1
|
Zhang AR, Wang Q, Zhou CE, Zhang JG, Wang XJ, Zhao JK, Lu BH, Yang CX, Gu L, Ma LY, Su JR, Cao B, Wang H. [Risk factors and clinical prognosis analysis of carbapenem-resistant Enterobacterales bacteria nosocomial infection]. Zhonghua Yi Xue Za Zhi 2021; 101:1572-1582. [PMID: 34098684 DOI: 10.3760/cma.j.cn112137-20201224-03455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the risk factors for carbapenem-resistant Enterobacterales (CRE) infection and death. Methods: A case-control analysis of 482 inpatients in 18 secondary or tertiary hospitals in Beijing in 2018 was conducted. Patients infected by CRE were selected as the case group (n=247), and infected by carbapenem susceptible Enterobacterales (CSE) as the control group (n=235). The risk factors and clinical prognosis of CRE infection were analyzed by single factor analysis and multivariate logistic regression analysis. Results: CRE were resistant to most antimicrobials, but were highly sensitive to colistin and tigecycline, with sensitivity of 94.0% and 99.5%, respectively. Multivariate analysis showed that prior 30-day tracheal intubation (OR=2.607, 95%CI: 1.655-4.108, P<0.001), empirical treatment using third or fourth generation cephalosporins (OR=2.339, 95%CI: 1.438-3.803, P=0.001), carbapenems (OR=2.468, 95%CI: 1.610-3.782, P<0.001) and quinolones (OR=2.042, 95%CI: 1.268-3.289, P=0.003) were independent risk factors for CRE infection. Mechanical ventilation (OR=3.390, 95%CI: 1.454-7.904, P=0.005), heart failure (OR=4.679, 95%CI: 1.975-11.083, P<0.001), moderate or severe liver disease (OR=3.057, 95%CI: 1.061-8.806, P=0.038), prior 30-day quinolones exposure (OR=2.882, 95%CI: 1.241-6.691, P=0.014) and septic shock (OR=7.772, 95%CI: 3.505-17.233, P<0.001) were independent risk factors for death after CRE infection. Conclusions: Reducing the use of antimicrobials and invasive procedures such as prior 30-day tracheal intubation may reduce the probability of CRE infection. Grading the severity of the underlying disease in patients with CRE infection, as well as predicting and preventing the occurrence of septic shock will help reduce the risk of death.
Collapse
Affiliation(s)
- A R Zhang
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Q Wang
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
| | - C E Zhou
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
| | - J G Zhang
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
| | - X J Wang
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
| | - J K Zhao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - B H Lu
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - C X Yang
- Department of Infection and Clinical Microbiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - L Gu
- Department of Infection and Clinical Microbiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - L Y Ma
- Department of Laboratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - J R Su
- Department of Laboratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - B Cao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - H Wang
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
| |
Collapse
|
2
|
Abstract
Clostridium difficile is the most common cause of hospital-acquired
diarrhea in patients treated with antibiotics, chemotherapeutic agents, and other
drugs that alter the normal equilibrium of the intestinal flora. A better
understanding of the risk factors for C. difficile-associated
disease (CDAD) could be used to reduce the incidence of CDAD and the costs associated
with its treatment. The aim of this study was to identify the risk factors for CDAD
in a cohort of Chinese patients in a Beijing hospital. Medical charts of a total of
130 inpatients (62 males and 68 females) with hospital-acquired diarrhea (45 with
CDAD; 85 without CDAD) were retrospectively reviewed. C. difficile
toxins A and B were detected in fecal samples using enzyme-linked fluorescence
assays. The drugs used by patients with and without CDAD before the onset of diarrhea
were compared. Factors that differed significantly between the two groups by
univariate analysis were analyzed by multivariate analysis using a logistic
regression model. Multivariate analysis showed that cephalosporin treatment was
associated with a significantly higher risk of CDAD in hospitalized patients, while
treatment with glycopeptides was significantly associated with a reduction in CDAD
(P<0.001 for cephalosporin; P=0.013 for glycopeptides). Our data confirmed
previous findings that empirical treatment with cephalosporins is positively
associated with CDAD compared to individuals using other CDAD-related drugs.
Additionally, we showed that treatment with glycopeptides was negatively associated
with CDAD, compared to individuals using other CDAD-related drugs.
Collapse
Affiliation(s)
- Z Lv
- Clinical Laboratory Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - G L Peng
- Clinical Laboratory Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - J R Su
- Clinical Laboratory Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Miao YC, Lang XD, Zhang ZZ, Su JR. Phylogeography and genetic effects of habitat fragmentation on endangered Taxus yunnanensis in southwest China as revealed by microsatellite data. Plant Biol (Stuttg) 2014; 16:365-74. [PMID: 23890056 DOI: 10.1111/plb.12059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/15/2013] [Indexed: 05/27/2023]
Abstract
It is not known how the profoundly complex topography and habitat heterogeneity generated by the uplift of the Qinghai-Tibetan Plateau (QTP) during the late Tertiary affected population genetic structure of endangered Taxus yunnanensis. In addition, the effects of habitat fragmentation due to anthropogenic disturbance on genetic diversity and population differentiation of this species have not been studied. T. yunnanensis is an ancient tree/shrub mainly distributed in southwest China. Recently, the species has suffered a sharp decline due to excessive logging for its famous anticancer metabolite taxol, resulting in smaller and more isolated populations. To understand the phylogeography and genetic consequences of habitat fragmentation of this endangered species, using 11 polymorphic microsatellites, we genotyped 288 individuals from 14 populations from a range-wide sampling in China. Our results suggest that two different population groups that were once isolated have persisted in situ during glacial periods in both areas, and have not merged since. Habitat fragmentation has led to significant genetic bottlenecks, high inbreeding and population divergence in this species. The two different population groups of T. yunnanensis could be attributed to restricted gene flow caused through isolation by geographical barriers and by habitat heterogeneity during uplift of the QTP, or the existence of two separate glacial refugia during the Pleistocene. In situ and ex situ conservation of the two Evolutionarily Significant Units (ESUs), artificial gene flow between populations and a comprehensive understanding of the pollination system in this endangered species are suggested from this study.
Collapse
Affiliation(s)
- Y C Miao
- Research Institute of Resource Insects, Chinese Academy of Forestry (CAF), Kunming, China; Department of Botany, School of Life Sciences, Yunnan University, Kunming, China
| | | | | | | |
Collapse
|