Objective To survey and analyze the drug resistance of clinical isolated strains of bloodborne infectious staphylococci, in order to provide references for clinical diagnosis of aureus septicemia and rational use of antimicrobial agents. Methods We retrospectively studied the clinical data of 496 patients with staphylococcal septicemia confirmed by blood culture between June 2008 and May 2015 in West China Hospital of Sichuan University. The microbiological characteristics of the disease were analyzed. Results In the included 496 cases, there were 216 (43.55%) cases of coagulase-positive Staphylococcus (CPS) septicemia and 280 (56.45%) of coagulase-negative Staphylococcus (CNS) septicemia; 85 (17.14%) cases were caused by community infection, while the other 411 (82.86%) resulted from hospital infection. The drug resistance rate of CPS and CNS toward oxacillin was respectively 27.78% (60/216) and 87.50% (245/280), with a significant difference (P < 0.05). In al l the clinical isolated strains of CPS, the drug resistance rate of community infected strains and hospital infected strains toward oxacillin was respectively 9.67% (6/62) and 35.06% (54/154), with a significant difference (P < 0.05). For the clinical isolated strains of CNS, the drug resistance rate of community infected strains and hospital infected strains toward oxacillin was respectively 69.57% (16/23) and 89.11% (229/257), also with a significant difference (P < 0.05). Conclusions The drug resistance of hospital infected staphylococcal strains is stronger than community infected strains. The CNS strains are more drug-resistant than CPS strains.
Objective To explore the expression differences of procalcitonin (PCT) in different infection sites and bacterial strains, and to provide the evidence for early differential diagnosis of infectious diseases with PCT as a biomarker. Methods The patients with various kinds of infections diagnosed in West China Hospital of Sichuan University between January 2012 and June 2016 were retrospectively included. The expression differences of PCT in various infection sites and bacterial strains were analyzed. Results A total of 1 005 patients were include in this study, including 259 with systemic infection and 746 with local infection. The median PCT level in the systemic infection group was higher than that in the local infection group (8.57 vs. 0.10 ng/mL, P<0.05). In the 779 patients with pulmonary infection, the median PCT level of the patients with sepsis caused by pulmonary infection was higher than that of the ones without sepsis (4.61vs. 0.10 ng/mL, P<0.05), and the median PCT level of the patients with positive sputum culture was higher than that of the ones with negative sputum culture (0.28vs. 0.08 ng/mL, P<0.05). In the 48 patients with urinary tract infection, the median PCT level of the patients with sepsis caused by urinary tract infection was higher than that of the ones without sepsis (12.00vs. 0.42 ng/mL, P<0.05), and the median PCT level of the patients with complicated urinary tract infection was higher than that of the patients with simplex urinary tract infection (19.15vs. 5.02 ng/mL, P<0.05). In the 259 patients with systemic infection, the median PCT level of the patients with infective shock was higher than that of the ones without infective shock (40.26vs. 3.83 ng/mL, P<0.05); the mean PCT level of patients with infection of Gram-negative bacteria, Gram-positive bacteria and fungi was 13.66, 0.99, and 3.30 ng/mL with a significant difference (P<0.05). Conclusion The PCT level has unique advantages in identifying different sites of the infection, early diagnosing complicated urinary tract infection, and evaluating the severity of infection, which could provide evidence in early identification for sepsis caused by various kinds of infectious pathogens.
Objective To review the experience of the surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery (ALCAPA). Methods A retrospective, single institution review was conducted on thirty-six adult patients with ALCAPA surgical treatment from November 1991 to November 2017 in Fuwai Hospital. Of these patients, nine were males and twenty-seven were females. The mean age was 36.6±13.3 years. The mean weight was 60.0±9.4 kg. The preoperative echocardiography showed the mean left ventricular ejection fraction (LVEF) was 57%±6% and the mean left ventricular end-diastolic dimension (LVEDD) was 52.3±6.3 mm. Severe mitral regurgitation (MR) was seen in one patient, moderate in five patients. The operative procedures included coronary artery re-implantation in seventeen patients, Takeuchi operation in sixteen patients, ligation of left coronary artery plus coronary artery bypass graft in three patients. In addition, six patients underwent mitral valve repair. Results There was no in-hospital mortality. The mean cardiopulmonary bypass time was 152.5±72.9 min and aortic cross clamp time was 101.9±43.6 min, respectively. The mean mechanical ventilation time and ICU time was 17.3±16.3 h and 43.1±30.7 h, respectively. The mean postoperative LVEF was 59%±6%, which did not significantly improve compared with preoperative LVEF. However, the mean postoperative LVEDD of 46.9±5.9 mm had significant reduction compared with the preoperative LVEDD. Of the six patients with mitral valve repair, one was mild and the other five were trivial. Thirty-five patients (97.2%) completed the follow-up with a mean time of 5.5 years. All the patients survived with New York Heart Association class Ⅰor Ⅱ. Two patients needed interventional occlusion or re-operation due to the fistula of internal tunnel within the pulmonary artery. At the latest echocardiography, the mean LVEF of 69%±7% improved significantly compared with the preoperative LVEF. Mild MR was detected in ten patients, moderate in two patients during the follow-up period. Conclusion The surgical treatment of adult patients with ALCAPA has satisfactory short- and long-term results. The patients who underwent Takeuchi procedure may need re-operation due to fistula of internal tunnel within the pulmonary artery during the long-term follow-up.
ObjectiveTo describe the current situation of the prevalence of hepatic hydatidosis, analyze the clinical characteristics and treatment method of the disease, in order to provide scientific basis for personal treatment plans of hepatic hydatidosis. MethodThe clinical data of 121 patients with recurrent hepatic hydatidosis treated between July 2006 and December 2013 were analyzed retrospectively. The general information of hydatid disease of liver, mass of liver, clinical manifestations, laboratory test results, treatment method, effectiveness of the treatment during hospitalization, and follow-up results were collected and analyzed. ResultsMost of the patients were adults from Sichuan and Tibet, and the majority of them had no clear occupation or clear animal contact history and had not taken raw or fresh meat. Lesions in the right lobe occurred in 87 cases, accounting for 71.90%. Abdominal pain and distension were the main clinical manifestations. Twenty-five (20.66%) of these patients were associated with hepatic dysfunction, among whom 23 patients had mild hepatic dysfunction. Alpha-fetoprotein level was increased in one (0.83%) of these cases. A total of 119 of the 121 patients received surgical treatment (98.35%) and all the surgeries were successful. Follow-up results revealed that three of the patients had recurrence. ConclusionsHepatic hydatidosis is an epidemic mainly in the Tibetan district of the West of China. The disease mainly occurs in the right lobe of the liver, which mainly causes mile liver damage. Hepatocellular carcinoma has not been found in these cases. Surgery treatment is the main therapy for liver hydatidosis and may result in good effectiveness.
Zhaojue is a deeply impoverished county located in Liangshan Autonomous Prefecture with high prevalence of human immunodeficiency virus infection. Based on local conditions, West China Hospital of Sichuan University has established a targeted supporting mode called “three-level organization and five-in-one”. This mode integrates administrative support teams, multiple disciplinary technical support teams and on-site expert teams to achieve five goals, including building effective teams, promoting clinical practice, enhancing skill training, focusing on academics and building a systematic platform. This model has improved the ability of treatment on human immunodeficiency virus infection and overall health services in Zhaojue County. It also reflects the responsibility of West China Hospital of Sichuan University in poverty alleviation and public welfare.