Master genes and co-expression network analysis in peripheral blood mononuclear cells of patients with gram-positive and gram-negative sepsis / 浙江大学学报·医学版

OBJECTIVE@#To investigate the functional pathways enriched and differentially expressed genes (DEGs) in peripheral blood mononuclear cells (PBMCs) of patients with gram-positive and gram-negative sepsis.@*METHODS@#Dataset GSE9960 obtained from NCBI GEO database containing PBMC samples from 16 non-infectious systematic inflammatory response syndrome (SIRS) patients, 17 gram-positive septic patients and 18 gram-negative septic patients were included in the study. Functional pathway annotations were conducted by gene set enrichment analysis and weighted gene co-expression network analysis. DEGs were filtered and master DEGs were then validated in PBMCs of gram-positive septic, gram-negative septic and non-infectious SIRS patients.@*RESULTS@#The enriched gene sets in gram-positive sepsis and gram-negative sepsis were significantly different. The results indicated the opposite co-expression networks in SIRS and gram-negative sepsis, and the entirely different co-expression networks in gram-positive and gram-negative sepsis. Furthermore, we validated that @*CONCLUSIONS@#The results indicate that there are differences in the mechanism and pathogenesis of gram-positive and gram-negative sepsis, which may provide potential markers for sepsis diagnosis and empirical antimicrobial therapy.

Distribution characteristics of pathogenic bacteria in infectious donors from organ donation after citizen's death and preventive strategies for renal transplant recipients: a single center experience / 器官移植

Objective To investigate the distribution characteristics of pathogenic bacteria in infectious donors from organ donation after citizen's death and preventive strategies for renal transplant recipients. Methods Clinical data of 412 donors and 803 recipients from organ donation after citizen's death were retrospectively analyzed. All donors underwent culture of airway secretions, urine, blood and renal lavage fluid. The incidence rate of infection, distribution and composition ratio of pathogenic bacteria of donors from organ donation after citizen's death were observed. The scores of all donors were evaluated according to the length of intensive care unit (ICU) stay for donors, the situation of abdominal trauma and the results of body fluid culture, etc. According to the score, the recipients received different infection prevention regimes. The incidence rate of donor-derived infection (DDI) and clinical prognosis of the recipients were analyzed. Results A total of 243 donors were diagnosed with infection in 412 donors from organ donation after citizen's death with an infection rate of 59.0%. In total, 456 strains of pathogenic bacteria were isolated, mainly derived from the airway secretions (71.7%). Gram-negative bacteria dominantly consisted of Klebsiella pneumoniae and acinetobacter baumannii. Gram-positive bacteria mainly included staphylococcus aureus and fungus mainly included yeast-type fungus. Three recipients (kidneys from 2 donors respectively) developed DDI with an incidence rate of 0.4%. Conclusions The infection rate of donors from organ donation after citizen's death is relatively high. It is effective to prevent the incidence of DDI by grading the risk of infection of donors and adopting rational preventive plan according to the score.

Diagnostic value of procalcitonin in distinguishing Gram-negative bacterial blood stream infection from Gram-positive bacterial infection in early stage of sepsis / 中华急诊医学杂志

Objective To investigate the diagnostic values of procalcitonin (PCT),high sensitive C-reactive protein (hs-CRP),white blood cell (WBC)and percentage of neutrocyte (NEU％)in Gramnegative and Gram-positive bacterial blood stream infection in early stage of sepsis in order to investigate the correlation between PCT and APACHE lⅡ score as well as between PCT and SOFA score,and the prognostic value in assessment of Gram-negative and Gram-positive bacterial blood stream infection.Methods Clinical data of patients admitted to ICU from January 2012 through December 2014 were retrospectively analyzed.A total of 124 sepsis patients with blood stream infection were checked with PCT,hs-CRP,WBC and NEU％ tests,and APACHE Ⅱ score and SOFA score were calculated.The differences in APACHE Ⅱ score and SOFA score were compared between Gram-negative group (n =41) and Gram-positive group (n =83).The correlation between PCT and APACHE Ⅱ score as well as between PCT and SOFA score was analyzed.The differences in diagnostic values of PCT,hs-CRP,WBC and NEU％ between Gram-negative group and Grampositive group were analyzed by using receiver operating characteristic (ROC) curve and it was plotted to assess the prognostic values of PCT,hs-CRP,WBC and NEU％ for septic patients with blood stream infection.Results Compared with Gram-positive group,the levels of PCT [.55.32 (22.01,97.11) vs.2.13 (0.27,5.27)] (P ＜0.01),hs-CRP [105.09 (69.97,186.12) vs.70.54 (42.37,138.63)] (P=0.508),NEU％ [88.30 (75.79,93.52) vs.55.32 (22.01,97.11)] (P=0.302) were higher but WBC was lower [13.59 (10.74,17.58) vs.13.73 (11.32,20.90)] (P=0.058) in Gram-negative group.The ROC curve analysis of PCT showed the area under the curve (AUC) was 0.867 (95％ CI:0.789-0.946).When the optimal cutoff point of PCT was 17.48 ng/mL,the largest Youden's index was found to be 0.661 with 76.9％ sensitivity and 89.2％ specificity.Between two groups,there were significant differences in APACHE Ⅱ score and SOFA score (27.46 ± 9.60 vs.23.67 ± 7.74,P =0.020;8.05 ±3.38 vs.6.59-±3.45,P =0.028).There was significant difference in diagnostic value between PCT and SOFA (r =0.536,P =0.036) in Gram-negative group but no significant difference in Gram-positive group.Conclusions Higher PCT levels are found in Gram-negative group and it can play a role in differntiation between the Gram-negative group and Gram-positive group rather than hs-CRP,WBC and NEU％.PCT can be a better indicator for evaluation of severity of sepsis as well as for prognosis of sepsis patients with Gram-negative bacterium infection.

Teicoplanin Treatment of Severe Community-acquired pneumonia among Elderly:A Retrospective Analysis / 中华医院感染学杂志

OBJECTIVE To evaluate the rationality of teicoplanin for the empirical treatment of severe community-acquired pneumonia(CAP) in the aged.METHODS Totally 179 hospitalized cases of severe CAP were enrolled and divided into two groups,teicoplanin treatment group(67 cases) and non-teicoplanin treatment group(112 cases),whose clinical data and antibiotic empirical treatment were analyzed respectively,compared their PSI scores and clinical outcomes after 5 day′s therapy.RESULTS The PSI scores had no significant difference of two groups.The total treatment failure rate in teicoplanin treatment group was 23.9%,lower than that in non-teicoplanin treatment group.The treatment failure rate of teicoplanin combining the third generation cephalosporin treatment cases was 19.4%,lower than that in single use of cephalosporin(50.0%),also less than that in the cases of cephalosporin combining other antibiotics therapy,which accounted for 32.1%.CONCLUSIONS The use of teicoplanin may reduce treatment failure rate of severe CAP among aged.

Category of Clinically Isolated Gram-positive Bacterium in Our Hospital and Their Drug Resistance in Recent 5 Years / 中国药房

OBJECTIVE:To probe into the category and drug resistance of clinically isolated gram-positive bacterium(G+)in our hospital. METHODS:The category and drug resistance of clinically isolated gram-positive bacterium(G+)in our hospital in the recent five years were surveyed and analyzed retrospectively. RESULTS:Of clinical isolated gram-positive bacterium(G+), Staphylococcus accounted for 65.47% and Enterococcus 20.24%. Majority of Staphylococcus were coagulase negative Staphylococcus,followed by Staphylococcus aureus. The most of Enterococcus were Enterococcus faecium and Enterococcus faecalis. The drug resistance rates of Staphylococcus to nitrofurantoin and ifampin reached low level and the sensitivity of Staphylococcus to vancomycin was 100%. There was difference between drug resistance of Enterococcus faecium and Enterococcus faecalis. Vancomycin has better effect than other drugs on Enterococcus. CONCLUSIONS:Doctors must pay attention to the component and drug resistance of bacteria so as to improve the application of antibiotics.