Objective:To explore the infective routes and the pathogen type distribution of ventilator associated pneumonia (VAP).Methods: 183 ventilator associated pneumonia patients (75 cases were early-onset VAP and 108 cases were late-onset VAP, and the different point was whether machine had been used 72 h) who once were treated in intensive care unit(ICU)during the term of January 2013 and December 2015 were researched in this paper. To collect samples from phlegm in lower respiratory tract, secrete of oropharynx, air sac of tracheal catheter, stomach juices, ventilator channel and condensate water, and identify pathogens and detect drug allergy. To compare the difference of pathogens distribution and infective routes between early-onset VAP and late-onset VAP by comparing identified result of the same case.Results: In 294 strains bacteria collected from different collective points, 71.09% was gram-negative bacteria, 21.09% was gram positive bacteria, 7.82% was fungus, and 129 strains were multiple-resistant bacteria. Gram-negative bacteria and gram positive bacteria in late-onset VAP patients were less than early-onset VAP patients, but the fungus was more than them, and the difference was statistically significant (x2=14.193, P=0.001); besides, the stains of multiple-resistant bacteria of late-onset patients were more than others, and the difference also was statistically significant (x2=26.375, P=0.000). Most of infection of VAP were original from stomach juices and tracheal catheter air sac, both of them were 59.77%. Most of early-onset VAP were infected by stomach juices and secrete of oropharynx, and most of late-onset VAP were infected by tracheal catheter air sac, ventilator channel and condensate water(x2=31.450,P= 0.000).Conclusion: The clinical prevention and cure for VAP should adopt comprehensive measures which depend on the aeration time of machine because there are some differences on pathogens distribution and infective routes between late-onset VAP and early-onset VAP. This research provide a evidence for efficiently prevent the occurrence and development of VAP in hospital.

Objective:To analyze the risk factors and pathogen distribution of ventilator-associated pneumonia (VAP) in patients with acute respiratory distress syndrome (ARDS).Methods:A retrospective analysis was conducted on the clinical data of 118 patients with ARDS who received treatment at Xi'an International Medical Center Hospital from January 2020 to January 2023. The patients were divided into two groups: the VAP group ( n = 38) and the non-VAP group ( n = 80), based on the presence of concurrent VAP. Serological indicators, blood gas analysis parameters, and ventilator settings were compared between the two groups to identify the risk factors associated with the occurrence of VAP. Pathogenic bacteria in the patients' sputum were also detected. Results:Among the 118 patients, there were 79 males and 39 females, with an average age of (53.1 ± 9.6) years. The primary underlying conditions leading to ARDS included chronic obstructive pulmonary disease in 49 cases (41.53%), sepsis in 20 cases (16.95%), severe pneumonia in 17 cases (14.41%), and extensive stroke in 16 cases (13.56%). Univariate analysis revealed that, compared with the non-VAP group, the VAP group had significantly more severe ARDS ( Z = -4.73, P < 0.05). Compared with the non-VAP group, the levels of albumin, platelets, and procalcitonin in the VAP group were significantly lower ( t = 13.75, 3.11, 2.27, all P < 0.05), while levels of high-sensitivity C-reactive protein, transforming growth factor beta (TGF-β), and angiotensin Ⅱin the VAP group were significantly higher ( t = 2.51, 26.63, 27.50, all P < 0.05). The VAP group had a significantly higher proportion of patients who experienced coma, underwent tracheostomy, and received more than two types of antibiotics (χ2 = 14.84, 19.04, 11.22, all P < 0.05). The VAP group also had significantly longer duration of antibiotic use compared with the non-VAP group ( t = 6.88, P < 0.05). Multivariate analysis showed that albumin ( OR = 2.632, 95% CI: 1.398-3.749), high-sensitivity C-reactive protein ( OR = 2.358, 95% CI: 1.534-4.036), coma ( OR = 3.035, 95% CI: 2.034-3.834), and use of more than two types of antibiotics ( OR = 2.005, 95% CI: 1.363-2.846) were independent risk factors for the occurrence of VAP in patients with ARDS (all P < 0.05). In 38 patients with VAP, 63 pathogenic strains were isolated from sputum, while in 80 patients with non-VAP, 128 pathogenic strains were isolated. The most common pathogens identified were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus. In the VAP group, a single pathogen was identified in 16 cases (42.11%), whereas in the non-VAP group, a single pathogen was identified in 51 cases (63.75%). Two types of pathogens were found in 14 cases (36.84%) of the VAP group and 25 cases (31.25%) of the non-VAP group, while three or more pathogens were detected in 8 cases (21.05%) of the VAP group and 4 cases (5.00%) of the non-VAP group. The survival rates for the VAP and non-VAP groups were 57.9% (22/38) and 85.0% (68/80), respectively, with the non-VAP group showing a significantly higher survival rate (χ2 = 22.67, P < 0.001). Conclusion:The risk of VAP in patients with ARDS is high, with two or more pathogen infections being predominant. Clinical interventions should be strengthened.

Objective To investigate the distribution characteristics of ABA (Acinetobacter baumannii) and to analyze the influencing factors of the prognosis of elderly patients with COPD (chronic obstructive pulmonary disease) and lung infection in Shaanxi. Methods A retrospective single-center survey was conducted on 1 078 elderly patients with COPD admitted to our hospital from January 2015 to November 2019. According to the presence or absence of ABA infection, the patients were divided into infection group (n=63) and non-infection group (n=1 015). Through the electronic medical record system, the basic information of all patients was collected, including name, sex, age, case number, length of stay in ICU, index of auxiliary examination, combined diseases and prognosis. The prognostic outcomes of the two groups of patients were compared. Univariate analysis was performed on the baseline data of the two groups of the patients, and unconditional logistic multivariate regression analysis was used to further analyze the single factors with statistical difference, to explore the distribution and influencing factors of ABA in elderly COPD patients with pulmonary infection in Shaanxi. Results The mortality rate of the infected group was significantly higher than that of the non-infected group (χ²=8.670, P=0.003). Univariate analysis showed that there were significant differences in age, Apache II score, diabetes, PCT and ICU length of stay between the infected and non-infected groups (P<0.05), while there were no significant differences in sex, cerebrovascular disease, malnutrition, bed rest and tumor (P<0.05). In the infection group, 55 patients survived, 42 patients were discharged, 13 patients received extended hospitalization and 8 patients died. Of those who died, 5 were resistant to cefoperazone and all were resistant to carbapenems. Of those remaining hospitalized, 3 patients were resistant to cefoperazone sulbactam and 7 were resistant to carbapenems. Patients discharged from the hospital were more sensitive to carbapenems, minocycline and cefoperazone. According to multiple logistic regression analysis, apache II score (OR=3.480，95%CI 1.154-10.491), diabetes mellitus (OR=2.732，95%CI 1.297-5.753), high serum PCT (OR=6.334，95%CI 1.142-35.129) and ICU hospitalization (OR=3.773，95%CI 1.087-13.100) were independent risk factors influencing the prognosis of elderly patients with COPD in Shaanxi. Conclusion ABA Infection was correlated with age, Apache II score, diabetes Mellitus, PCT and length of stay in ICU, which could influence prognosis of elderly patients with COPD.

A new definition of metabolic dysfunction-associated fatty liver disease (MAFLD) has recently been proposed. We aim to examine the associations of MAFLD, particularly its discordance from non-alcoholic fatty liver disease (NAFLD), with the progression of elevated brachial-ankle pulse wave velocity (baPWV) and albuminuria in a community-based study sample in Shanghai, China. After 4.3 years of follow-up, 778 participants developed elevated baPWV and 499 developed albuminuria. In comparison with the non-MAFLD group, the multivariable adjusted odds ratio (OR) of MAFLD group for new-onset elevated baPWV was 1.25 (95% confidence interval (CI) 1.01-1.55) and 1.35 (95% CI 1.07-1.70) for albuminuria. Participants without NAFLD but diagnosed according to MAFLD definition were associated with higher risk of incident albuminuria (OR 1.77; 95% CI 1.07-2.94). Patients with MAFLD with high value of hepamet fibrosis score or poor-controlled diabetes had higher risk of elevated baPWV or albuminuria. In conclusion, MAFLD was associated with new-onset elevated baPWV and albuminuria independently of body mass index, waist circumference, and hip circumference. Individuals without NAFLD but diagnosed as MAFLD had high risk of albuminuria, supporting that MAFLD criteria would be practical for the evaluation of long-term risk of subclinical atherosclerosis among fatty liver patients.
Humans ; Pulse Wave Analysis ; Albuminuria ; Ankle Brachial Index ; Non-alcoholic Fatty Liver Disease/diagnosis* ; Vascular Stiffness ; Prospective Studies ; Risk Factors ; China/epidemiology*