OBJECTIVE To study the staphylococcus infection and the drug resistance among the outpetients and the inpatients, and to provide information for the clinical treatment.METHODS To cultivate and isolate bacteria according to the Clinical Laboratory Operation Regulation.Bacteria were identified with the automated analyzer VITEK-60.made by Bio-Merieux Company in France.The drug susceptibility was one with the method of single split agar diffusion.RESULTS Totally 159 strains of Staphylococcus were isolated from the outpatients,(46.1%) of which were MRSA.Most of the infection were caused through genital tract;390 strains of(Staphylococcus) were(isolated) from the inpatients,87.1% of which were MRSA.Most of the infection were caused through respiratory tract.Most of MSSA resisted to penicillin,but MRSA were sensitive to vancomycin and(teicoplanin.) (CONCLUSIONS) Preventing the spread of the MRSA is very important to the control of the nosocomial(infection).As far as the infective situation,most of the outpatients are infected through genital tract;while most of the inpatients are infected through respiratory tract.As far as the drug susceptibility,vancomycin is the best antibiotics,the next is teicoplanin.It is necessary to use combined drugs for the MRSA infection.

Objective To analyze the clinical infection distribution and drug resistance status of 442 strains of Escherichia coli to provide the basise for the treatment of Escherichia coli infection and the control of nosocomial infection.Methods The clinically submitted various kinds of specimens during 2013 were performed the bacterial culture and identification.The susceptibility of Escherichia coli to commonly used bacterial drugs were detected by adopting the MIC method.The data were analyzed by WHO-NET V5.5 and SPSS V13.0 softwares.Results 442 strains of Escherichia coli were isolated from the middle urine and secretion. The detection rate of ESBLs-producing Escherichia coli was 61.3%.442 strains of Escherichia coli had the high resistance to peni-cillins,cephalosporins and fluoroquinolones,better sensitivity toβ-lactam/β-lactamase inhibitor compounds and highest sensitivity to carbapenems.ESBLs-producing Escherichia coli had the higher resistance to commonly used antibacterial drugs than non-ESBLs-producing Escherichia coli .Conclusion The drug resistance of Escherichia coli is severe.ESBLs-producing Escherichia coli are u-sually resistant to many different types of antimicrobial drugs.Carbapenems are the first choice to treatment of severe infections of Escherichia coli .

Objective:To explore the expression of programmed cell death-ligand 1 (PD-L1) in invasive breast cancer and its relationship with clinicopathological characteristics.Methods:A total of 651 paraffin-embedded specimens of newly diagnosed invasive breast cancer patients including 98 cases of triple-negative breast cancer (TNBC) in the Affiliated Nanjing Drum Tower Hospital of Medical School of Nanjing University from January 2018 to August 2019 were collected. The immunohistochemical EnVision method was used to detect the expression of PD-L1 protein in tumor cells of breast invasive cancer and infiltrating lymphocytes. The expression rate of PD-L1 in tumor cells of cancer section tissues and tumor interstitial lymphocytes ≥1% was positive and < 1% was negative.Results:The positive expression rate of PD-L1 expression in breast invasive carcinoma was 47.0% (306/651), among which the positive expression rate of TNBC was 69.3% (68/98). PD-L1 had a high positive expression rate in patients with high World Health Organization (WHO) grade, large tumor size, vascular invasion, advanced pathological stage, negative estrogen receptor (ER) expression, negative progesterone receptor (PR) expression, positive p53, positive CK5/6, positive epidermal growth factor receptor (EGFR), and high Ki-67 value (all P < 0.05). In TNBC, PD-L1 had a high positive expression rate in patients with high WHO grade, invaded nerves, high Ki-67 value, positive CK5/6, and positive EGFR (all P < 0.05). Multivariate analysis showed that WHO grade ( HR = 1.511, 95% CI 1.139-2.003, P = 0.004), Ki-67 value ( HR = 1.847, 95% CI 1.259-2.709, P = 0.002), p53 expression ( HR = 2.083, 95% CI 1.487-2.916, P < 0.01), and EGFR expression ( HR = 3.490, 95% CI 2.002-6.086, P < 0.01) were independent influencing factors of PD-L1 expression. Conclusions:PD-L1 is highly expressed in invasive breast cancer, especially in TNBC. It could be used as a potential treatment target for patients with invasive breast cancer.

Objective:To investigate the risk factors of diabetes mellitus complicated by pulmonary tuberculosis.Methods:The clinical data of 83 patients with diabetes mellitus complicated by pulmonary tuberculosis who received treatment in Taiyuan Fourth People's Hospital from March 2020 to March 2022 were collected. These patients were divided into sensitive group ( n = 45) and resistant group ( n = 38 ) according to the results of drug sensitivity test. Univariate and multivariate non-conditional logistic regression was performed to analyze the influential factors of drug resistance. Results:Univariate logistic regression results revealed that there were significant differences in blood CD4 +T lymphocyte count ( χ2 = 11.73, P = 0.001) and diabetic complications ( χ2 = 4.94, P = 0.026). Multivariate non-conditional logistic regression analysis was performed taking whether blood CD4 +T lymphocyte count was lower than the average level and whether patients with diabetes mellitus had complications as independent variables, and taking whether drug resistance was a dependent variable. The results showed that the OR (95% CI) value of the decreased blood CD4 +T lymphocyte count was 4.909 (1.926-12.514). It is a risk factor for drug resistance of diabetes mellitus complicated by pulmonary tuberculosis. Conclusion:The decrease of blood CD4 +T lymphocyte count is a risk factor of drug resistance in diabetes mellitus complicated by pulmonary tuberculosis, and it should be intervened early in the clinic.

Objective To investigate distribution and antimicrobial resistance among nosocomial pathogens from 13 teaching hospitals in China in 2009. Methods Non-repetitive pathogens from nosocomial BSI, HAP and IAI were collected and sent to the central lab for MIC determination by agar dilution method.WHONET5.6 software was used to analyze the data. Results A total of 2 502 clinical isolates were collected. The top three pathogens of BSI were Escherichia coli [27. 1% (285/1 052 )] , coagulase-negutive staphylococcus [12. 6% ( 133/1 052)] and Klebsiella pneumoniae [10. 8% ( 114/1 052)]. The top three pathogens of HAP were Acinetobacter baumannii [28. 8% (226/785)], Pseudomonas aeruginosa [16. 1% (126/785)] and Klebsiella pneumoniae [14.6% (115/785 )] . The top three pathogens of IAI were Escherichia coli[31.0% ( 206/665 )], Klebsiella pneumonia [11.3% ( 75/665 )] and Enterococcus faecium [10. 8% (72/665)]. Against Escherichia coil and Klebsiella spp. , the antimicrobial agents with higher than 80% susceptibility rate included imipenem and meropenem (98. 1%-100% ), tigecycline (95.3%-100% ), piperacillin-tazobactam ( 88.6% -97. 1% ) and amikacin ( 88. 3% -92. 5% ). Against Enterobacter spp. , Citrobacter spp. and Serratia spp. , the susceptibility rates of tigecycline were 93.5% -100% whereas the value of imipenem and meropenem were 92.9% -100%. Other antimicrobial agents with high activity included amikacin ( 85.2% -96. 7% ), pipcracillin-tazobactam ( 82.4% -96.4% ), cefepime ( 79. 6% -96. 7% ) and cefoperazonc-sulbactam (78. 7%-90. 0% ). Polymyxin B showed the highest susceptibility rateagainst Pseudomonas aeruginosa ( 100% ), followed by amikacin ( 81.9% ) and piperacillin-tazobactam (80.1% ). Polymyxin B also showed the highest susceptibility rate against Acinetobacter baumannii (98. 8% ), followed by tigecycline (90. 1% ) and minocycline (72. 0% ). The incidence of carbapenemresistant Acinetobacter baumannii was 60. 1%. The MRSA rate was 60. 2% and the MRSCoN rate was 84. 2%. All Staphylococcus strains were susceptible to tigecycline, vancomycin, teicoplanin and linezolid except for one isolate of Staphylococcus haemolysis with intermediate to teicoplanin. Two Enterococcus faecalis isolates which were intermediate to linezolid and one Enterococcus faecium isolate which was resistant to vancomycin and teicoplanin was found in this surveillance, while the MICs of tigecycline against these three isolates were 0. 032-0. 064 μg/ml. Conclusions Tigecycline, carbapenems, piperacillin-tazobactam,amikacin and cefepime remain relatively high activity against nosocomial Enterobacteriaceae. Pseudomonas aeruginosa exhibite high susceptibility to polymyxin B, while Acinetobacter baumanni shows high susceptibility to polymyxin B and tigecycline. Tigecycline, vancomycin, teicoplanin and linezolid remain high activity against nosocomial gram-positive cocci.