社区肺炎抗感染治疗、VAP预防效果及军团菌基因组临床与实验研究

发布时间：2018-05-11 12:15

本文选题：抗菌药物 + 社区获得性肺炎　；参考：《复旦大学》2013年硕士论文

【摘要】：目的比较住院前后72小时内经验性抗感染治疗是否覆盖非典型病原体,对于患者住院期间的临床疗效及经济学指标的影响。方法本研究为基于人群的、多中心、回顾性队列设计。纳入江浙沪地区4家三级医院、6家二级医院,在2010年6月1日至2011年5月31日期间符合研究设计标准的住院CAP患者。收集人口学资料、基础疾病、临床体检、实验室检查、治疗和预后等相关信息。采用统计分析比较治疗组和对照组之间临床疗效及经济学指标的差异。结果共纳入住院CAP患者827例。入院前后72小时内抗感染治疗中覆盖非典型病原体(AP覆盖组)的全因病死率为0.9%(95%CI,0.1-1.7%)显著低于对照组(抗感染治疗中覆盖非典型病原体)的4.9%(95%CI,2.6-8.2%),纠正倚偏后的相对危险度(RR)为0.18(95%CI,0.06-0.50)。主要经济学指标：AP覆盖组的住院天数(length of stay, LOS)为10.1(95%CI,9.79-10.50)天,对照组的LOS为11.6(95%CI,11.00-12.25)天,p0.01。总的住院费用在AP覆盖组为7306.0(95%CI,6905.9-7706.2)元,显著低于对照组的9411.8(95%CI,8613.9-10209.6)元,p0.01。直接抗菌药物费用,AP覆盖组为2653.1(95%CI,2477.6-2828.7)元,低于对照组的费用3133.0(95%CI,2860.8-3405.2)元,p0.01。药物使用强度(DDD)在AP覆盖组为19.2(95%CI,18.3-20.2),同对照组的18.3(95%CI,17.0-19.6),p=0.28。结论抗感染治疗方案早期经验性覆盖非典型病原体有利于降低CAP患者的全因病死率，减少住院时间，降低总住院费用和抗菌药物直接费用。目的评价组合干预措施对上海市176个ICU呼吸机相关肺炎(VAP)发病率的影响。方法本研究为前-后对照研究,起止时间为2007年1月至2012年6月,分为3个阶段：基线调查、过渡期和干预期。主要VAP组合干预措施包括为加强手卫生、半卧位,采用消毒剂进行口腔护理以及对医护人员的宣教和督查。由医院感染控制专职人员收集ICU出入院人数、患者基本信息、住院天数、接受机械通气天数和VAP发病情况等资料。比较干预前、后VAP发病率,评价组合干预措施效果。结果共收集患者资料463,208例名患者资料,总计监测ICU床日数为2,535,917天,累计总机械通气日数(ventilator days, VDs)为695,185天。基线调查阶段,VAP发病率为每千VDs23.4例。实施组合干预后,VAP发病率明显开始下降,2009-2012年VAP平均发病率为每千VDs14.3例(2009-2012vs2007,RR=0.61(95%CI,0.59-0.64),RD=9.1(95%CI,8.3-9.9)。结论在ICU中施行VAP组合千预措施,可显著降低患者VAP发病率。目的通过分析嗜肺军团菌环境分离株和临床分离株在基因组水平上的差异,探索其对人类致病性的影响。方法对分离于医院环境中的嗜肺军团菌(LPE509)采用高通量Illumina技术denovo测序。。通过对测序结果进行拼接、组装后获得完整的基因组数据。采用生物信息学分析方法预测基因和可能编码的蛋白。利用OrthoMCL和Vaxign系统将LPE509基因组同已经公布序列的L.pneumophila(strains130b,570-CO-H,Alcoy, Corby, Lens, Paris, Philadelphia1)比较基因组水平的差异。结果基因组数据已经保存于GenBank,检索号为CP003885、CP003886。LPE509同其它7株已经测序的Lpneumophila存在一定相似性。LPE509基因组中发现了编码分泌系统的基因,其中包括type I secretion system(T1SS)、T2SS以及Dot/IcinT4BSS。在所有已完成测序的L.pneumophila菌株中Dot/Icm T4SSB相对保守,LPE509基因组中发现了同致病性高度相关的T4BSS的重要组分Lvh基因。7.3kbp的质粒为LPE509所特有,其中发现了可能编码多重耐药的基因。通过于其它7株序列(130b,570-CO-H, Alcoy, Corby, Lens, Paris, Philadelphia1)序列比对,LPE509编码的580,235,512,522,669,443,562为首次发现的蛋白。结论不同种属L.pneumophila基因组水平存在高度异质性,而编码分泌系统的基因,T1SS、T2SS以及Dot/Icm T4BSS目对保守。
[Abstract]:Objective to compare the effects of empirical anti infection treatment on atypical pathogens within 72 hours before and after hospitalization and on the clinical efficacy and economic indicators of patients during hospitalization.
Methods the study was based on population, multi center and retrospective cohort design. It was included in 4 three level hospitals in Jiangsu, Zhejiang and Shanghai, 6 class two hospitals, which met the research design criteria for CAP patients during the period from June 1, 2010 to May 31, 2011. The related letters, basic diseases, clinical physical examination, laboratory examination, treatment and prognosis were collected. Statistical analysis was used to compare the differences in clinical and economic indicators between the treatment group and the control group. The results were included in 827 hospitalized CAP patients. The total cause fatality rate of 0.9% (95%CI, 0.1-1.7%) covering the atypical pathogens (AP coverage group) in the anti infection treatment was significantly lower than that of the control group (anti infection treatment coverage) within 72 hours before and after admission. 4.9% (95%CI, 2.6-8.2%) of the atypical pathogen (95%CI, 0.06-0.50) after correction (95%CI, 0.06-0.50). The main economic indicators: the number of hospital days in the AP coverage group (length of stay, LOS) was 10.1 (95%CI, 9.79-10.50) days, and the control group was 11.6 (9), and the total hospitalization expenses were 7306 (9) 5%CI, 6905.9-7706.2) yuan, significantly lower than the control group of 9411.8 (95%CI, 8613.9-10209.6), p0.01. direct antibacterial drug costs, AP coverage group of 2653.1 (95%CI, 2477.6-2828.7), lower than the control group costs 3133 (95%CI, 2860.8-3405.2), p0.01. drug use strength (DDD) in 19.2 (9), with the control group of 18.3 (9) 5%CI, 17.0-19.6), p=0.28.
Conclusion the early empirical coverage of atypical pathogens in the anti infection treatment regimen is beneficial to reducing the total cause of death in CAP patients, reducing the time of hospitalization, reducing the total hospitalization expenses and the direct cost of antibacterial drugs.
Objective to evaluate the effect of combined interventions on the incidence of 176 ICU ventilator-associated pneumonia (VAP) in Shanghai.
Methods the study was a pre and post control study. The onset and stop time was from January 2007 to June 2012. It was divided into 3 stages: baseline survey, transition period and dry expectation. The main VAP intervention measures included strengthening hand hygiene, semi lying position, using disinfectants for oral care and education and supervision of medical staff. The staff collected the number of ICU entrance and exit, the basic information of the patients, the days of hospitalization, the number of days of mechanical ventilation and the incidence of VAP, compared the incidence of VAP before and after the intervention, and evaluated the effect of the combined intervention measures.
Results a total of 463208 patient data were collected, the total number of ICU bed days was 2535917 days, the total total mechanical ventilation day (ventilator days, VDs) was 695185 days. The incidence of VAP was per 1000 VDs23.4 cases at the baseline survey stage. The incidence of VAP incidence began to decline, and the average incidence of VAP in 2009-2012 years was per thousand. VDs14.3 cases (2009-2012vs2007, RR=0.61 (95%CI, 0.59-0.64), RD=9.1 (95%CI, 8.3-9.9).
Conclusion VAP combined with 1000 preconditioning in ICU can significantly reduce the incidence of VAP in patients.
Objective to explore the effect of Legionella pneumophila on the pathogenicity of human beings by analyzing the differences in genomic level between Legionella pneumophila isolates and clinical isolates.
Methods the Legionella pneumophila (LPE509) isolated from the hospital environment was sequenced with high throughput Illumina technology, denovo, and complete genome data were obtained by sequencing. The gene and possible encoded proteins were predicted by bioinformatics analysis. The LPE509 genome was used by OrthoMCL and Vaxign system. The differences in comparative genomic level of published sequences of L.pneumophila (strains130b, 570-CO-H, Alcoy, Corby, Lens, Paris, Philadelphia1) were compared.
Results genomic data had been stored in GenBank, the search number was CP003885, CP003886.LPE509 and other 7 other sequenced Lpneumophila had a certain similarity in the.LPE509 genome and found the genes encoding the secretory system, including type I secretion system (T1SS), T2SS, and Dot/IcinT4BSS. in all completed sequencing. The Dot/Icm T4SSB in the hila strain is relatively conservative. The plasmid of the important component of the T4BSS that is highly related to the pathogenicity of the Lvh gene.7.3kbp is unique to LPE509, and the genes that may be coded for multidrug resistance are found. The sequence ratio of the other 7 sequences (130b, 570-CO-H, Alcoy, Corby, Corby) Yes, LPE509 encoded 580235512522669443562 is the first protein found.
Conclusion the L.pneumophila genomes of different species are highly heterogeneous, while genes encoding the secretory system, T1SS, T2SS and Dot/Icm T4BSS are conservative.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.1

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