[Death-Related Factors in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease Treated by Sequential Mechanical Ventilation].

Objective To analyze the death-related factors of elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) treated by sequential mechanical ventilation,so as to provide evidence for clinical practice. Methods The clinical data of 1204 elderly patients (≥60 years old) with AECOPD treated by sequential mechanical ventilation from June 2015 to June 2021 were retrospectively analyzed.The probability and influencing factors of death were analyzed. Results Among the 1204 elderly patients with AECOPD treated by sequential mechanical ventilation,167 (13.87%) died.Multivariate analysis showed that plasma procalcitonin ≥0.5 µg/L (OR=2.762, 95%CI=1.920-3.972, P<0.001),daily invasive ventilation time ≥12 h (OR=2.202, 95%CI=1.487-3.262,P<0.001),multi-drug resistant bacterial infection (OR=1.790,95%CI=1.237-2.591,P=0.002),oxygenation index<39.90 kPa (OR=2.447,95%CI=1.625-3.685,P<0.001),glycosylated hemoglobin >6% (OR=2.288,95%CI=1.509-3.470,P<0.001),and acute physiology and chronic health evaluation Ⅱ score ≥25 points (OR=2.126,95%CI=1.432-3.156,P<0.001) were independent risk factors for death in patients with AECOPD treated by sequential mechanical ventilation.Oral care>twice/d (OR=0.676,95%CI=0.457-1.000,P=0.048) and sputum excretion>twice/d (OR=0.492, 95%CI=0.311-0.776, P=0.002) were independent protective factors for death in elderly patients with AECOPD treated by sequential mechanical ventilation. Conclusions The outcomes of sequential mechanical ventilation in the treatment of elderly patients with AECOPD are affected by a variety of factors.To reduce the mortality,we put forward the following measures:attaching great importance to severe patients,restoring oxygenation function,shortening unnecessary invasive ventilation time,controlling blood glucose,preventing multidrug resistant bacterial infection,oral care twice a day,and sputum excretion twice a day.

[Relationship between Asymptomatic Bacteriuria and Vaginal Colonization of Group B Streptococcus in the Third Trimester of Pregnancy].

Objective To reveal the relationship between asymptomatic bacteriuria (ASB) and vaginal colonization of group B Streptococcus in the third trimester of pregnancy.Methods A total of 4287 pregnant women who were followed up from January 2018 to June 2021 were enrolled in this study.The pregnant women with ASB were assigned as the observation group,and those without ASB were matched at a ratio of 1∶4 as the control group.Results Among the 4287 pregnant women,158 (3.69%) pregnant women had ASB,including 28 (17.72%) with group B Streptococcus colonization in the third trimester.Among the 632 pregnant women without ASB (control),44 cases (6.96%) had vaginal colonization of group B Streptococcus in the third trimester.The colonization rate of group B Streptococcus in the pregnant women with ASB was significantly higher than that in the pregnant women without ASB (χ2=17.666,P<0.001).Logistic regression showed that ASB was positively correlated with the vaginal colonization of group B Streptococcus in the third trimester of pregnancy (OR=2.577,95%CI=1.509-4.402,P=0.001).Conclusions ASB is positively correlated with the vaginal colonization of group B Streptococcus in the third trimester.The screening,prevention,and control of ASB in the early trimester is of great significance to reduce the vaginal colonization of group B Streptococcus in the third trimester.

[Relationship between Stress Hyperglycemia and Catheter-related Urinary Tract Infection in Stroke Patients].

Objective To verify the relationship between catheter-related urinary tract infection(CAUTI)and stress hyperglycemia during catheter retention in stroke patients. Methods We used nosocomial infection monitoring system to track the status of CAUTI in stroke patients in a hospital.The study cohort was all the patients who received retention catheterization from January 2016 to March 2020.According to the nested case-control design,multivariate logistic regression analysis was performed to explore the relationship between stress hyperglycemia and CAUTI in stroke patients with indwelling catheter. Results A total of 322 cases of CAUTI and 644 cases of non-CAUTI were enrolled in this study.The length of stay in the case group was(20.68 ± 3.73)d,significantly longer than that[(13.00 ± 4.01)d]in the control group(t=29.473,P <0.001).Compared with non-stress hyperglycemia,stress hyperglycemia posed a higher risk of CAUTI in the stroke patients with indwelling catheter(OR=2.020,95% CI=1.447-2.821,P=0.000)and led to the higher incidence of CAUTI in one thousand days(P<0.001). Conclusion Stress hyperglycemia in the stroke patients with indwelling catheter can significantly increase the risk of CAUTI.

[Risk Factors for Postoperative Recurrence of Chronic Suppurative Otitis Media].

Objective To analyze the risk factors for postoperative recurrence of chronic suppurative otitis media(CSOM) and explore the intervention measures to prevent postoperative recurrence of CSOM. Methods A total of 1066 patients with CSOM who underwent concurrent surgical treatment and achieved clinical cure in our hospital from January 2012 to December 2018 were enrolled.The clinical data and laboratory findings were reviewed by using an electronic medical record system and the patients were followed up for 1 year.The patients were divided into the non-recurrent group and the recurrent group.Chi-square test and multivariate logistic regression were used to compare the factors may contribute to the postoperative recurrence. Results The recurrence rate of CSOM was 6.38%.Multi-drug-resistant(MDR) infection before surgery(χ 2=16.338,P=0.000),aged ≥60 years(χ 2=5.182,P=0.023),frequency of occurrence ≥3 times/year(χ 2=4.388,P=0.036),duration of active period>7 d(χ 2=4.729,P=0.030),repeated upper respiratory tract infection>3 times/year(χ 2=11.913,P=0.001),accompanied by chronic sinusitis(χ 2=11.077,P=0.001),blood glucose>6.11 mmol/L(χ 2=15.327,P=0.000),postoperative serum procalcitonin(PCT)>0.5 µg/L(χ 2=8.337,P=0.004) were the risk factors for postoperative recurrence.The use of snorkel was a protective factor for postoperative recurrence(χ 2=5.308,P=0.021).Multivariate analysis showed that MDR infection(OR=3.373,95%CI:1.825-6.234,P=0.000),repeated upper respiratory tract infection>3 times/year(OR=2.727,95%CI:1.479-5.030,P=0.001),accompanied by chronic sinusitis(OR=2.980,95%CI:1.654-5.369,P=0.000),blood glucose>6.11 mmol/L(OR=3.219,95%CI:1.741-5.953,P=0.000),and postoperative serum PCT>0.5 µg/L(OR=2.085,95%CI:1.106-3.931,P=0.023) were independent risk factors for postoperative recurrence in CSOM patients. Conclusions Effective prevention and control of MDR infection,control of blood sugar,prevention of upper respiratory tract infection,and lowering the recurrence of chronic sinusitis are the main measures to reduce postoperative recurrence of CSOM.Monitoring of the infection marker PCT can help to achieve early intervention.

[Prognostic Factors of Central Venous Catheter-related Bloodstream Infections].

Objective To explore the prognostic factors of central venous catheter-related bloodstream infection(CR-BSI)and provide reference for clinical practice. Methods The clinical data of 346 CR-BSI patients from February 2014 to July 2019 were retrospectively reviewed,and the prognostic factors were analyzed. Results Of the 346 CR-BSI patients,62 died,yielding a case-fatality rate of 17.92%.Univariate analysis showed that 18 factors including age(t=2.838,P=0.006),history of diabetes(χ2=5.966,P=0.015),time to withdrawing the tube after infection(t=5.026,P=0.000),ICU stay(χ2=6.885),P=0.009),catheter placement(χ2=5.468,P=0.019),use of glucocorticoids(χ2=4.731,P=0.030),Acute Physiology and Chronic Health Score Ⅱ(APACHE Ⅱ)after CR-BSI(t=3.556,P=0.000),methicillin-resistant Staphylococcus aureus(MRSA)infection(χ2=10.209,P=0.001),multidrug-resistant Pseudomonas aeruginosa(MDR-PA)infection(χ2=22.668,P=0.000),carbapenem-resistant Klebsiella pneumonia(CRKP)infection(χ2=16.758,P=0.000),infection with extended-spectrum ß-lactamase-producing enterobacteriaceae(χ2=7.784,P=0.005),fungal infection(χ2=6.576,P=0.010),use of antibacterial drugs before infection(χ2=5.315,P=0.021),combined use of antibacterial drugs before infection(χ2=4.260,P=0.039),time to start using antibacterial drugs(t=2.805,P=0.006),time to start using antibacterial drugs according to the results of susceptibility test(t=2.877,P=0.005),serum albumin concentration(t=-2.976,P=0.003),blood sugar(t=2.632,P=0.010)were associated with CR-BSI death.Multivariate logistic analysis showed that 6 factors including hyperglycemia(OR=5.047,95% CI=1.805-14.114,P=0.002),MRSA infection(OR=18.278,95% CI=3.732-89.527,P=0.000),MDR-PA infection(OR=42.380,95% CI=9.477-189.528,P =0.000),CRKP infection(OR=72.834,95% CI=16.061-330.286,P=0.000),increased APACHE Ⅱ score after CR-BSI(OR=6.615,95% CI=2.625-16.667, P=0.000),time from infection to extubation(OR=4.071,95% CI=1.743-9.508, P=0.001),and time from infection to use of antibiotics according to drug sensitivity test(OR=5.047,95% CI=1.805-14.114,P=0.001)were independent risk factors for CR-BSI death.Serum albumin concentration(OR=0.365,95% CI=0.136-0.978,P=0.045)was an independent protective factor for CR-BSI death. Conclusions Hyperglycemia,hypoproteinemia,critical illness,and multidrug-resistant bacterial infection are the risk factors for CR-BSI death.Early extubation,early bacterial culture,and early drug sensitivity test may help to reduce the mortality of CR-BSI.

[Correlation between Asymptomatic Bacteriuria and Surgical Site Infection in Middle-aged and Elderly Patients Undergoing Open Hysterectomy].

Objective To explore the correlation between asymptomatic bacteriuria(AB)and surgical site infection(SSI)in middle-aged and elderly women undergoing open hysterectomy.Methods The clinical data of 1469 middle-aged and elderly women undergoing open hysterectomy in the Third Affiliated Hospital of Guizhou Medical University from June 2011 to August 2018 were retrospectively analyzed.Factors associated with SSI after operation were analyzed by univariate and multivariate regression models to identify the relationship of AB with SSI after open hysterectomy.Results Of these 1469 patients,101(6.88%)had SSI and 124 had AB[including 14 patients(11.29%)with infections].In addition,1345 patients had no AB,among whom 87(6.47%)had infections.Thus,the infection rate in patients with AB was significantly higher than that in patients without AB(χ 2=4.123,P=0.042).Univariate analysis showed AB,history of diabetes mellitus,surgical procedure,length of stay(>15 d),season(summer and autumn),body mass index(≥25 kg/m 2),nature of lesions(malignant tumors),ASA grade(>grade Ⅱ),incision length(≥10 cm),and operative time(≥3 h),bleeding volume(≥1000 ml),serum albumin concentration(<30 g/L),blood glucose(≥10 mmol/L),and hemoglobin concentration(<90 g/L)were associated with SSI(all P <0.05).Multivariate analysis showed that AB,nature of lesions(malignant tumors),blood glucose(≥10 mmol/L),operative time(≥3 h),and ASA grade(>grade Ⅱ)were risk factors for SSI in these patients(all P <0.05). Conclusions AB is one of the risk factors for SSI in middle-aged and elderly women undergoing open hysterectomy.Screening and treatment of AB before surgery can reduce the risk of SSI.ASA grading shall be performed before surgery before corresponding preparation was offered.Effective control of blood glucose,improved surgical skills,and shorter operative time are helpful for lowering postoperative SSI.

[Logistic Regression Analysis of the Risk Factors for Multidrug-resistant Bacterial Infections in Chronic Rhinosinusitis].

Objective To analyze the risk factors of multidrug-resistant bacterial infections in patients with chronic rhinosinusitis.Methods The clinical data of 221 patients with chronic rhinosinusitis who were treated in our center from January 2010 to January 2017 were collected retrospectively. Specimens were collected for bacterial culture and antibiotic susceptibility testing. The risk factors for multidrug-resistant bacterial infections were analyzed.Results Univariate analysis showed that combined use of 3 or more antibiotics,high visual analogue scale score,high Lund-Kennedy score,long disease course(>5 years),high frequency of acute infections(more than 3 times a year),long duration of acute infection(>7 days),recurrent upper respiratory tract infections(>3 times per year),chronic otitis media,smoking history,allergic rhinitis,poor drainage,high frequency of antimicrobial use(≥3 times/year),use of multiple antibiotics(more than 3 types),aged over 60 years,and use of antibacterial drugs for over 7 days were the risk factors for production of multi-drug-resistant organism(MDRO) in patients with chronic sinusitis(all P<0.05). After adjusting for other factors,combined use of 3 or more antibiotics,high frequency of acute infections(more than 3 times a year),recurrent upper respiratory tract infections(>3 times per year),smoking history,allergic rhinitis,poor drainage,and high frequency of antimicrobial use(≥3 times/year) remained the risk factors for MDRO in patients with chronic sinusitis(all P<0.05).Conclusions Multidrug-resistant bacterial infections in patients with chronic sinusitis can be caused by a variety of factors. In the clinical practice,by focusing on the major risk factors,a comprehensive management strategy should be adopted to reduce the production of MDRO and improve the therapeutic outcomes.