Objective:To explore the relationship between ventilator-associated pneumonia (VAP) and neutrophil/lymphocyte ratio (NLR) before mechanical ventilation in patients with malignant tumors.Methods:A retrospective nested case-control study was conducted. Patients with malignant tumor treated by mechanical ventilation admitted to the Third Affiliated Hospital of Guizhou Medical University from February 2015 to February 2020 were enrolled. The patients with VAP were selected as the case group, and the matched non-VAP cases were selected according to 1∶2 as the control group. The clinical data were collected, and the differences of each index between the two groups were compared. The influencing factors of VAP in patients with malignant tumor were analyzed by multivariate Logistic regression.Results:During the study period, 1 271 patients with malignant tumors were treated with mechanical ventilation, of which 241 cases had VAP, and the incidence of VAP was 18.96%. There were 232 VAP patients in the case group matched 464 non-VAP patients in the control group. The clinical data of age, gender, hospitalization diagnosis, primary tumor, regional lymph node and distant metastasis (TNM) stage, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), complications, duration of mechanical ventilation, hemoglobin (Hb) and serum albumin (Alb) levels were balanced and comparable between the two groups, and the cluster nursing measures were consistent. Compared with the control group, although there was no significant difference in neutrophil count (NEU) and lymphocyte count (LYM) in the case group [NEU (×10 9/L): 3.81±1.07 vs. 3.64±1.05, LYM (×10 9/L): 2.06±0.59 vs. 2.15±0.62, both P > 0.05], NLR was significantly increased (2.07±1.05 vs. 1.89±0.96, P < 0.05), and the hospital stay was significantly longer (days: 24.84±3.81 vs. 13.19±3.98, P < 0.01). NLR, gender, age, APACHEⅡ score, TNM stage, Hb, serum Alb and duration of mechanical ventilation were included in multivariate Logistic regression analysis. The results showed that patients with elevated NLR had higher risk of VAP [odds ratio ( OR) = 1.187, 95% confidence interval (95% CI) was 1.015-1.387, P = 0.032]. In patients with VAP, NLR was negatively correlated with the time of mechanical ventilation before VAP (r = -0.327, P = 0.000), and positively correlated with the time of treatment with antibiotics after VAP (r = 0.559, P = 0.000). Conclusion:Elevated NLR in patients with malignant tumors who were on mechanical ventilation can significantly increase the risk of VAP and increase the difficulty of treatment.

ObjectiveTo investigate related factors for severe acute pancreatitis (SAP) with sepsis. MethodsA retrospective analysis was performed for the clinical data of 178 SAP patients who were admitted from January 2007 to March 2020, and according to the presence or absence of sepsis, they were divided into sepsis group with 56 patients and non-sepsis group with 122 patients. The t-test was used for comparison of continuous data between the two groups, and the chi-square test was used for comparison of categorical data between the two groups. A logistic regression model was used for multivariate analyses. ResultsThe incidence rate of sepsis was 31.46% in SAP patients. The univariate analysis showed that there were significant differences between the patients without sepsis and those with sepsis in APACHEⅡ score, blood glucose, blood calcium, serum total cholesterol, serum triglyceride, blood urea nitrogen, serum creatinine, serum albumin, admission to the intensive care unit, hypoxemia, deep venous catheterization, mechanical ventilation, surgical procedure, blood purification, indwelling urinary catheterization, and extent of pancreatic necrosis (all P＜0.05). The multivariate analysis showed that APACHEⅡ score (odds ratio ［OR］=6.748, 95% confidence interval ［CI］: 2.191-20.788, P＜0.05), hypoxemia (OR=3.383, 95% CI: 1.112-10.293, P＜0.05), blood glucose (OR=5.288, 95%CI: 1.176-23.781, P＜0.05), extent of pancreatic necrosis (OR=5.523, 95%CI: 1.575-19.360, P＜0.05), and serum creatinine (OR=5.012, 95%CI: 1.345-18.762, P＜0.05) were independent risk factors for infectious SAP with sepsis, while laparoscopic removal of focal necrotic tissue (OR=0.250, 95%CI: 0.066-0951, P＜0.05) was an independent protective factor against SAP with sepsis. ConclusionThere are several important measures to reduce SAP with sepsis, including blood glucose control, protection of the functions of important organs such as lungs and kidneys, application of minimally invasive surgery to remove focal necrotic tissue, and emphasis on the treatment of critically ill patients with a high degree of pancreatic necrosis.

Objective:To study the correlation between L-form bacterial infection and surgical site infection (SSI) after laparoscopic cholecystectomy (LC) in patients with chronic calculous cholecystitis, and to find out the interventional measures which can be used in clinical prevention of SSI.Methods:Using a prospective nested case-control study, patients with chronic calculous cholecystitis who underwent LC at the Third Affiliated Hospital of Guizhou Medical University from September 2016 to June 2020 were prospectively studied. The postoperative follow-up observation time was within 1 month from the date of surgery. The patients’ general information, perioperative conditions, presence of L-form bacteria in gallbladder contents, postoperative SSI and other indicators, as well as the data entered by the surgeons before the operations were collected in detail. According to whether SSI occurred or not after operation, these patients were paired and grouped in a ratio of 1∶4 between the SSI group versus the control group. Multivariate logistic regression analysis was used to determine the risk factors for SSI after LC.Results:Of 695 patients included in the study, there were 248 males and 447 females, aged (46.0±15.0) years old. The infection rates of L-form bacteria in the case group and the control group were 45.32% and 30.94%, respectively. The infection rate of L-form bacteria in the case group was significantly higher than that in the control group ( P<0.05). The L-form bacterial infection rate ( OR=2.082, 95% CI: 1.335-3.197, P=0.001) suggested that L-form bacterial infection significantly increased the risk of SSI. In addition, rupture of gallbladder during surgery, ( OR=2.249, 95% CI: 1.352-3.740, P=0.002), adhesion of gallbladder to surrounding tissues ( OR=1.903, 95% CI: 1.133-3.194, P=0.015), and excessive bleeding during operation ( OR=2.247, 95% CI: 1.418-3.561, P=0.001) also increased the risk of SSI, while increased experience of operating surgeons on number of surgical cases ( OR=0.549, 95% CI: 0.340-0.888, P=0.014) decreased the risk of SSI. Conclusion:L-form bacterial infection was one of the risk factors of SSI. L-form bacterial culture and tests for drug sensitivity were important in selecting antibiotics. Improved surgical skills, careful dissection of gallbladder from surrounding adhesions, reduction on intraoperative blood loss and avoiding gallbladder rupture contributed to a decrease in SSI.

OBJECTIVE:To provide reference for rational drug use and hospital infection control. METHODS:AmpC enzyme-producing Enterobacter cloacae were isolated from non-sputum specimen of a hospital during Jan. 2011-Oct. 2017. Drug sensitivity test was conducted by using MIC. The situation of AmpC enzyme production was confirmed by three dimensional test, and that of ESBLs-producing stain was detected with double-disk synergy test. RESULTS:There were 546 strains of AmpC enzyme-producing E. cloacae isolated from non-sputum specimen of the hospital,accounting for 4.80% of non-sputum specimen (546/11 375)and 38.97% of E. cloacae(546/1 401). Top 3 non-sputum samples in the list of detection rate were wound secretion (27.29%),midstream urine(25.82%)and blood(21.79%),and the departments with high detection rate were ICU(22.89%), neurosurgery department(18.68%)and general surgery department(16.67%). Resistance rate of AmpC enzyme-producing E. cloacae to most commonly used antibiotics was higher than 40%. There was statistical significance in resistant rate of the bacteria to ceftriaxone, cefotaxime, gentamicin, nitrofurantoin, levofloxacin, piperacillin/tazobactam, cefoperazone, ceftazidime,cefepime,tobramycin and minocycline among different years (P<0.05). The resistant rate to imipenem and meropenem was lower than 2%. Among 546 strains of AmpC enzyme-producing E. cloacae,68 strains of ESBLs were detected,and detection rates were 5.77%,6.06%,8.70%,10.26%,13.79%,17.35%,18.75% during 2011-2017. CONCLUSIONS:AmpC enzyme-producing E. cloacae are mainly isolated from samples as wound secretion and midstream urine,and mainly come from ICU and neurosurgery department. The drug resistance of the bacteria is severe,and drug resistance of the bacteria to antibiotics as β-lactams and quinolones is increased significantly. The detection rate of ESBLs-producing strain increases year by year. The bacteria are sensitive to carbapenems antibiotics,which can be regarded as first choice. It is necessary to strengthen drug resistance and enzyme production monitoring of AmpC enzyme-producing E. cloacae,select antibiotics combined with results of drug sensitivity test so as to prevent or delay the rapid increase of its resistance rate.

Objective:To study the factors related to infection by multiple drug-resistant bacteria (MDROs) in patients with infectious pancreatic necrosis (IPN).Methods:A retrospective study was conducted on the clinical data of 134 IPN patients with definitive etiologies treated in the Department of General Surgery, the Third Affiliated Hospital of Guizhou Medical University from January 2009 to February 2020. There were 85 males and 49 females. The age was (46.69±14.11) years. The IPN patients were divided into the multiple and the non-multiple MDROs infection groups based on drug resistance of pathogens in drainage fluid. The difference between the two groups of patients, including the number of antibacterial drugs used, the number of combined antibacterial drugs, the length of ICU stay, and other related factors were analyzed. Univariate and multivariate analyses were performed.Results:Among the 134 patients with IPN, 41 (30.60%) had complex MDROs infection and 93 (69.40%) had non complex MDROs infection. Univariate analysis showed that the course of disease, APACHE II score, extrapancreatic infection, number of surgical operations, time from onset to operation, patency of drainage tube, length of ICU stay, time of using antibiotics, number of changing courses of antibiotics, number of combined antibiotics, blood glucose and glycosylated hemoglobin were related to occurrence of multiple MDROs (all P<0.05); Multivariate analysis showed that glycated hemoglobin ( OR=3.957, 95% CI: 1.073-14.600), time from onset to operation ( OR=6.086, 95% CI: 1.263-29.325), number of changing courses of antibiotics ( OR=3.560, 95% CI: 1.077-11.772), number of combined antibiotics ( OR=3.560, 95% CI: 1.077-11.772), length of ICU stay ( OR=3.590, 95% CI: 1.126-11.448) were independent risk factors of MDROs infection in IPN patients ( P<0.05). Conclusion:Early debridement of infective foci, good control of blood glucose, reduced length of ICU stay, rational use of antibiotics to avoid unnecessary changing courses of antibiotics, appropriate use of combination of antibiotics could reduce the number of MDROs infection in IPN patients.