mNGS技术在儿童重症肺炎病原学诊断中的价值

目的探讨宏基因组二代测序(mNGS)技术在儿童重症肺炎病原学诊断中的价值。方法选取2017年12月至2020年6月武汉儿童医院收治住院治疗的219例社区获得性重症肺炎患儿临床资料,比较肺泡灌洗液mNGS检测与传统实验室病原检测对诊断儿童重症肺炎的诊断价值。结果 219例送检标本中mNGS共检出阳性病例190例(86.76%);而传统实验室病原共检出阳性病例173例(78.99%),两种检测方法比较,差异有统计学意义(P<0.05)。mNGS和传统实验室病原病原总检出率在各年龄段之间比较,差异有统计学意义(Χ²=76.488 7,P<0.05)。mNGS与传统实验室病原学检测均阳性患者163例,mNGS与传统实验室病原学检测均阴性患者22例,mNGS阳性而传统实验室病原学检测阴性患者27例,mNGS阴性而传统实验室病原学检测阳性患者7例。mNGS和传统实验室病原诊断儿童重症肺炎病原学灵敏度、特异度比较,差异有统计学意义(P<0.05)。结论二代测序技术较传统实验室病原检测可快速检测重症肺炎患儿病原学诊断,指导临床早期合理用药。     

mNGS在鹦鹉热衣原体肺炎中的应用价值

摘要:目的检测并分 析鹦鹉热衣原体肺炎患者的临床病理参数及实验室检查结果。方法收集2021年7月至2022年8月经宏基因组二代测序技术( mNGS)诊断为鹦鹉热衣原体肺炎患者17例,对其临床病理参数及实验室检查结果进行回顾性分析及总结。结果17 例鹦鹉热衣原体肺炎患者临床主要表现为发热,白细胞计数正常或升高,中性粒细胞百分比、C反应蛋白、纤维蛋白原、D-二聚体、乳酸脱氢酶B型钠尿肽等升高，淋巴细胞百分比及清蛋白降低。结论mNGS检测为鹦鹉热衣原.体肺炎的诊断及防治缩短了诊疗时间,可使患者得到及时、精准治疗。     

人工瓣膜感染性心内膜炎的护理

目的 探讨人工瓣膜感染性心内膜炎的护理方法.方法 对5例人工瓣膜感染性心内膜炎的患者使用敏感的抗生素长疗程治疗以及做好心理护理,生命体征监测,饮食护理以及并发症的护理等.结果 5例患者只有1例发生了严重的并发症转入外科治疗,其余4例均痊愈出院.结论 精心细致的护理在人工瓣膜感染性心内膜炎的治疗中起重要的作用.     

感染性心内膜炎瓣膜损害的外科治疗

目的 总结43例感染性心内膜炎瓣膜损害的外科治疗经验。方法 43例中累及主动脉瓣35例次 ,二尖瓣16例次。术前心功能Ⅱ级11例 ,Ⅲ级23例 ,Ⅳ级9例。均在体外循环下清除赘生物、感染瓣膜及组织 ,选用机械瓣行AVR26例 ,AVR +MVR8例 ,MVR8例 ,AVR +TVR1例 ,合并畸形同期矫治。其中3例紧急手术 ,28例亚急症手术。 结果 本组无手术死亡 ,术后随访率100% ,平均随访 (27.4±22.1)个月 ,心内膜炎复发率4.7 % ,晚期死亡率1.75%病人年。结论 感染性心内膜炎瓣膜损害应积极手术治疗。只要术中彻底清除感染组织 ,选用人工机械瓣膜替换 ,合理应用抗菌素 ,手术疗效令人满意     

感染性心内膜炎合并瓣膜病变的外科处理

目的探讨感染性心内膜炎合并瓣膜病变的外科处理方法。方法回顾性分析我院186例感染性心内膜炎合并瓣膜病变患者的临床资料,以发热就诊132例,心悸185例,术前血培养阳性86例。所有患者均在体外循环下进行赘生物清除及原发病手术,同期进行瓣膜病变处理,其中二尖瓣膜替换79例,二尖瓣成型16例,主动脉瓣置换45例,双瓣置换46例,三尖瓣成型90例,三尖瓣替换7例,术后根据血培养和赘生物培养结果选择敏感抗生素抗感染治疗4～6周。结果186例患者术后早期死亡10例（5．36％）,均因术后出现低心排或肾功能衰竭等并发症导致病情恶化死亡,其余均痊愈出院,术后主要并发症有低心排综合征15例,急性肾功能不全14例,肝功能损伤6例,上消化道出血5例,术后广泛出血延迟关胸1例。结论早发现、早诊断、早治疗,并掌握好手术时机和术后原则,感染性心内膜炎治疗可取得良好的效果。     

感染性心内膜炎患者瓣膜置换的观察与护理

感染性心内膜炎是指心脏瓣膜、心内膜以及血管内膜的细菌性、真菌性、立克次体或病毒性感染。内科保守治疗效果较差,病死率高达79％～89％。我院2009年2月-2012年9月对19例感染性心内膜炎患者进行瓣膜置换术,取得较好效果,现将临床观察与护理报道如下。     

原发性感染性心内膜炎瓣膜损害的外科治疗

目的 :总结原发性感染性心内膜炎 (PIE)致瓣膜损害的外科治疗经验。方法 :本组 2 7例 ,主动脉瓣置换术 17例 ,二尖瓣置换术 8例 ,双瓣置换术 2例 ;同期行肺动脉瓣及三尖瓣病灶清除术 1例 ;所用人工瓣膜均为机械瓣。结果 :术后早期死亡 3例 (病死率 11.1% ) ;随访 15例 (随访率 6 2 .5 % )、随诊时间 3～ 79个月 (平均 37.2个月 ) ,1例术后超声心动图证实存在二尖瓣瓣周漏 ,其余病例情况良好。结论 :PIE致瓣膜损害时应积极手术治疗 ;进行性充血性心力衰竭和感染不能控制时 ,具有急诊手术治疗的指征     

19例感染性心内膜炎患者瓣膜置换的临床观察和护理

总结了19例感染性心内膜炎患者瓣膜置换的临床观察和护理。主要包括术前心理护理,发热护理和栓塞护理,术后加强呼吸道护理和心功能监测。由于患者病情危重,手术前后针对性做好以上护理措施是保证患者顺利度过围手术期的关键。     

人工瓣膜感染性心内膜炎

人工瓣膜感染性心内膜炎（prosthetic valve endocarditis，PVE）是人工心脏瓣膜置换术后发生在人工瓣膜上或经过成形术后自体瓣膜上的一种心内微生物感染。自1963年Geraci等首次报道PVE后，立即引起心脏外科学界的广泛关注。40多年来，尽管PVE的预防、诊断和治疗水平在不断提高，但它仍是心脏瓣膜手术后1种少见而严重的并发症。     

采用mNGS技术诊断皮氏罗尔斯顿菌脑膜炎一例并文献复习

目的提高临床医师对皮氏罗尔斯顿菌脑膜炎的认识。方法对1例确诊为皮氏罗尔斯顿菌脑膜炎患者的临床资料进行分析,并以"皮氏罗尔斯顿菌""脑膜炎"或"Ralstonia pickettii""meningitis"为检索词对中国期刊全文数据库(CNKI)、万方数据知识服务平台、维普中文科技期刊数据及生物医学文献数据库(PubMed)中的文献进行检索,对相关病例的临床资料进行总结。结果该例患者因发热、头痛伴恶心、呕吐入院,通过宏基因组二代测序(mNGS)明确皮氏罗尔斯顿菌脑膜炎诊断,经美罗培南抗感染治疗有效,其后好转出院,出院后无继续服用药物,出院后3个月随访无复发。在数据库检索到3例皮氏罗尔斯顿菌脑膜炎患者,其中2例有颅内手术史、1例为早产儿,3例经积极的抗感染治疗均痊愈。结论皮氏罗尔斯顿菌作为条件致病菌引起的颅内感染临床少见,mNGS技术的应用可提高该病的确诊水平。     

Quadricuspid aortic valve infective endocarditis

Infective endocarditis complicating a quadricuspid aortic valve (QAV) is rare. Previous reports highlight the increased risk for complications, including progressive aortic regurgitation, decompensated heart failure, and valve perforation. Thus, cardiologists must be able to quickly identify QAVs to guide rapid evaluation and treatment. We report a case of infective endocarditis in a QAV identified on echocardiography and effectively managed with medical therapy alone without complications over an 8‐year follow‐up period. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46 :145–148, 2018     

先天性心脏病合并感染性心内膜炎73例病原学分析

目的探讨先天性心脏病（CHD）合并感染性心内膜炎（IE）的病原学分布及其耐药状况,为指导临床选择抗生素提供依据。方法选择沈阳军区总医院1997年1月--2009年12月收治的73例IE患者进行血培养,分析病原学种类及药敏试验结果。结果术前血培养及术中赘生物细菌培养总阳性率23．3％（17／73）。感染细菌以草绿色链球菌为主,其次为金葡菌、肠球菌和口腔链球菌。结论CHD合并IE病原菌菌种呈现多样化趋势,积极加强对IE患者的血培养检查和药敏试验极为重要。传统的经验性应用大剂量青霉素治疗的观念需要改变。     

Current diagnosis and treatment of infective endocarditis

The incidence of infective endocarditis continues to rise with a yearly incidence of around 15,000 to 20,000 new cases in the USA. As a result, rapid diagnosis, effective treatment and prompt recognition of complications are essential to desirable clinical outcomes. Recent guidelines such as the Duke criteria have incorporated echocardiography for diagnosis of infective endocarditis, making this diagnostic test mandatory for patients with suspected infective endocarditis. The diversity of pathogens that can cause infective endocarditis, some of which cannot be cultured easily, makes diagnosis even more difficult. Coagulase-negative staphylococci and viridans streptococci groups continue to be the major causative microorganisms of infective endocarditis. In the case of culture-negative endocarditis or infective endocarditis caused by fastidious microorganisms, the polymerase chain reaction and probe-based diagnostic methods are available to clinical reference laboratories.     

16S rRNA基因序列分析在感染性心内膜炎瓣膜内病原菌检测中的应用

目的探讨16S rRNA基因序列法在感染性心内膜炎(IE)患者瓣膜赘生物内致病原检测中的应用价值。方法对129例IE患者术中赘生物进行DNA提取、PCR扩增及测序分析,并与传统血培养及赘生物培养进行比较分析。结果配对卡方检验显示16S rRNA基因序列分析法检测阳性率明显高于血培养[83.53%(71/85)vs 28.24%(24/85),P0.05]和赘生物培养[77.5%(100/129)vs 18.6%(24/129),P0.05],可检出苛养菌及立克次体、巴通体、支原体等特殊病原体。结论应用16S rRNA基因序列分析法可提高IE患者瓣膜赘生物致病原的检出率。     

Seven-year survey of infective endocarditis at Keio University Hospital

To determine the recent clinical features of infective endocarditis (IE), the author evaluated data on 19 cases of 16 patients with IE who were treated at Keio University Hospital between April 1, 1987 and March 31, 1994. There were 13 men and 3 women aged 24 to 65 years (mean 43.4 years). Echocardiography revealed the presence of valve vegetation in 12 patients. Viridans streptococci were the most common pathogen, and were identified in seven cases. Two cases of native valve endocarditis (NVE) due toStreptococcus agalactiae and three cases due to group D streptococci (two of which were identified asEnterococcus faecalis) were encountered. One of two cases infected wthS. agalactiae had no underlying diseases. NVE due to viridans streptococci,S. agalactiae, and group D streptococcus was successfully treated with penicillin G or ampicillin combined with gentamicin. One case of NVE due to methicillin-resistantStaphylococcus aureus improved following treatment with a combination of cefmetazole and fosfomycin. Five patients underwent valve replacement surgery following antimicrobial therapy. One of these patients developed later endocarditis on the prosthetic valve. Three patients developed recurrent NVE. All but one of the 16 patients survived; the single death was due to a cerebral infarction. Based on these results, the author believes that currently available antibiotics are efficacious against IE.     

先天性心脏病合并感染性心内膜炎30例诊治分析

目的:探讨先天性心脏病合并感染性心内膜炎的诊断及治疗。方法:回顾性分析30例先天性心脏病合并感染性心内膜炎患者的临床特点、手术时机、手术方法及疗效。结果:本组治愈率90%,病死率10%;术前1例死于脑栓塞,术后早期死亡2例分别死于心力衰竭和脑出血;术后随访3个月~5 a,心功能恢复良好。结论:先天性心脏病不明原因发热>1周应考虑感染性心内膜炎;掌握手术时机,选择合适术式,结合围手术期抗感染治疗可提高治愈率。     

Pacemaker endocarditis in patients with prosthetic valve replacements: case trilogy and literature review

Infective endocarditis is not uncommon in patients with both a permanent pacemaker system and a prosthetic valve. No guidelines exist to aid management. The recommendations for pacemaker infective endocarditis alone are limited and contradictory. We present a case trilogy and literature review that highlights these shortcomings and the challenges facing physicians. Complete extraction of the infected pacemaker system is essential. The timing of extraction, duration of antibiotic therapy, and timing of reimplantation are all controversial. The presence of a concomitant prosthetic valve exacerbates these dilemmas further.     

A commercially available multiplex real-time PCR for detection of pathogens in cardiac valves from patients with infective endocarditis

Infective endocarditis (IE) is a life-threatening condition, burdened by high mortality. Current guidelines recommend that, in case of negative culture result, tissues from excised heart valves or vegetations from patients with suspected IE should be referred for broad-range bacterial PCR and sequencing. In this proof-of-concept study, the diagnostic utility of the commercially available multiplex real-time PCR system SeptiFast (SF), performed on cardiac valves, was evaluated in a selected population of 20 patients with definite IE of known origin, in comparison with culture. A significant difference was found between SF and culture in the rate of pathogen detection (19 versus 3 respectively; chi-square 14.06; P = 0.0002). SF sensitivity was 95%; specificity, 100%; positive predictive value (PPV), 100%; and negative predictive value (NPV), 83.3%. Culture sensitivity was 15%; specificity, 100%; PPV, 100%; and NPV, 22.7%. SF assay, performed on culture-negative excised heart valves, can be useful for the etiological diagnosis of IE.