BackgroundThe aim of this study was to investigate the prevalence and risk factors of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae related urinary tract infections (UTI) in adult cancer patients.MethodsWe conducted a retrospective study of three cancer hospitals centered on Cancer Hospital of Chinese Academy of Medical Sciences from 2015 to 2019. The clinical characters, risk factors and antimicrobial susceptibility of ESBL-producing Enterobacteriaceae UTI in adult cancer patients were described and analyzed.ResultsA total of 4967 specimens of UTI were evaluated, of which 909 were positive. After excluding multiple infection bacteria, non-conforming strains, inconsistent pathological information, no drug sensitivity test or medical records, 358 episodes remained. Among them, 160 episodes belonged to ESBL-producing Enterobacteriaceae, while 198 were classified into non-ESBL group. The prevalence of ESBL UTI circled around 39.73 to 53.03% for 5 years. Subgroup analysis by tumor type revealed that 62.5% of isolates from patients with urological tumors were ESBL positive. Multivariate analysis showed that tumor metastasis (OR 3.41, 95%CI 1.84-6.30), urological cancer (OR 2.96, 95%CI 1.34-6.53), indwelling catheter (OR 2.08, 95%CI 1.22-3.55) and surgery or invasive manipulation (OR 1.98, 95%CI 1.13-3.50) were the independent risk factors. According to antimicrobial sensitivity, meropenem, imipenem and piperacillin/tazobactam were the most commonly used antibiotics for ESBL-producing Enterobacteriaceae UTI.ConclusionsIn view of the high prevalence, clinicians should be alert to the occurrence of ESBL UTI, especially for patients with urological cancer or metastatic tumors. Regular replacement of urinary catheters, reduction of unnecessary invasive operations and selection of appropriate antibiotics are the necessary conditions to deal with the occurrence of ESBL UTI in adult cancer patients.

临床微生物学是一门紧密联系临床的应用性学科,临床微生物学检验医师应具备扎实的理论知识 、熟练的操作技能 、良好的沟通能力及临床病例分析能力.该基地以实验室建设为依托,以住院医师规范化培训细则为指导,应用多样化的教学方法,实施递进式 、螺旋式考核模式,逐步建立起具有基地特色的临床微生物学教学模式,为培养高素质临床微生物学检验医师提供了教学支撑作用.

目的 探讨人异常凝血酶原即维生素K缺乏或拮抗剂II诱导的蛋白(PIVKA-II)在监测结直肠癌肝转移中的应用价值.方法 采集治疗前结直肠癌患者120例(结直肠癌无器官转移组80例和结直肠癌肝转移组40例)、早期肝癌患者(早期肝癌组)80例和查体健康人群(健康组)80例血清样本,检测其PIVKA-II和癌胚抗原(CEA)浓度,确定PIVKA-II监测结直肠癌肝转移的临界值,分析PIVKA-II和CEA对监测结直肠癌肝转移的诊断效能.结果 健康组、结直肠癌无器官转移组、结直肠癌肝转移组和早期肝癌组的血清PIVKA-II浓度依次呈增高趋势,分别为18(15～20.8)mAU/mL、20(17～24)mAU/mL、32(22.3～41.8)mAU/mL和345(31.8～3787)mAU/mL,结直肠癌肝转移组显著高于健康组(P<0.001)和结直肠癌无器官转移组(P<0.001),低于早期肝癌组(P<0.001).血清PIVKA-II检测结直肠癌肝转移的曲线下面积(AUC)为0.818(95％CI:0.736～0.901),与CEA的AUC差异无统计学意义[0.799(95％CI:0.710～0.888),Z=0.332,P=0.74].PIVKA-II检测结直肠癌肝转移的最佳临界值为28.5 mAU/mL,此时灵敏度为60％,特异度为90％.联合PIVKA-II和CEA,结直肠癌患者肝转移的检测灵敏度提高到85％.结论 血清PIVKA-II可用于结直肠癌肝转移的监测.

目的 探讨实体瘤患者发生血流感染(BSI)的病原学特点及导致患者死亡的影响因素,为合理使用抗菌药物提供临床依据.方法 选择2012年1月-2014年12月医院220例实体瘤并发BSI的患者为研究对象,分析患者病原学特点,统计患者的年龄、性别、住院天数、基础疾病等基本信息,采用单因素变量和多因素Logistic回归方法评估影响14-d病死率及住院病死率的影响因素.结果 220例患者共检出病原菌234株,其中革兰阴性菌102株占43.6％,革兰阳性菌100株占42.7％,真菌9株占3.9％,复数菌23株占9.8％;革兰阴性菌住院病死率高于革兰阳性球菌及真菌(P=0.014);多因素Logistic分析结果显示,实体瘤患者发生BSI 14-d病死率与GCS≤8分及血小板≤50 g/L有关,住院病死率与脓毒性休克、Child-C级、GCS≤8分有关(P＜0.05).结论 实体瘤患者BSI的病死率较高,早期识别、有效地逆转器官功能衰竭是降低实体瘤患者BSI病死率有效的方法.

DJ-1 is a novel oncogene that can transform NIH3T3 cells in cooperation with the activated ras gene. DJ-1 appears to have its greatest effect on tumourigenesis, and it may have a greater impact on early-stage lung cancers. In this study, we proposed to investigate the clinical value of DJ-1 protein in the early diagnosis of lung cancer and compared its diagnostic value with other biomarkers. Preoperative serum DJ-1 levels were measured in 300 lung cancer patients and compared with benign pulmonary disease (n = 44) and healthy volunteers (n = 64). Using tissue microarrays and immunohistochemical analyses, we compared the DJ-1 expression between the primary squamous cell carcinoma tumours and matched metastatic tissues from a lymph node. The baseline preoperative serum DJ-1 of lung cancer patients was significantly higher than that of benign diseases and healthy controls (p < 0.001). In the early-stage subgroup, the median DJ-1 concentration (ng/mL) was significantly higher than that of the advanced stage (12.90 vs 7.75, p < 0.05). Using immunohistochemistry, we observed that the DJ-1 staining intensity was generally weaker and less common in the metastatic tissues compared with that in the primary tumour (McNemar–Bowker Test, p = 0.008). DJ-1 was highly expressed in the early stage of lung cancer, and its expression was significantly decreased after metastasis. Therefore, DJ-1 may be a potential biomarker for the early diagnosis and monitoring of lung cancer metastasis.

OBJECTIVE To explore the characteristics of bloodstream infections in patients with malignant tumors and analyze the risk factors so as to provide guidance for reasonable prevention and treatment of the bloodstream infections .METHODS A total of 150 malignant tumor patients who were positive for blood culture from Mar 2013 to Mar 2015 were recruited as the study objects ,then the univariate analysis and multivariate logistic regression a-nalysis were carried out ,and the statistical analysis of data was performed with the use of SPSS 16 .0 software . RESULTS Of 150 patients whose blood specimens were cultured positive for pathogens ,83 (52 .2% ) were positive for gram-negative bacteria ,55 (42 .8% ) were positive for gram-positive bacteria ,and 8 (5 .0% ) were positive for fungi.The Escherichiacoli,Staphylococcus epidermidis,and Klebsiella pneumoniae were the common species of pathogens .The univariate analysis indicated that the risk factors for the bloodstream infections included the neu-tropenia ,mechanical ventilation ,central venous catheter indwelling ,Charlson complication index ,and time of use of antibiotics no less than 7 days (P<0 .05);the multivariate logistic analysis showed that the intravenous cathe-ter indwelling and time of use of antibiotics no less than 7 days were the independent risk factors for the blood-stream infections .CONCLUSION It is an effective way to reduce the invasive operations and strictly control the time of use of antibiotics so as to reduce the incidence of the bloodstream infections .

OBJECTIVE:To evaluate the value of urine sediment analyzer in the screening of clinically suspected urinary tract infection (UTI) in cancer patients.METHODS:The results of bacterial count of 1 053 midstream urine samples by UF-1000i urine sediment analyzer (UF-1000i urine sediment analyzer, UF-1000i) were compared with the results of bacterial culture. Moreover, the results of distinguishing bacterial species by the bacterial scattergram were compared with the results of bacteria culture. At the same time, the sensitivity, specificity, positive predictive value and negative predictive value of UF-1000i analyzer for UTI screening were evaluated.RESULTS:Of all the 1 053 samples, the top three bacteria were E. coli, Enterococci and P. aeruginosa. The top three malignant tumors of UTI were bladder, lung cancer and cervical cancers. The positive rate of UF-1000i analyzer was 20% (211/1 053), and that of bacteria culture was 17.9% (188/1 053). There was statistically no significant difference in the positive rates between the two methods (χ(2)=1.636, P>0.05), and the two methods had a considerable consistency (Kappa=0.756). Compared with the clinical diagnosis, UTI screening by UF-1000i analyzer showed a sensitivity of 79.6% (160/201), specificity of 95.5% (814/852), positive predictive value of 80.8% (160/198) and negative predictive value of 95.2%(814/855). The distribution of cocci and bacilli acquired by the bacterial scattergram was basically in accordance with the results of bacterial culture.CONCLUSIONS:Bacterial count by UF-1000i analyzer plays an important role in early screening of UTI, and the bacterial scattergram may help to distinguish bacterial species, providing reference for the use of antibiotics in early medication.

Objective To explore the clinical significance of cytokeratin 18(CK18)in evaluating the chemotherapy effect on gastric cancer.Methods Ninety-six patients were divided into metastasis group(n=13)and non-metastasis group(n=83)after chemotherapy.The serum carcinoembryonic antigen(CEA),carbohydrate antigen(CA)19-9,CA72-4and CK18were detected before and after chemotherapy.The levels of tumor markers were compared between two groups,and the consistency of CK18effect and objective effect was analyzed.Results The levels of CEA,CA72-4and CK18and their positive rates were all significantly lower after chemotherapy in non-metastasis group(P0.05),and the levels of CEA, CA19-9,CA72-4and CK18and their positive rates showed no significant differences before and after chemotherapy in metastasis group(P0.05).There were significant differences in the levels of CEA,CA19-9and CK18between two groups before and after chemotherapy(P0.05).In 35patients with CK18level higher than the cut-off value,the coincidence rate of CK18effect and objective effect was 71.43%,with a higher consistency(Kappa=0.559). Conclusions The serum CK18level before and after chemotherapy can be the referent index for evaluating the chemotherapy effect on gastric cancer.

OBJECTIVE To study the clinical characteristics and related risk factors of blood stream infections (BSIs)in patients with malignant tumors and to provide clinical basis for the prevention and treatment of BSIs , thus to reduce the mortality in BSIs . METHODS This retrospective cohort study was conducted among 123 patients with BSIs in our hospital from Mar .2012 to Mar .2014 .RESULTS Of the 123 patients ,31 patients died , and in‐hospital mortality for 90‐day was 25 .2% .Totally 127 strains of pathogenic bacteria were detected .Among them gram‐negative bacteria was in the majority (68 strains ) , accounting for 53 .7% . Single‐factor analysis showed that BSIs were highly related to respiratory failure ,renal failure ,the type of admissions ,high Pitt bacte‐remia scores ,the need for vasopressors and so on .The difference was significant (P<0 .05) .Multi‐logistic anal‐ysis revealed that four clinical factors had a significant association with mortality including the need for vasopres‐sors ,high Pitt bacteremia scores ,the type of admissions and the presence of respiratory failure .CONCLUSION Mortality of BSIs remains high ,the need for vasopressors ,high Pitt bacteremia scores ,the type of admissions and the presence of respiratory failure are associated with incidence of mortality among patients with BSIs .

OBJECTIVE:The aim of this study was to investigate the prevalence of Clostridium difficile (C. difficile) infection and the risk factors for acquisition of C. difficile-associated diarrhea (CDAD) among cancer patients who received chemotherapy or radiation therapy.METHODS:We analyzed 277 stool samples from cancer patients with diarrhea between Sep 2010 and Dec 2011 in our hospital. Stool C. difficile toxin A/B test, stool culture for C. difficile and routine stool examination were performed. In addition, the risk factors for CDAD were investigated in a set of 41 C. difficile toxin-positive cancer patients and 82 matched C. difficile toxin-negative controls by univariate analysis and multivariate analysis.RESULTS:Out of a total of 277 cancer patients with diarrhea, 41 (14.8%) were C. difficile toxin-positive. Among these 41 cases, 11 (26.8%, 11/41) were C. difficile culture-positive. Univariate analysis showed that antibiotics use (P = 0.853), proton pump inhibitor use (P = 0.718), hypoproteinemia (P = 0.139) and white blood cell count (P = 0.454) did not appear to be associated with acquisition of CDAD in cancer patients. However, receiving chemotherapy (P = 0.023), receiving radiotherapy (P = 0.003), a positive fecal occult blood test result (P = 0.005) and the presence of fecal leukocytes (P = 0.007) showed close association with acquisition of CDAD in cancer patients. Multivariate analysis showed that receiving chemotherapy (OR, 8.308; 95% CI, 1.997-34.572; P = 0.004) and a positive result of fecal occult blood test (OR, 8.475; 95% CI, 1.463-49.109; P = 0.017) were independent risk factors for acquisition of CDAD among cancer patients.CONCLUSIONS:Our results support that receiving chemotherapy and a positive fecal occult blood test result are independent risk factors for acquisition of CDAD among cancer patients. Cancer patients who are at high-risk for CDAD should take stool C. difficile toxin A/B test and stool culture for C. difficile regularly and prevention of CDAD.

Objective To investigate the molecular epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus(MRSA) strains collected from seven teaching hospitals in China in 2007.Methods Multilocus sequence typing(MLST) and Staphylococcus protein A gene(spa) typing were used to type the 114 strains of MRSA.The lukS gene encoding Panton–Valentine leukocidin(PVL) was detected.Antibiotic susceptibility testing was performed by agar dilution method.Results Among the 114 strains,eight MLST-spa molecular types were identified,of which ST239-t030,ST239-t037 and ST5-t002 were the most predominant types,accounting for 41.2%,28.8% and 21.9%,respectively.Only one MRSA strain was lukS positive.Vancomycin and tigecycline were most active against all the MRSA strains tested(100%),followed by trimethoprim-sulfamethoxazole(86.8%).The major molecular types,ST239-t030,ST239-t037 and ST5-t002,were found with similar susceptibility patterns.However,all strains resistant to trimethoprim-sulfamethoxazole were identified as ST239-t037.Conclusions The prevalence of MRSA in China is predominated by several major molecular clones,which is consistent with the situation in surrounding countries or regions.

Objective To explore the expression of serum S100BB protein in brain metastases from lung cancer.Methods The levels of serum S100BB protein were measured in 43 brain metastases from lung cancer patients(tumor less than 1 cm:12 cases,1-2 cm:9 cases,greater than 2 cm:17 cases and unknown size:5 cases),44 lung cancer patients and 45 pneumonia patients as well as control subjects using enzyme-linked immunosorbent assay.The association of serum S100BB protein with brain metastases from lung cancer patients was analyzed.Results The median value of semm S100BB protein,which was higher in the lung cancer patients with brain metastases[42.8(38.56-121.70)ng/L]than that in lung cancer patients[34.09(27.38-43.89)ng/L],in pneumonia patients[31.11(26.79-37.15)ng/L]and in control subjects[30.97(7.27-35.84)ng/L,U=422.5,325.5 and 237.5,respectively,P<0.01].The area under the ROC curve AUC was 0.828.When cutoff value of the serum S100BB protein was 37.15 ng/L.the diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy rate were83.7%(36/43),74.4%(99/133),51.4%(36/70),93.4%(99/106),76.7%(135/176).The positive rates of S100BB were 83.7%(36/43),36.4%(16/44),24.4%(11/45)and 15.9%(7/44)in the four groups respectively,which was higher in lung Cancer patients with brain metastases than lung cancer patients and pneumonia patients as well as control subjects(X~2= 50.705,P<0.01).The levels of serum S100BB protein were stratified according to their sizes of the brain metastases from Lung Cancer.The levels of serum S100BB protein were[47.87(39.63-131.68)ng/L,45.28(40.02-126.7)ng/L,38.79(34.86-58.23)ng/L in lung cancer patents with metastatic tumor less than 1 cm,1-2 cm and greater than 2 cm,respectively.There was no significant difference(U=50.5,65.0 and 56.0,respectively,P>0.05).Conclusions The serum S100BB protein is valuable in auxiliary diagnosis of brain metastases in Lung cancer patients.However,the size of brain metastases is not associated with the levels of serum S100BB protein.

To study the influence of high lipid on the detection of tissue polypeptide specific antigen(TPS) in patients with high serum lipid level,The serum TPS was detected by ELISA and serum TG、CHOL、HDL and LDL was detected by HITACHI 7600 automatic biochemical analyzer.The results showed that the level of TPS of high lipid group was significantly higher than those in normal group(P0.01).The level of TPS of high-TG group patients has the highest positive rate(72.46%);The high-TG with normal CHOL and high-TG with normal LDL patients have the highest positive rates that was 78.79% and 78.41% separately.The levels of TPS increased significantly with the increase of TG levels.High lipid levels have influence on the detection of TPS level,especially when the patients with a high TG level.