Cardiac implantable electronic device (CIED) is commonly used to treat arrhythmias. The amount of CIED implantation has increased year by year since its first application in 1958. At the same time, the CIED infection rate also increases significantly. Although the infection rate is very low for the primary implantation, the consequences of CIED infection are serious, and it is often necessary to remove the equipment for treatment. The mortality rate in patients with CIED infections is high, and the economic burden is huge. In this paper, the epidemiology, pathogenesis and pathogen, manifestations and diagnosis, risk factors, treatment and preventive measures of CIED infection were systematically described based on the recently published guidelines and international consensus literature, so as to provide theoretical guidance for the prevention of CIED infections.
ObjectiveTo explore the value of bronchoscopy alveolar lavage cytology in diagnosis of pulmonary fungus infection and distinguishing colonization from true fungal infections. MethodsA retrospective analysis was conducted on the patients with positive fungi results in bronchoalveolar lavage cytology admitted in Shanghai Xinhua Hospital between January 2009 and December 2013.Clinical,radiological,bronchoalveolar lavage and histopathology findings were recorded and analyzed. ResultsFungi were found in alveolar lavage fluid in 60 cases.The most common fungal organism identified was Aspergillus,followed by Candida and Cryptococcosis.Twenty-seven cases (45.00%) by lung biopsy pathology were diagnosed as pulmonary fungal infection and 33 cases (55.00%) were diagnosed as lung bacteria colonization.Aspergillus was found in 35 cases (58.33%),as pathogenic bacteria in 12 cases (34.28%),and colonization bacteria in 23 cases (65.72%).Candida was found in 13 cases (21.67%),as pathogenic bacteria in 3 cases (23.08%),and colonization bacteria in 10 cases (76.92%).Ten cases of Cryptococcus and 2 cases of pulmonary sporozoan were all as pathogenic bacteria.Most cases of Aspergillus and Candida in cytological specimens presented as a pulmonary mass or endobrochial growth and were diagnosed as carcinomas in biopsy specimens,so bacteria colonization should be considered in these cases first of all.All cases of Pneumocystis with bilateral ground glass infiltrates and cryptococcosis with parenchymal mass lesion in radiology represented true infection.The coincidence rate of bronchoscopy alveolar lavage cytology and histopathology was 45%. ConclusionAspergillus and Candida species are the most common fungal organisms in the bronchoscopy alveolar lavage.Fluid cytological examination is an important diagnostic modality for pulmonary mycoses,however it is important to correlate with clinical,bronchoscopy and biopsy findings for accurate diagnosis and appropriate management.
ObjectiveTo understand the current situation of hospital infection management related to the hospital maternity ward, learn the risks of infection, discover problems existing in hospital infection management, and seek appropriate solutions for hospital infection. MethodsBetween January 2011 and December 2012, using uniform questionnaire for prospective survey and field interviews, we investigated the hospital infection situation in medical health care workers, pregnant women, and live newborns. ResultsA total of 2 225 questionnaires were retreated with a retreat rate of 100%. Hospital infection occurred in 23 cases, of which 15 cases were maternal infection (1.35%) and 8 cases were neonate infection (0.72%). Maternal infection was mainly focused on reproductive tract, surgery incision and urinary tract. Neonate infection was mainly focused on lower respiratory tract and skin. The management system of hospital infection in the maternity ward was basically strengthened, but the infection monitoring work was still not timely, and staff training in infection control knowledge was not in place. The overall environment, sterilization, disinfection and isolation should be strengthened, and there were also some other safety hazards. ConclusionThe management of infection in hospital maternity ward is the key to control the infection in maternity ward. The infection management seems perfect, but there are still some hidden dangers. The management system needs to be improved and the management should be implemented strictly according to the system, in order to avoid the occurrence of infection in maternity ward and ensure the safety of patients.
Objective To review the association between chlamydia pneumoniae (CP) infection and cerebral infarction. Methods We electronically searched MEDLINE, BIOSIS, VIP database, and China Full Text Journal Database from Jan. 1990 through Dec. 2007 to identify case-control studies about the association of CP and cerebral infarction. The quality of the included studies was assessed and the RevMan 4.2 software was used for meta-analyses. Results A total of 22 studies were included. The results of meta-analyses showed: ① When the microimmunofluorescence (MIF) method was used to examine CP antibody in serum, the positive rate of the cerebral infarction group was higher than that of the control group when the positive infection was defined by IgA≥1?16 [n=8, OR=2.18, 95%CI (1.49 to 3.49), Plt;0.0001]; but when positive infection was defined by IgA≥1?32 (n=3), IgG≥1?32 (n=6), or IgG≥1?64 (n=5), there were no significant differences in the positive rate between the two groups [OR (95%CI) were 1.47 (0.97 to 2.24), 1.24 (0.82 to 1.86), and 1.23 (0.98 to 1.55), respectively]; ② When the ELISA method was used to examine CP-IgG antibody in serum, the positive rate of the cerebral infarction group was higher than that of the controlled group [n=8, OR=2.40, 95%CI (1.42 to 4.06), P=0.000 2]. ③ The acute and chronic CP infections were associated with the incidence of cerebral infarction [n=4, OR=7.22, 95%CI (2.68 to 19.49); n=4, OR=4.30, 95%CI (3.40 to 7.40)]. Conclusion ① The association between CP infection and cerebral infarction is determined by the positive criterion. IgA antibody is more sensitive than the IgG antibody. When the positive infection is determined by IgA≥1?16, CP infection is associated with cerebral infarction. ② The results of ELISA for examining CP-IgG support the association between CP infection and cerebral infarction. ③ Both acute and chronic CP infections are associated with cerebral infarction, but these associations needed to be proven by more scientific studies.
ObjectiveTo systematically review the risk factors of related infections on the totally implantable venous access device (TIVAD) in adult.MethodsPubMed, EMbase, CINAHL, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect case-control studies and cohort studies about the risk factors of TIVAD-related infections in adult from inception to April 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of one case-control study and 12 retrospective cohort studies involving 9 166 patients were included. The results of meta-analysis showed that: longer catheter utilization-days in the previous months (RR=1.06, 95%CI 1.02 to 1.10, P=0.001), inpatient treatment (RR=2.53, 95%CI 1.68 to 3.81, P<0.000 01), palliative care (RR=2.71, 95%CI 1.77 to 4.15,P<0.000 01), parenteral nutrition (RR=3.89, 95%CI 2.37 to 6.40,P<0.000 01), neutropenia (RR=2.20, 95%CI 1.30 to 3.72,P=0.003) and haematological malignancies (RR=3.54, 95%CI 2.03 to 6.17, P<0.000 01) were associated with increased risk of TIVAD-related infections in adult.ConclusionCurrent evidence shows that the risk factors of TIVAD-related infections include catheter utilization-days in the previous months, inpatient, palliative care, parenteral nutrition, neutropenia and hematological malignancies. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify conclusion.
ObjectiveTo analyze hospitalized patients of respiratory diseases with mechanical ventilation (MV). MethodsHospitalized patients with or without MV were enrolled into the current study from January 2010 to December 2014. Patients' characteristics including age and sex, type of illness and costs of hospital treatment were retrospectively analyzed. ResultsA total of 9,539 patients were hospitalized into Department of Respiratory Medicine, The General Hospital of Shenyang Military Area Command in the past 5 years. Of them, 1,531 (16.0%) patients were treated with MV, 764 of the 1,531 (49.9%) patients received non-invasive mechanical ventilation (NIMV), 135 of the 1,531 (8.8%) received invasive mechanical ventilation (IMV), and 632 of the 1,531 (41.3%) received NIMV plus IMV. The percentage of patients older than 65 years in the three groups as above were 71.3%, 63.0% and 72.2%, significantly higher than the Non-MV group's 47.7% (P<0.05); the percentage of males were 52.7%, 82.2% and 63.3% respectively, the later two groups was significantly higher than the Non-MV group's 59.2% (P<0.05); the percentage of ICU admission were 67.0%, 70.4% and 82.8%, significantly higher than the Non-MV group's 24.0% (P<0.05); the percentage of type Ⅰ respiratory failure were 12.4%, 29.6% and 12.4%, the later two groups was significantly higher than the Non-MV group's 13.2% (P<0.05); the percentage of type Ⅱ respiratory failure were 76.6%, 17.8% and 47.0%, all were significantly higher than the Non-MV group's 7.6% (P<0.05). Twenty-one kinds of common co-morbidities for respiratory hospitalized patients were analyzed and it was found that MV patients were likely to have more co-morbidities. Compared to Non-MV group, IMV group had more co-morbidities of type Ⅰ or type Ⅱ respiratory failure caused by pneumonia, bronchiectasis and other infectious diseases and concomitant with hypoalbuminemia, gastrointestinal bleeding and liver and kidney dysfunction and cerebrovascular disease, with statistically significant differences (P<0.05); NIMV group had more co-morbidities of type Ⅱ respiratory failure caused by chronic bronchitis, emphysema, pulmonary heart disease and other chronic airway diseases, and concomitant with coronary heart disease, heart failure, cerebrovascular disease and renal dysfunction, with statistically significant differences (P<0.05); the co-morbidity spectrum of NIMV plus IMV group was between those of IMV and NIMV groups, but more similar to that of IMV group. The high risk factors for IMV were pneumonia, hypoalbuminemia, gastrointestinal bleeding, and cerebrovascular disease; for NIMV were chronic bronchitis, emphysema, pulmonary heart disease, type Ⅱ respiratory failure and cardiac dysfunction. Cost analysis showed that average cost of Non-MV, NIMV, IMV, and NIMV plus IMV patients were 16 359 yuan, 31 872 yuan, 66 924 yuan, and 98 648 yuan respectively, in which the expense of NIMV plus IMV patients was vastest. ConclusionsHospitalized patients receiving MV therapy tend to be older, stay in ICU, complicated with respiratory failure and multiple co-morbidities. Respiratory failure by chronic obstructive airways disease is more often treated with NIMV, but respiratory failure by lung infection often need IMV.
ObjectivesTo systematically review the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect cohort or case-control studies on the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates from inception to May 2020. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies, and meta-analysis was performed by RevMan5.3 software.ResultsA total of 9 case-control studies involving 759 patients were included. The results of meta-analysis showed that, maternal factors like placental abruption (OR=6.25, 95%CI 1.47 to 26.61, P=0.01), premature rupture of fetal membranes of parturient (OR=5.62, 95%CI 2.63 to 12.00, P<0.000 01), pregnancy-induced hypertension (OR=2.04, 95%CI 1.49 to 2.80, P<0.000 01), carbapenem antibiotics used in mothers (OR=1.77, 95%CI 1.10 to 2.81, P=0.017), neonatal factors like premature delivery (OR=1.96, 95%CI 1.06 to 3.61, P=0.03), mechanical ventilation (OR=2.14, 95%CI 1.01 to 4.55, P=0.05), surgical procedure (OR=14.17, 95%CI 2.46 to 81.70, P=0.003), umbilical vein catheter (OR=1.93, 95%CI 1.20 to 3.11, P=0.007), peripherally inserted central catheter (OR=4.30, 95%CI 1.86 to 9.93, P=0.000 6), nasogastric feeding (OR=4.37, 95%CI 1.44 to 13.29, P=0.009), use of carbapenems (OR=3.04, 95%CI 1.91 to 4.84, P<0.000 01), and admission to NICU (OR=2.78, 95%CI 1.79 to 4.33, P<0.000 01) were the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates. Breastfeeding (OR=0.30, 95%CI 0.13 to 0.70, P=0.005) was the protective factor of carbapenem-resistant enterobacteriaceae colonization or infection in neonates.ConclusionsThe current evidence shows that maternal factors like placental abruption, premature rupture of fetal membranes, pregnancy-induced hypertension, carbapenem antibiotics used in mothers, and neonatal factors like premature delivery, mechanical ventilation, surgical procedure, umbilical vein catheter, peripherally inserted central catheter, nasogastric feeding, use of carbapenems, and admission to NICU are the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates; while breastfeeding is the protective factor of carbapenem-resistant enterobacteriaceae colonization or infection in neonates. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the conclusions.
ObjectivesTo systematically review the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy.MethodsPubMed, EMbase, The Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect clinical studies on the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy from January 1990 to September 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software and Stata 15.0 software.ResultsA total of 8 retrospective cohort studies and 1 randomized controlled trial involving 60 136 subjects were included. The results of the meta-analysis showed that: there was no difference in the post-operational infection rate among patients with and without antimicrobial prophylaxis for arthroscopies (OR=0.51, 95%CI 0.25 to 1.04, P=0.06). For knee arthroscopies, the post-operational infection rate had no difference between patients with and without antimicrobial prophylaxis (OR=0.89, 95% CI 0.65 to 1.23, P=0.48). However, for shoulder arthroscopies, the post-operational infection rate in the antimicrobial prophylaxis group was significantly lower than that in the group without the antimicrobial prophylaxis(OR=0.18, 95%CI 0.08 to 0.37, P<0.000 01).ConclusionsCurrent evidence shows that there is no association between preoperative antimicrobial prophylaxis and a decreased infection rate for knee arthroscopies. Antimicrobial prophylaxis appears to lead to fewer infections after shoulder arthroscopies. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To explore the clinical application of the postanesthetic autologus donation and the post-operative transfusion during the knee and hipreplacement surgeries. Methods Thirty-three patients (17 males,16 females) admitted for the elective joint replacement surgeries from September 2004 to January 2005 were included in this study. Of the 33 patients, 5 were diagnosed with rheumatoid arthritis, 23 with femoral head necrosis, and 5 with knee osteoarthritis. Immediately after anesthesia, 400 ml of the blood was drawn and transfused after the surgery. The blood pressure was monitored during the blood drawing, postoperative blood parameters were recorded, surgical site drainage and signs of infections were observed, and the other clinical data were collected.Results Of the 33 patients, 27 only received autologoustransfusion, including 21 patients who underwent the unilateral hip replacement and 6 patients who underwent the unilateral knee replacement. All these 6 patients with the unilateral knee replacement received the blood drained from the surgical sites in addition to the blood obtained from the postanesthetic autologous donation. Another 6 cases with the bilateral hip and knee replacement received the blood drained from the surgical sites, the blood obtained from the post-anesthetic autologous donation and 400 ml of the allogeneic blood transfusion. The blood received postoperatively averaged 650 ml (range, 200-1 150 ml), haemoglobin(Hb) was averaged 88 g/L (68-102 g/L), and Hct was averaged 24.6% (20.5% 31.5%). Hb and Hct were lower after operation than before operation(Plt;0.01). Conclusion Postoperative blood transfusion following the postanesthetic and preoperative autologous donation can be successfully applied to most of the patients undergoing theknee or hip replacement so as to reduce complications of the allogeneic blood transfusion.
ObjectiveTo investigate the clinical and CT findings in patients with coronavirus disease 2019 (COVID-19).MethodsThe epidemiological data and clinical manifestations of 83 COVID-19 patients admitted to Chongqing Public Health Medical Center from January 24, 2020 to February 4, 2020 were analyzed retrospectively. According to the clinical classification, they were divided into four groups: mild group 8 patients, common group 62 patients, severe group 10 patients, and critically severe group 3 patients. The CT characteristics and their relationship with clinical classification were analyzed.ResultsThe average age of 70 mild patients was (43.7±15.0) years, 13 severe patients was (57.4±11.8) years. The average age of mild patients was lower than that of severe patients (Z=–3.185, P=0.001). The average course of mild disease was (5.5±4.2) days, lower than that of severe disease (11.8±5.0) days (Z=–3.978, P=0.000). The clinical manifestations were fever in 72 patients, cough in 60 patients, expectoration in 34 patients, asthenia in 25 patients and shortness of breath in 19 patients. Basic diseases were complicated in 16 patients. CT findings: Both lung lobes were affected in 70 patients (93.3%), pure right lung lobe was affected in 3 patients (4.0%), pure left lung lobe was affected in 2 patients (2.7%), and there was no focus in 8 patients. The total number of affected lung segments was 203 in severe type, with an average of 15.6±5.4 and 530 in the common type, with an average of 9.6±5.3. The number of the severe type was more than that in the common type (Z=–3.456, P=0.001). The focus was mainly in the posterior part, 62 in the dorsal and 65 in the posterior basal segments, 41 in the anterior part of the upper lobe, and less in the common type (P<0.05). The main lesions were ground-glass opacities in 74 patients, patchy shadow in 72 patients, piece shadow in 46 patients, strip shadows in 51 patients and consolidation in 34 patients. Among them, the common CT showed patchy shadow in 34 patients (54.8%), less than severe patients in 12 patients (92.3%) (χ2=4.880, P=0.027). There was no significant difference between the mild CT and the severe patients (P>0.05).ConclusionsThere are some radiographic characteristics in COVID-19. Chest CT is helpful for the diagnosis and the judgement of the disease.