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马车

Risk Factors and Outcomes of Fungal Ventricular-Assist Device Infections
Background. Infection is a common complication of ventricular-assist devices (VADs) and is associated with rehospitalization, thromboembolic events, VAD malfunction, delay in heart transplantation, and a high mortality rate. The objectives of this study were to investigate the frequency of fungal VAD infections and assess various risk factors and their effects on mortality as compared with bacterial VAD infections.
Methods. We conducted a retrospective chart review of patients with infected VADs at a single tertiary care center. The freuency ,  risk factors, and outcomes of fungal versus bacterial VAD infections were compared.
Results. Of the 300 patients who received a VAD, 108 (36%) developed VAD infection, including 85 bacterial and 23 fungal infections. Most common bacterial causes of infection were Staphylococcus aureus, coagulase-negative staphylococci, enterococci, and Pseudomonas aeuruginosa. The most common fungal etiologic agent was Candida albicans. Only the use of total parenteral nutrition was associated with the development of a fungal VAD infection in multivariate analysis (odds ratio, 6.95; 95% confidence interval, 1.71–28.16; P=0.007). Patients who experienced fungal VAD infection were less likely to be cured (17.4% vs 56.3%; P=0.001) and had greater mortality (91% vs 61%; P=0.006), compared with those who experienced bacterial VAD infection.
Conclusions. Fungi were responsible for approximately one-fifth of VAD infections and were associated with a mortality rate of 91%. Restriction of total parenteral nutrition use is essential in decreasing the rate of fungal VAD infection. Trials are needed for investigating the use of echinocandins or lipid formulations of amphotericin B for prevention and/or treatment of fungal VAD infection.

马车

Linezolid in the Treatment of Multidrug-Resistant Tuberculosis
Background. Linezolid is a new antibiotic with activity against Mycobacterium tuberculosis in vitro and in animal studies. Several small case series suggest that linezolid is poorly tolerated because of the side effects of anemia/thrombocytopenia and peripheral neuropathy. To characterize our clinical experience with linezolid, the
California Department of Public Health Tuberculosis Control Branch’s Multidrug-Resistant Tuberculosis (MDRTB) Service reviewed cases in which the MDR-TB treatment regimens included linezolid therapy.
Methods. Record review was performed for 30 patients treated with linezolid as part of an MDR-TB regimen. Data were collected on clinical and microbiological characteristics, linezolid tolerability, and treatment outcomes. The dosage of linezolid was 600 mg daily. Vitamin B6 at a dosage of 50–100 mg daily was used to mitigate
hematologic toxicity.
Results. During 2003–2007, 30 patients received linezolid for the treatment of MDR-TB. Patients had isolates resistant to a median of 5 drugs (range, 2–13 drugs). Of the 30 cases, 29 (97%) were pulmonary; of these 29, 21 (72%) had positive results of acid-fast bacilli smear, and 16 (55%) were cavitary. Culture conversion occurred in
all pulmonary cases at a median of 7 weeks. At data censure (31 December 2008), 22 (73%) of 30 patients had successfully completed treatment. Five continued to receive treatment. There were no deaths. Three patients had a poor outcome, including 2 defaults and 1 treatment failure. Side effects occurred in 9 patients, including peripheral and optic neuropathy, anemia/thrombocytopenia, rash, and diarrhea. However, only 3 patients stopped linezolid treatment because of side effects.
Conclusions. Linezolid was well tolerated, had low rates of discontinuation, and may have efficacy in the treatment of MDR-TB.

马车

Etiology of Community-Acquired Pneumonia: Increased Microbiological Yield with New Diagnostic Methods

Background. The microbial etiology of community-acquired pneumonia (CAP) is still not well characterized. During the past few years, polymerase chain reaction (PCR)–based methods have been developed for many pathogens causing respiratory tract infections. The aim of this study was to determine the etiology of CAP among adults—especially the occurrence of mixed infections among patients with CAP—by implementing a newdiagnostic PCR platform combined with conventional methods.
Methods. Adults admitted to Karolinska University Hospital were studied prospectively during a 12-month period. Microbiological testing methods included culture from blood, sputum, and nasopharyngeal secretion samples; sputum samples analyzed by real-time quantitative PCR for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis; nasopharyngeal specimens analyzed by use of PCR; serological testing for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and viruses common in the respiratory tract; and urine antigen assays for detection of pneumococcal and Legionella pneumophila antigens.
Results. A microbial etiology could be identified for 67% of the patients (np124). For patients with complete sampling, a microbiological agent was identified for 89% of the cases. The most frequently detected pathogens were S. pneumoniae (70 patients [38%]) and respiratory virus (53 patients [29%]). Two or more pathogens were present in 43 (35%) of 124 cases with a determined etiology.
Conclusions. By supplementing traditional diagnostic methods with new PCR-based methods, a high microbial yield was achieved. This was especially evident for patients with complete sampling. Mixed infections were frequent (most commonly S. pneumoniae together with a respiratory virus).

马车

Etiology of Community-Acquired Pneumonia: Increased Microbiological Yield with New Diagnostic Methods

Background. The microbial etiology of community-acquired pneumonia (CAP) is still not well characterized. During the past few years, polymerase chain reaction (PCR)–based methods have been developed for many pathogens causing respiratory tract infections. The aim of this study was to determine the etiology of CAP among adults—especially the occurrence of mixed infections among patients with CAP—by implementing a newdiagnostic PCR platform combined with conventional methods.
Methods. Adults admitted to Karolinska University Hospital were studied prospectively during a 12-month period. Microbiological testing methods included culture from blood, sputum, and nasopharyngeal secretion samples; sputum samples analyzed by real-time quantitative PCR for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis; nasopharyngeal specimens analyzed by use of PCR; serological testing for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and viruses common in the respiratory tract; and urine antigen assays for detection of pneumococcal and Legionella pneumophila antigens.
Results. A microbial etiology could be identified for 67% of the patients (np124). For patients with complete sampling, a microbiological agent was identified for 89% of the cases. The most frequently detected pathogens were S. pneumoniae (70 patients [38%]) and respiratory virus (53 patients [29%]). Two or more pathogens were present in 43 (35%) of 124 cases with a determined etiology.
Conclusions. By supplementing traditional diagnostic methods with new PCR-based methods, a high microbial yield was achieved. This was especially evident for patients with complete sampling. Mixed infections were frequent (most commonly S. pneumoniae together with a respiratory virus).

马车

Efficacy and Limitation of a Chlorhexidine-Based Decolonization Strategy in Preventing Transmission of Methicillin-Resistant Staphylococcus aureus
in an Intensive Care Unit

Background. Surface-active antiseptics, such as chlorhexidine, are increasingly being used as part of intervention programs to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission, despite limited evidence and potential for resistance. We report on the effect of an antiseptic protocol on acquisition of both endemic MRSA and an outbreak strain of MRSA sequence type 239 (designated TW).
Methods. Interrupted time-series data on MRSA acquisitions in two 15-bed intensive care units were analyzed using segmented regression models to estimate the effects of sequential introduction of an educational campaign, cohorting, and a chlorhexidine-based antiseptic protocol on transmission of TW and non-TW MRSA strains. Representative TW and non-TW MRSA strains were assessed for carriage of qacA/B genes and antiseptic susceptibility.
Results. The antiseptic protocol was associated with a highly significant, immediate 70% reduction in acquisition of non-TW MRSA strains (estimated model-averaged incidence rate ratio, 0.3; 95% confidence interval, 0.19–0.47) and an increase in acquisition of TW MRSA strains (estimated model-averaged incidence rate ratio, 3.85; 95% confidence interval, 0.80–18.59). There was only weak evidence of an effect of other interventions on MRSA transmission. All TW MRSA strains (21 of 21 isolates) and !5% (1 of 21 isolates) of non-TW MRSA strains tested carried the chlorhexidine resistance loci qacA/B. In vitro chlorhexidine minimum bactericidal concentrations of TW strains were 3-fold higher than those of non-TW MRSA strains, and in vivo, only patients with non-TW MRSA demonstrated a reduction in the number of colonization sites in response to chlorhexidine treatment.
Conclusion. A chlorhexidine-based surface antiseptic protocol can interrupt transmission of MRSA in the intensive care unit, but strains carrying qacA/B genes may be unaffected or potentially spread more rapidly.

舒窈

Risk Factors and Outcomes of Fungal Ventricular-Assist Device Infections
Background. Infection is a common complication of ventricular-assist devices (VADs) and is associated with rehospitalization, thromboembolic events, VAD malfunction, delay in heart transplantation, and a high mortality rate. The objectives of this study were to investigate the frequency of fungal VAD infections and assess various risk factors and their effects on mortality as compared with bacterial VAD infections.
Methods. We conducted a retrospective chart review of patients with infected VADs at a single tertiary care center. The freuency ,  risk factors, and outcomes of fungal versus bacterial VAD infections were compared.
Results. Of the 300 patients who received a VAD, 108 (36%) developed VAD infection, including 85 bacterial and 23 fungal infections. Most common bacterial causes of infection were Staphylococcus aureus, coagulase-negative staphylococci, enterococci, and Pseudomonas aeuruginosa. The most common fungal etiologic agent was Candida albicans. Only the use of total parenteral nutrition was associated with the development of a fungal VAD infection in multivariate analysis (odds ratio, 6.95; 95% confidence interval, 1.71–28.16; P=0.007). Patients who experienced fungal VAD infection were less likely to be cured (17.4% vs 56.3%; P=0.001) and had greater mortality (91% vs 61%; P=0.006), compared with those who experienced bacterial VAD infection.
Conclusions. Fungi were responsible for approximately one-fifth of VAD infections and were associated with a mortality rate of 91%. Restriction of total parenteral nutrition use is essential in decreasing the rate of fungal VAD infection. Trials are needed for investigating the use of echinocandins or lipid formulations of amphotericin B for prevention and/or treatment of fungal VAD infection.

真菌性心室辅助装置相关感染的危险因素和转归
背景：感染是心室辅助装置（VADs）的常见并发症之一，并且与患者再次入院，血栓发生，VAD故障，延误心脏移植以及较高的死亡率有关。本次研究的目的是为了观察真菌性VAD相关感染的发生率，评估与细菌性VAD相关感染相比较，多种影响因素以及这些因素对死亡的影响程度。
方法：本次研究以一家三级医疗中心发生VAD相关感染的患者为研究对象，采用回顾性查阅病历的方法。比较真菌性VAD相关感染以及细菌性VAD相关感染发生率，危险因素以及转归。
结果：在300名接受VAD的患者中，108人（36%）发生VAD相关感染，包括85例细菌性感染以及23例真菌性感染。大部分细菌性感染是金黄色葡萄球菌，凝固酶阴性葡球菌，肠球菌，铜绿假单胞菌。大部分真菌性感染是白色念球菌。在多因素分析中，只有肠外营养与真菌性VAD相关感染有关（OR值为6.95，95%的可信区间为1.71-28.16，P值=0.007）。与细菌性VAD相关感染相比，真菌性VAD感染患者治愈率较低(17.4% vs 56.3%; P=0.001)，死亡率较高(91% vs 61%; P=0.006)。
结论：VAD相关性感染越五分之一为真菌性，与91%的死亡率有关。限制肠外营养的应用是降低真菌性VAD相关感染的必要手段之一。对于预防和治疗真菌性VAD相关性感染，棘球白素<抗真菌药>和两性霉素B的效果还有待进一步研究。

尝试一下，希望老师指正。

Adler007

利奈唑胺治疗多重耐药性结核病 背景：在体外和动物试验研究中，利奈唑对于活动结核分枝杆菌是一种新型的抗生素。几个案例表明，由于其副作用会引起贫血/血小板减少症和周围神经病变，利奈唑耐受性差，关于利奈唑胺的临床经验是：加利福尼亚一个公共卫生健康研究机构回顾分析关于利奈唑胺治疗多重耐药结核分支杆菌案例。 方法:回顾分析关于利奈唑胺治疗30个多重耐药结核分支杆菌感染的患者,数据收集是关于临床和微生物学特性、利奈唑胺的耐药性和治疗结果。利奈唑胺的剂量是每天600毫克，维生素B6每日用量在50到100毫克之间，是被用来减轻副作用。 结果:在2003-2007年，30个多重耐药结合分支杆菌的患者被利奈唑胺所治疗。患者的药物剂量中位数是5（范围是2-13）,30人中29 (97%)是肺结核，在抗酸染色涂片阳性29人中21 (72%) 有积极治疗结果和  16 (55%)是空洞型肺结核.肺结核治疗效果是发生在所有病例的平均治疗7周左右。截止2008年十二月31日30列患者中22 (73%)取得了满意的效果,其他5列仍在继续治疗。没有死亡患者，3例患者结果不好包括2例取消协议和1例治疗失败，9例有副作用,其中包括微视神经病变、贫血、血小板减少、皮疹/和腹泻，然而只有3名患者由于副作用停止治疗。 结论：利奈唑胺有很好的效果,有很低耐药率并有可能达到治疗肺结核的治疗效果 尝试一下，也同样希望老师指正。 ezolid in the Treatment of Multidrug-Resistant Tuberculosis Background. Linezolid is a new antibiotic with activity against Mycobacterium tuberculosis in vitro and in animal studies. Several small case series suggest that linezolid is poorly tolerated because of the side effects of anemia/thrombocytopenia and peripheral neuropathy. To characterize our clinical experience with linezolid, theCalifornia Department of Public Health Tuberculosis Control Branch’s Multidrug-Resistant Tuberculosis (MDRTB) Servicereviewed cases in which the MDR-TB treatment regimens included linezolid therapy. Methods. Record review was performed for 30 patients treated with linezolid as part of an MDR-TB regimen. Data were collected on clinical and microbiological characteristics, linezolid tolerability, and treatment . The dosage of linezolid was 600 mg daily. Vitamin B6 at a dosage of 50–100 mg daily was used to mitigatehematologic toxicity. Results.During 2003–2007, 30 patients received linezolid for the treatment of MDR-TB.Patients had isolates resistant to a median of 5 drugs (range, 2–13 drugs). Of the 30 cases, 29 (97%) were pulmonary;of these 29, 21 (72%) had positive results of acid-fast bacilli smear, and 16 (55%) were cavitary. Culture conversion occurred inand all pulmonary cases at a median of 7 weeks. At data censure (31 December 2008), 22 (73%) of 30 patients had successfully completed treatment.  Five continued to receive treatment. There were no deaths. Three patients had a poor outcome, including 2 defaults and 1 treatment failure. Side effects occurred in 9 patients, including peripheral and optic neuropathy, anemia/thrombocytopenia, rash, and diarrhea. However,  only 3 patients stopped linezolid treatment because of side effects.Conclusions. Linezolid was well tolerated, had low rates of discontinuation, and may have efficacy in the treatment of MDR-TB.

蝶儿飞

英语，英语，恨不能回到从前，好好用功啊

Adler007

Etiology of Community-Acquired Pneumonia: Increased Microbiological Yield with New Diagnostic Methods

Background. The microbial etiology of community-acquired pneumonia (CAP) is still not well characterized. During the past few years, polymerase chain reaction (PCR)–based methods have been developed for many pathogens causing respiratory tract infections. The aim of this study was to determine the etiology of CAP among adults—especially the occurrence of mixed infections among patients with CAP—by implementing a newdiagnostic PCR platform combined with conventional methods.
Methods. Adults admitted to Karolinska University Hospital were studied prospectively during a 12-month period. Microbiological testing methods included culture from blood, sputum, and nasopharyngeal secretion samples; sputum samples analyzed by real-time quantitative PCR for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis; nasopharyngeal specimens analyzed by use of PCR; serological testing for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and viruses common in the respiratory tract; and urine antigen assays for detection of pneumococcal and Legionella pneumophila antigens.

Results. A microbial etiology could be identified for 67% of the patients (np124). For patients with complete sampling, a microbiological agent was identified for 89% of the cases. The most frequently detected pathogens were S. pneumoniae (70 patients [38%]) and respiratory virus (53 patients [29%]). Two or more pathogens were present in 43 (35%) of 124 cases with a determined etiology.

Conclusions. By supplementing traditional diagnostic methods with new PCR-based methods, a high microbial yield was achieved. This was especially evident for patients with complete sampling. Mixed infections were frequent (most commonly S. pneumoniae together with a respiratory virus).

社区获得性肺炎的病原学：在微生物学领域中逐渐增多的新的鉴别方法

背景：社区获得性肺炎(CAP)的微生物病原学仍然被不能很好地鉴别。过去这些年，对于许会导致呼吸道感染的病原体方面，以聚合酶链反应(PCR)为基础的方法相当成熟。本研究的目的是用一种新型PCR平板联合传统的方法以确定尤其在成年人中的发生混合性感染的社区获得性肺炎的病因

方法：在12个月期间，来自Karolinska大学附属医院的成年患者作为前瞻性研究对象。微生物检测方法包括培养血、痰及鼻咽部的分泌物,而且分析痰样本是采用PCR定量技术来鉴别肺炎链球菌、流感嗜血杆菌和莫拉氏菌；鼻咽部分泌物标本分析依靠PCR的应用。肺炎支原体血标本的分析，常常处在呼吸道中的肺炎支原体和病毒分析是血标本，尿液抗原检测是为了检测肺炎球菌和军团菌肺炎菌抗原             结果： 67%的患者（124例）能够被检出微生物病原菌。对于取得完整标本的患者来说，89%患者可以用一种微生物制剂鉴定。通常检验出的病原菌是肺炎链球菌(70例患者(38%])和呼吸道病毒(53例(29%)。研究确定43(35%)患者（124例）可以鉴定出有两种或两种以上的病原菌。

结论：在微生物学领域中取得了一种通过以传统鉴别方法为补充的新型PCR为基础的鉴别方法。这种方法取决于能否取得患者完整的标本。混合性感染常常是(通常情况下，肺炎链球菌感染者伴随者一种呼吸道病毒)。