OBJECTIVE To explore the risk factors for carbapenem-resistant Klebsiella pneumoniae（CRKP） bloodstream infection so as to provide scientific basis for clinical diagnosis and treatment and improve prognosis. METHODS A total of 86 patients with CRKP bloodstream infection who were treated in the hospital from Mar 2019 to Feb 2022 were assigned as the CRKP group, meanwhile, 180 patients who had carbapenem-sensitive K. pneumoniae（CSKP） bloodstream infection were chosen as the CSKP group. The clinical data were collected from the two groups of patients, univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the CRKP bloodstream infection. RESULTS There were significant differences in the drug resistance rates to the commonly used antibiotics except for nitrofurantoin between the CRKP strains and the CSKP strains（P＜0.05）, the drug resistance rates to cefoperazone-sulbactam, ampicillin, cefazolin and piperacillin-tazobactam were relatively high. The 28-day mortality rate of the CSKP group was remarkably higher than that of the CRKP group（P＜0.05）. The result of univariate analysis showed that the risk factors for the CRKP bloodstream infection included hypoproteinemia, use of antibiotics, use of hormones, central venous catheter indwelling, invasive instrument indwelling, ICU stay and use of no less than 3 types of antibiotics（all P＜0.05）. Multivariate logistic regression analysis indicated that the central venous catheter indwelling, use of no less than 3 types of antibiotics and use of carbapenems were the independent risk factors for the CRKP bloodstream infection（all P＜0.05）. CONCLUSION The central venous catheter indwelling, use of no less than 3 types of antibiotics, use of carbapenems, ICU stay and hypoproteinemia are the risk factors for the CRKP bloodstream infection.

Objective:To explore the effect of microdynamic negative pressure technique on diabetic foot ulcer patients and its effect on wound healing and reducing bacterial infection.Methods:A total of 98 patients with diabetic foot ulcer from November 2020 to November 2022 in Wound Center of Yellow River Central Hospital were selected and grouped according to random number table method.Both groups were treated with antibiotics, 49 cases in the control group were treated with foam plastic dressing, and 49 cases in the observation group were treated with microdynamic negative pressure technology intervention.Two weeks later, the healing situation of ulcer surface in the two groups including wound healing rate, complete healing time of ulcer, dressing change times, and 1-month follow-up ulcer recurrence rate was compared.The effusion indexes of ulcer surface including vascular endothelial growth factor (VEGF), matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase tissue inhibitor-1 (TIMP-1) were further compared.Positive bacterial culture of wound surface and incidence of adverse reactions between two groups were also compared.Results:After 1 month of follow-up, the wound healing rate, ulcer recurrence rate and incidence of adverse reactions were not statistically significant between the two groups ( P>0.05).After intervention, the ulcer complete healing time, dressing change times, bacterial culture positive rate and MMP-2 level in the observation group were significantly lower than those in the control group, while the VEGF and TIMP-1 levels in the observation group were significantly higher than those in the control group ( P<0.05). Conclusion:Compared with foam plastic dressings, microdynamic negative pressure technique can effectively regulate the level of growth factor in effusion, reduce the positive rate of bacteria, and promote rapid wound healing with high safety in patients with diabetic foot ulcer.

化疗性静脉炎主要是由于化疗药物对血管的刺激而引起的管壁化学性炎症,表现为组织红肿、疼痛,血管变硬、阻塞坏死.目前为了有效地控制肿瘤,采用反复多次的静脉化疗已成为临床抗肿瘤的常规治疗方法.

对我院2001/2006年收治的支原体肺炎误诊46例分析如下. 1 临床资料 1.1 一般资料本组男26例,女20例,年龄3～6月龄6例,～1岁8例,～3岁11例,～6岁15例,～14岁6例.均查血支原体抗体IgM阳性和胸片而确诊. 1.2主要临床表现发热25例,咳嗽44例,气急12例,喘憋16例,胸痛2例,皮疹、抽搐各1例,肺部干湿啰音30例,无阳性体征16例,胸腔积液3例.

咳嗽变异性哮喘(CVA)是引起小儿慢性咳嗽的常见病之一,因其统一症状是慢性咳嗽,极易误诊,现将32例误诊病例分析如下.

随着人们物质和精神文明程度的不断提高,法律意识和自我保护意识的不断增强,以及对医疗护理服务需求层次的不断提高,使医疗护理纠纷在近几年呈明显的上升趋势,这种现象在急诊科尤为突出.急诊科是医院门诊的一个重要窗口,由于其工作性质和病人疾病突出急、危、抢救等的特殊性,也是医院医疗、护理纠纷最多发的部门.那么,如何防范和杜绝在急诊、急救过程中引发护理纠纷是每一位急诊护理管理者和工作者应该认真思考和面对的问题.通过对急诊护理纠纷多发原因的分析和探讨,并针对性地提出了相应的防范措施,旨在引起广大急诊护理工作者的关注和认可,提高急诊护理质量.