and availability at a low cost. Once the few limitations such as very low persistence in the environment are addressed successfully, these chemicals may be used as an effective tool for controlling mosquitoes and other disease-transmitting vector populations.
胆固醇是动物体内最重要的化合物之一,因为它参与了各种生物过程,并作为身体的结构材料。然而,昆虫不具备胆固醇生物合成途径中的一些必需酶,这使得它们依赖于膳食胆固醇。因此,阻断胆固醇摄取可能对昆虫的生存有不利影响。利用这一特性,某些植物化学物质可以通过竞争结合抑制蚊子甾醇载体蛋白-2 (AeSCP-2)的活性,并被证明对传播疾病的蚊子和其他昆虫媒介具有有效的杀虫活性。一系列的合成化合物、植物化学物质和植物化学物质的合成类似物被发现具有AeSCP-2抑制活性。考虑到对环境影响最小且成本低,α -山竹苷等植物化学物质可以被认为是最有前途的一类化合物。一旦成功地解决了环境中持久性极低等少数限制,这些化学品就可以作为控制蚊子和其他疾病传播媒介种群的有效工具。
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引用次数: 6
Phenotypic Characterization and Antibiotic Resistance Patterns of Extended-Spectrum β-Lactamase- and AmpC β-Lactamase-Producing Gram-Negative Bacteria in a Referral Hospital, Saudi Arabia 沙特阿拉伯一家转诊医院产广谱β-内酰胺酶和AmpC β-内酰胺酶革兰氏阴性菌的表型特征和耐药性模式
M. Ibrahim, M. Abbas, Abdullah M. Al-Shahrai, B. K. Elamin
Background Emergence of pathogenic bacteria carrying β-lactamase-resistant determinants has become a major health problem in the hospital setting. The study aimed to determine antibiotic-resistant patterns and frequency of extended-spectrum β-lactamase- (ESBL-) producing Gram-negative bacteria (GNB) and AmpC β-lactamase-producing GNB. Methodology A prospective cross-sectional study was conducted during a period from September 2017 to August 2018 at King Abdullah Hospital, Bisha Province, Saudi Arabia. GNB (n = 311) were recovered from patients' clinical specimens including sputum, urine, wound pus, blood, tracheal aspirates and high vaginal swabs, umbilical discharge, eye discharge, and cerebrospinal fluids. Isolates were identified by the Phoenix identification system. Antimicrobial susceptibility was tested by the Kirby–Bauer disk procedure. Phenotypic characterization of ESBLs and AmpC β-lactamases was performed utilizing the double-disk synergy test and inhibitor-based method, respectively. Associations with outcome measures were determined by simple descriptive statistics and a chi-square test. Results Out of 311 GNB isolates, the frequency of ESBL and AmpC β-lactamase producers was 84 (27%) and 101 (32.5%), respectively. Klebsiella pneumoniae and Escherichia coli were common ESBL producers. AmpC β-lactamases predominate among Acinetobacter spp. and Pseudomonas aeruginosa. Coproduction of ESBLs and AmpC β-lactamases was found in 36 (11.6%) isolates, with very close relative frequencies among K. pneumoniae, Acinetobacter spp., and P. aeruginosa. β-Lactamase producers were predominantly found in the surgical department (56.5%) and ICUs (44.2%). ESBL producers revealed high resistance for cefuroxime (96.4%), cefotaxime (92.9%), and trimethoprim/sulfamethoxazole (90.5%). The resistance rates were significantly higher among ESBL producers than nonproducers for cephalosporins (p < 0.001), amoxicillin/clavulanate (p < 0.001), piperacillin/tazobactam (p = 0.010), nitrofurantoin (p = 0.027), aztreonam (p < 0.001), ciprofloxacin (p = 0.002), and trimethoprim/sulfamethoxazole (p < 0.001). Significantly higher (p < 0.05) resistance rates were observed among AmpC β-lactamase producers than nonproducers for all tested antibiotics. Conclusions This finding showed a high prevalence of ESBL- and AmpC β-lactamase-producing GNB in our hospital. Quality control practice and routine detection of β-lactamase producers before deciding on antibiotic therapy are advocated.
背景携带β-内酰胺酶耐药决定因素的病原菌的出现已成为医院环境中的主要健康问题。本研究旨在确定产广谱β-内酰胺酶(ESBL-)的革兰氏阴性菌(GNB)和产AmpC β-内酰胺酶的GNB的耐药模式和频率。研究人员于2017年9月至2018年8月在沙特阿拉伯比沙省阿卜杜拉国王医院进行了一项前瞻性横断面研究。从患者的痰、尿、创面脓液、血液、气管吸出液和阴道高位拭子、脐分泌物、眼分泌物和脑脊液等临床标本中检出GNB (n = 311)。分离菌株采用Phoenix鉴定系统进行鉴定。采用Kirby-Bauer纸片法检测抗菌药物敏感性。利用双盘协同试验和基于抑制剂的方法分别对ESBLs和AmpC β-内酰胺酶进行表型表征。通过简单的描述性统计和卡方检验确定与结果测量的关联。结果311株GNB分离株中,产生ESBL和AmpC β-内酰胺酶的菌株分别为84株(27%)和101株(32.5%)。肺炎克雷伯菌和大肠杆菌是常见的ESBL产生菌。AmpC β-内酰胺酶主要存在于不动杆菌和铜绿假单胞菌中。在36株(11.6%)分离株中发现ESBLs和AmpC β-内酰胺酶的共产,其中肺炎克雷伯菌、不动杆菌和铜绿假单胞菌的相关频率非常接近。β-内酰胺酶产生者主要出现在外科(56.5%)和icu(44.2%)。ESBL生产者对头孢呋辛(96.4%)、头孢噻肟(92.9%)和甲氧苄啶/磺胺甲恶唑(90.5%)的耐药性较高。ESBL生产者对头孢菌素(p < 0.001)、阿莫西林/克拉维酸酯(p < 0.001)、哌拉西林/他唑巴坦(p = 0.010)、呋喃托因(p = 0.027)、氨曲南(p < 0.001)、环丙沙星(p = 0.002)和甲氧苄啶/磺胺甲恶唑(p < 0.001)的耐药率显著高于非ESBL生产者。AmpC β-内酰胺酶产生者对所有抗生素的耐药率均显著高于非产生者(p < 0.05)。结论本院产ESBL-和AmpC β-内酰胺酶的GNB患病率较高。提倡在决定抗生素治疗前进行质量控制和β-内酰胺酶生产厂家的常规检测。
{"title":"Phenotypic Characterization and Antibiotic Resistance Patterns of Extended-Spectrum β-Lactamase- and AmpC β-Lactamase-Producing Gram-Negative Bacteria in a Referral Hospital, Saudi Arabia","authors":"M. Ibrahim, M. Abbas, Abdullah M. Al-Shahrai, B. K. Elamin","doi":"10.1155/2019/6054694","DOIUrl":"https://doi.org/10.1155/2019/6054694","url":null,"abstract":"Background Emergence of pathogenic bacteria carrying β-lactamase-resistant determinants has become a major health problem in the hospital setting. The study aimed to determine antibiotic-resistant patterns and frequency of extended-spectrum β-lactamase- (ESBL-) producing Gram-negative bacteria (GNB) and AmpC β-lactamase-producing GNB. Methodology A prospective cross-sectional study was conducted during a period from September 2017 to August 2018 at King Abdullah Hospital, Bisha Province, Saudi Arabia. GNB (n = 311) were recovered from patients' clinical specimens including sputum, urine, wound pus, blood, tracheal aspirates and high vaginal swabs, umbilical discharge, eye discharge, and cerebrospinal fluids. Isolates were identified by the Phoenix identification system. Antimicrobial susceptibility was tested by the Kirby–Bauer disk procedure. Phenotypic characterization of ESBLs and AmpC β-lactamases was performed utilizing the double-disk synergy test and inhibitor-based method, respectively. Associations with outcome measures were determined by simple descriptive statistics and a chi-square test. Results Out of 311 GNB isolates, the frequency of ESBL and AmpC β-lactamase producers was 84 (27%) and 101 (32.5%), respectively. Klebsiella pneumoniae and Escherichia coli were common ESBL producers. AmpC β-lactamases predominate among Acinetobacter spp. and Pseudomonas aeruginosa. Coproduction of ESBLs and AmpC β-lactamases was found in 36 (11.6%) isolates, with very close relative frequencies among K. pneumoniae, Acinetobacter spp., and P. aeruginosa. β-Lactamase producers were predominantly found in the surgical department (56.5%) and ICUs (44.2%). ESBL producers revealed high resistance for cefuroxime (96.4%), cefotaxime (92.9%), and trimethoprim/sulfamethoxazole (90.5%). The resistance rates were significantly higher among ESBL producers than nonproducers for cephalosporins (p < 0.001), amoxicillin/clavulanate (p < 0.001), piperacillin/tazobactam (p = 0.010), nitrofurantoin (p = 0.027), aztreonam (p < 0.001), ciprofloxacin (p = 0.002), and trimethoprim/sulfamethoxazole (p < 0.001). Significantly higher (p < 0.05) resistance rates were observed among AmpC β-lactamase producers than nonproducers for all tested antibiotics. Conclusions This finding showed a high prevalence of ESBL- and AmpC β-lactamase-producing GNB in our hospital. Quality control practice and routine detection of β-lactamase producers before deciding on antibiotic therapy are advocated.","PeriodicalId":22481,"journal":{"name":"The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73310384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 36
Resistance of House Fly, Musca domestica L. (Diptera: Muscidae), to Five Insecticides in Zhejiang Province, China: The Situation in 2017 2017年浙江省家蝇(双翅目:蝇科)对5种杀虫剂的抗性情况
Jinna Wang, J. Hou, Yuyan Wu, Song Guo, Qinmei Liu, Tianqi Li, Z. Gong
Objectives High dependency on pesticides could cause selection pressure leading to the development of resistance. This study was conducted to assess the resistance of the house fly, Musca domestica, to five insecticides, namely, permethrin, deltamethrin, beta-cypermethrin, propoxur, and dichlorvos, in Zhejiang Province. Methods Field strains of house flies were collected from the 12 administrative districts in Zhejiang Province in 2011, 2014, and 2017, respectively. Topical application method was adopted for the bioassays. The probit analysis was used to determine the median lethal doses with the 95% confidence interval, and then the resistance ratio (RR) was calculated. The insecticides resistance in different years and the correlations of the resistance between different insecticides were also analyzed. Results The resistance of field strains house flies to insecticides in Zhejiang Province was relatively common, especially for permethrin, deltamethrin, and beta-cypermethrin. The reversion of the resistance to dichlorvos was found, and most of the field strains in Zhejiang Province became sensitive to dichlorvos in 2017. Propoxur was much easier to cause very high level of resistance; the Hangzhou strain had the highest RR value more than 1000 in 2014, and five field strains had the RR value more than 100 in 2017. Compared to 2011 and 2014, the resistance of the house flies to propoxur and deltamethrin increased significantly in 2017. The resistance of permethrin, deltamethrin, beta-cypermethrin, and propoxur was significantly correlated with each other, and the resistance of dichlorvos was significantly correlated with beta-cypermethrin. Conclusions Our results suggested that resistance was existed in permethrin, deltamethrin, beta-cypermethrin, and propoxur in the house flies of Zhejiang Province, while the resistance reversion to dichlorvos was found.
目的对农药的高度依赖会产生选择压力,导致抗药性的产生。本研究对浙江省家蝇对氯菊酯、溴氰菊酯、高效氯氰菊酯、残杀威和敌敌畏5种杀虫剂的抗性进行了研究。方法分别于2011年、2014年和2017年在浙江省12个行政区采集家蝇现场种群。采用外用法进行生物测定。采用概率分析,以95%置信区间确定中位致死剂量,计算耐药比(RR)。并分析了不同年份的抗药性情况及不同杀虫剂之间的相关性。结果浙江省野外家蝇对杀虫剂的抗药性较为普遍,其中以氯菊酯、溴氰菊酯和高效氯氰菊酯抗药性最为明显。结果显示,2017年浙江省大部分田间品系对敌敌畏敏感,抗性出现逆转。残杀威更容易引起高水平的抗药性;2014年,杭州毒株的RR值最高,均超过1000;2017年,5个大田毒株的RR值均超过100。与2011年和2014年相比,2017年家蝇对残杀威和溴氰菊酯的抗性明显增强。氯氰菊酯、溴氰菊酯、高效氯氰菊酯和残杀威的抗性呈显著相关,敌敌畏的抗性与高效氯氰菊酯呈显著相关。结论浙江省家蝇对氯菊酯、溴氰菊酯、高效氯氰菊酯和残杀威均存在抗性,对敌敌畏出现抗性逆转。
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引用次数: 32
Elevated Blood Urea Nitrogen-to-Serum Albumin Ratio as a Factor That Negatively Affects the Mortality of Patients with Hospital-Acquired Pneumonia 血尿素氮与血清白蛋白比升高是影响医院获得性肺炎患者死亡率的一个不利因素
Ding-yun Feng, Yu-qi Zhou, Xiao-ling Zou, Mi Zhou, Hailing Yang, Xiao-xia Chen, Tiantuo Zhang
This study aimed to evaluate the factors that affect 30-day mortality of patients with HAP. The data used in this study were collected from all HAP occurred in our hospital between January 2014 and December 2017. A total of 1158 cases were included. 150 (13.0%) of whom died within 30 days. This reported mortality identified by the univariate Cox regression analysis is found to have been affected by the following factors: age greater than 70 years, presence of diabetes mellitus and chronic obstructive pulmonary disease, gastric tube intubation, administration of proton-pump inhibitor, blood albumin level less than 30 g/l, elevated neutrophil-to-lymphocyte ratio, antibiotics therapy in the preceding 90 days, intensive care unit (ICU) admission, blood lymphocyte count less than 0.8 × 109/L, elevated blood urea nitrogen/albumin (BUN/ALB) level, and presence of multidrug-resistant (MDR) pathogens. In the second multivariate analysis, administration of proton-pump inhibitor, administration of antibiotics in the preceding 90 days, ICU admission, blood lymphocyte count less than 0.8 × 109/L, elevated BUN/ALB level, and presence of MDR pathogens were still associated with 30-day mortality. The area under the receiver operating characteristic curves in the BUN/ALB predicting 30-day mortality due to HAP was 0.685. A high BUN/ALB was significantly associated with a worse survival than a low BUN/ALB (P < 0.001). Therefore, an elevated BUN/ALB level is a risk factor for mortality on patients with HAP.
本研究旨在探讨影响HAP患者30天死亡率的因素。本研究使用的数据收集自2014年1月至2017年12月在我院发生的所有HAP。共纳入1158例病例。其中150人(13.0%)在30天内死亡。单变量Cox回归分析发现,报告的死亡率受以下因素影响:年龄大于70岁,有糖尿病和慢性阻塞性肺疾病,胃管插管,使用质子泵抑制剂,血白蛋白水平小于30 g/l,中性粒细胞与淋巴细胞比值升高,90天前使用抗生素,入住重症监护病房(ICU),血淋巴细胞计数小于0.8 × 109/ l,血尿素氮/白蛋白(BUN/ALB)水平升高,存在多药耐药(MDR)病原体。在第二个多因素分析中,质子泵抑制剂的使用、90天前抗生素的使用、ICU入院、血淋巴细胞计数小于0.8 × 109/L、BUN/ALB水平升高、MDR病原体的存在仍与30天死亡率相关。BUN/ALB预测HAP 30天死亡率的受试者工作特征曲线下面积为0.685。与低BUN/ALB相比,高BUN/ALB与更差的生存率显著相关(P < 0.001)。因此,BUN/ALB水平升高是HAP患者死亡的危险因素。
{"title":"Elevated Blood Urea Nitrogen-to-Serum Albumin Ratio as a Factor That Negatively Affects the Mortality of Patients with Hospital-Acquired Pneumonia","authors":"Ding-yun Feng, Yu-qi Zhou, Xiao-ling Zou, Mi Zhou, Hailing Yang, Xiao-xia Chen, Tiantuo Zhang","doi":"10.1155/2019/1547405","DOIUrl":"https://doi.org/10.1155/2019/1547405","url":null,"abstract":"This study aimed to evaluate the factors that affect 30-day mortality of patients with HAP. The data used in this study were collected from all HAP occurred in our hospital between January 2014 and December 2017. A total of 1158 cases were included. 150 (13.0%) of whom died within 30 days. This reported mortality identified by the univariate Cox regression analysis is found to have been affected by the following factors: age greater than 70 years, presence of diabetes mellitus and chronic obstructive pulmonary disease, gastric tube intubation, administration of proton-pump inhibitor, blood albumin level less than 30 g/l, elevated neutrophil-to-lymphocyte ratio, antibiotics therapy in the preceding 90 days, intensive care unit (ICU) admission, blood lymphocyte count less than 0.8 × 109/L, elevated blood urea nitrogen/albumin (BUN/ALB) level, and presence of multidrug-resistant (MDR) pathogens. In the second multivariate analysis, administration of proton-pump inhibitor, administration of antibiotics in the preceding 90 days, ICU admission, blood lymphocyte count less than 0.8 × 109/L, elevated BUN/ALB level, and presence of MDR pathogens were still associated with 30-day mortality. The area under the receiver operating characteristic curves in the BUN/ALB predicting 30-day mortality due to HAP was 0.685. A high BUN/ALB was significantly associated with a worse survival than a low BUN/ALB (P < 0.001). Therefore, an elevated BUN/ALB level is a risk factor for mortality on patients with HAP.","PeriodicalId":22481,"journal":{"name":"The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale","volume":"151 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79822395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 40
Epidemic Situation of Brucellosis in Jinzhou City of China and Prediction Using the ARIMA Model 锦州市布鲁氏菌病流行情况及ARIMA模型预测
Lulu Wang, C. Liang, Wei Wu, Sheng-wen Wu, Jinghua Yang, Xiaobo Lu, Yuan Cai, Cuihong Jin
Objective This study aimed to investigate the specific epidemiological characteristics and epidemic situation of brucellosis in Jinzhou City of China so as to establish a suitable prediction model potentially applied as a decision-supportive tool for reasonably assigning health interventions and health delivery. Methods Monthly morbidity data from 2004 to 2013 were selected to construct the autoregressive integrated moving average (ARIMA) model using SPSS 13.0 software. Moreover, stability analysis and sequence tranquilization, model recognition, parameter test, and model diagnostic were also carried out. Finally, the fitting and prediction accuracy of the ARIMA model were evaluated using the monthly morbidity data in 2014. Results A total of 3078 cases affected by brucellosis were reported from January 1998 to December 2015 in Jinzhou City. The incidence of brucellosis had shown a fluctuating growth gradually. Moreover, the ARIMA(1,1,1)(0,1,1)12 model was finally selected among quite a few plausible ARIMA models based upon the parameter test, correlation analysis, and Box–Ljung test. Notably, the incidence from 2005 to 2014 forecasted using this ARIMA model fitted well with the actual incidence data. Notably, the actual morbidity in 2014 fell within the scope of 95% confidence limit of values predicted by the ARIMA(1,1,1)(0,1,1)12 model, with the absolute error between the predicted and the actual values in 2014 ranging from 0.02 to 0.74. Meanwhile, the MAPE was 19.83%. Conclusion It is suitable to predict the incidence of brucellosis in Jinzhou City of China using the ARIMA(1,1,1)(0,1,1)12 model.
目的了解锦州市布鲁氏菌病的具体流行病学特征和流行情况,建立适宜的预测模型,为合理配置卫生干预措施和卫生服务提供决策支持。方法选取2004 - 2013年各月发病率数据,采用SPSS 13.0软件构建自回归综合移动平均(ARIMA)模型。此外,还进行了稳定性分析和序列镇定、模型识别、参数检验和模型诊断。最后,利用2014年月度发病率数据对ARIMA模型的拟合和预测精度进行了评价。结果1998年1月至2015年12月,锦州市共报告布鲁氏菌病3078例。布鲁氏菌病的发病率逐渐呈波动增长。通过参数检验、相关分析和Box-Ljung检验,在众多合理的ARIMA模型中最终选择了ARIMA(1,1,1)(0,1,1)12模型。值得注意的是,该ARIMA模型预测的2005 - 2014年的发病率与实际发病率数据拟合良好。值得注意的是,2014年实际发病率在ARIMA(1,1,1)(0,1,1)12模型预测值的95%置信限范围内,2014年预测值与实际值的绝对误差在0.02 ~ 0.74之间。MAPE为19.83%。结论ARIMA(1,1,1)(0,1,1)12模型适用于预测锦州市布鲁氏菌病发病情况。
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引用次数: 22
Detection of Methicillin Resistant Staphylococcus aureus and Determination of Minimum Inhibitory Concentration of Vancomycin for Staphylococcus aureus Isolated from Pus/Wound Swab Samples of the Patients Attending a Tertiary Care Hospital in Kathmandu, Nepal 耐甲氧西林金黄色葡萄球菌的检测及万古霉素对尼泊尔加德满都三级医院脓/伤口拭子标本中金黄色葡萄球菌的最低抑菌浓度测定
Raghabendra Adhikari, N. Pant, S. Neupane, Mukesh Neupane, Roshan Bhattarai, S. Bhatta, R. Chaudhary, B. Lekhak
The present study was conducted to evaluate the performance of cefoxitin disc diffusion method and oxacillin broth microdilution method for detection of methicillin resistant S. aureus (MRSA), taking presence of mecA gene as reference. In addition, inducible clindamycin resistance and beta-lactamase production were studied and minimum inhibitory concentration (MIC) of vancomycin for S. aureus isolates was determined. A total of 711 nonrepeated pus/wound swab samples from different anatomic locations were included in the study. The Staphylococcus aureus was identified on the basis of colony morphology, Gram's stain, and biochemical tests. A total of 110 (15.47%) S. aureus isolates were recovered, of which 39 (35.50%) isolates were identified as MRSA by cefoxitin disc diffusion method. By oxacillin broth microdilution method, 31.82% of the Staphylococcus aureus isolates were found to be MRSA. However, mecA gene was present in only 29.1% of the isolates. Further, beta-lactamase production was observed in 71.82% of the isolates, while inducible clindamycin resistance was found in 10% of S. aureus isolates. The MIC value of vancomycin for S. aureus ranged from 0.016 μg/mL to 1 μg/mL. On the basis of the absolute sensitivity (100%), both phenotypic methods could be employed for routine diagnosis of MRSA in clinical microbiology laboratory; however cefoxitin disc diffusion could be preferred over MIC method considering time and labour factor.
本研究以mecA基因的存在为参照,评价头孢西丁圆盘扩散法和奥西林肉汤微量稀释法检测耐甲氧西林金黄色葡萄球菌(MRSA)的性能。此外,还研究了万古霉素对金黄色葡萄球菌的诱导耐药性和β -内酰胺酶的产生,并确定了万古霉素对金黄色葡萄球菌的最低抑制浓度(MIC)。共有711份来自不同解剖部位的非重复脓液/伤口拭子样本被纳入研究。根据菌落形态、革兰氏染色和生化试验鉴定金黄色葡萄球菌。共检出金黄色葡萄球菌110株(15.47%),其中头孢西丁纸片扩散法检出MRSA 39株(35.50%)。用莫西林肉汤微量稀释法检出金黄色葡萄球菌为MRSA的比例为31.82%。然而,mecA基因仅在29.1%的分离株中存在。71.82%的金黄色葡萄球菌产生β -内酰胺酶,10%的金黄色葡萄球菌产生克林霉素诱导耐药。万古霉素对金黄色葡萄球菌的MIC值为0.016 ~ 1 μg/mL。在绝对敏感性(100%)的基础上,两种表型方法均可用于临床微生物实验室常规诊断MRSA;但考虑到时间和劳动因素,头孢西丁圆盘扩散法优于MIC法。
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引用次数: 49
期刊
The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale
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