In December 2019, cases of pneumonia appeared in Wuhan, China. The etiology of these infections was a novel coronavirus (2019-nCoV),^1,2 possibly connected to zoonotic or environmental exposure from the seafood market in Wuhan. Human-to-human transmission has accounted for most of the infections, including among health care workers.^3,4 The virus has spread to different parts of China and at least 26 other countries.¹ A high number of men have been infected, and the reported mortality rate has been approximately 2%, which is lower than that reported from other coronavirus epidemics including severe acute respiratory syndrome (SARS; mortality rate, >40% in patients aged >60 years)⁵ and Middle East respiratory syndrome (MERS; mortality rate, 30%).⁶ However, little is known about the clinical manifestations of 2019-nCoV in healthy populations or cases outside Wuhan. We report early clinical features of 13 patients with confirmed 2019-nCoV infection admitted to hospitals in Beijing.

Background: The prevalence of infections with multidrug-resistant organism (MDRO) pose great challenges for anti-infective therapy. Previous research on MDRO infections after cardiac surgery was limited. Therefore, understanding and mastering the clinical characteristics and risk predictors of MDRO infection after cardiac surgery is of great significance for standardized management of perioperative patients. Methods: The medical records of adult patients with MDRO infection after cardiac surgery from January 2018 to October 2021 were collected, and patients were divided into MDR infection group (n = 176) and non-MDR infection group (n = 233). Univariate and multivariate regression analysis of variables was performed to determine the risk predictors of MDRO infection. Results: The incidence of MDRO infection was 8.6%. Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common, accounting for 37.3%, 23.5% and 18.0%, respectively. The main infection type were lower respiratory tract infection (LTRI = 29.0%). Univariate analysis showed that underwent coronary artery bypass graft (CABG) (P = 0.001) and secondary operation (P = 0.008), pre-infection exposure to vancomycin (P < 0.001) and linezolid (P = 0.002), combination antibiotics (P < 0.001), four antibiotics in combination (P = 0.005), glucocorticoid use (P = 0.029), preoperative hypoalbuminemia (P = 0.003) were risk factors for post-operative MDRO infection. Multivariate regression analysis showed that underwent CABG (OR = 1.228, 95%CI = 1.056∽1.427, P = 0.008), secondary operation (OR = 1.910, 95%CI = 1.131∽3.425, P = 0.015) and pre-infection exposure to linezolid (OR = 3.704, 95%CI = 1.291∽10.629, P = 0.005) were independent risk predictors for MDRO infection. The risk of MDRO infection increased with the length of stay in the ICU (P < 0.001) and the length of stay before diagnosis of infection (P = 0.003), and the difference was statistically significant. Meanwhile, the length of stay after infection (P = 0.005) and the total length of hospital stay (P < 0.001) were significantly longer in the MDRO infection group, and the all-cause mortality was numerically higher in the MDRO infection group (31.3% versus 23.2%). Conclusions: The morbidity and mortality of MDRO infection was high in adult cardiac surgery, and many risk factors influence the occurrence of MDRO infection. In the future, clinicians should focus on high-risk patients, strengthen multidisciplinary collaboration on infection prevention and control measures, reduce the morbidity and mortality of MDRO infection, and improve the prognosis of in-hospital patients.

Despite advances in treatment strategies, acute respiratory distress syndrome (ARDS) after cardiac surgery remains associated with high morbidity and mortality. A method of screening patients for risk of ARDS after cardiac surgery is needed. To develop and validate an ARDS prediction score designed to identify patients at high risk of ARDS after cardiac or aortic surgery. An ARDS prediction score was derived from a retrospective derivation cohort and validated in a prospective cohort. Discrimination and calibration of the score were assessed with area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test, respectively. A sensitivity analysis was conducted to assess model performance at different cutoff points. The retrospective derivation cohort consisted of 201 patients with and 602 patients without ARDS who had undergone cardiac or aortic surgery. Nine routinely available clinical variables were included in the ARDS prediction score. In the derivation cohort, the score distinguished patients with versus without ARDS with area under the curve of 0.84 (95% CI, 0.81-0.88; Hosmer-Lemeshow P = .55). In the validation cohort, 46 of 1834 patients (2.5%) had ARDS develop within 7 days after cardiac or aortic surgery. Area under the curve was 0.78 (95% CI, 0.71-0.85), and the score was well calibrated (Hosmer-Lemeshow P = .53). The ARDS prediction score can be used to identify high-risk patients from the first day after cardiac or aortic surgery. Patients with a score of 3 or greater should be closely monitored. The score requires external validation before clinical use.

Nosocomial infection (NI) is one of the most common complications after acute aortic dissection surgery (AADS) and contributes significantly to mortality and length of hospital stay. Therefore, this study analysed the clinical characteristics of NI and determined the risk factors for the occurrence and development of NI and in-hospital outcomes. During this study, 429 adult patients with AADS were divided into an infected group (n = 141) and a noninfected group (n = 288). Complete clinical data (including baseline clinical characteristics and laboratory results, surgery-related variables, and clinical outcomes) were collected for statistical analysis. Multivariate logistic regression was used to determine the independent risk factors for the occurrence of NI after AADS. The incidence of NI in AADS was 29.0%. The main clinical presentations were hospital-acquired pneumonia (HAP = 51.8%), ventilator-associated pneumonia (VAP = 24.8%) and bloodstream infection (BSI = 18.4%). The most common pathogenic bacteria were gram-negative bacilli (GNB = 68.8%), including Klebsiella pneumoniae (27.7%), Pseudomonas aeruginosa (16.3%) and Acinetobacter baumannii (13.5%). Multivariate regression analysis found that preexisting cerebrovascular disease, lower estimated glomerular filtration rate (eGFR), total protein and serum albumin, longer operation time and cardiopulmonary bypass (CPB) time, second operation in-hospital, exposure to extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), and proton pump inhibitor (PPI) use were independent risk factors for the occurrence of NI (all P < 0.01). Compared with noninfected patients, the intensive care unit (ICU) stay time and total hospital stay time were significantly prolonged after the occurrence of NI (all P < 0.001). The risks of other complications, such as acute kidney injury (AKI), acute upper gastrointestinal haemorrhage, new cerebral infarction, paraplegia or hemiplegia, and new cerebral haemorrhage, were significantly higher in patients with NI after AADS than in noninfected patients (all P < 0.001). The in-hospital mortality (46.1%) of NI after AADS was significantly higher than that of noninfected patients (3.5%, P < 0.001). This study identified the high morbidity and mortality of NI after AADS. The most common types of infection were HAP, VAP and BSI, and the pathogenic microorganisms were Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii. Total protein, serum albumin, eGFR, longer operation time and CPB time, second operation in-hospital, exposure to ECMO and CRRT, and PPI use were independent risk factors for the occurrence of NI.

Background Nosocomial infection (NI) is one of the most common complications after acute aortic dissection surgery (AADS) and contributes significantly to mortality and length of hospital stay. Therefore, this study analysed the clinical characteristics of NI and determined the risk factors for the occurrence and development of NI and in-hospital outcomes. Methods During this study, 429 adult patients with AADS were divided into an infected group (n = 141) and a noninfected group (n = 288). Complete clinical data (including baseline clinical characteristics and laboratory results, surgery-related variables, and clinical outcomes) were collected for statistical analysis. Multivariate logistic regression was used to determine the independent risk factors for the occurrence of NI after AADS. Results The incidence of NI in AADS was 29.0%. The main clinical presentations were hospital-acquired pneumonia (HAP = 51.8%), ventilator-associated pneumonia (VAP = 24.8%) and bloodstream infection (BSI = 18.4%). The most common pathogenic bacteria were gram-negative bacilli (GNB = 68.8%), including Klebsiella pneumoniae (27.7%), Pseudomonas aeruginosa (16.3%) and Acinetobacter baumannii (13.5%). Multivariate regression analysis found that preexisting cerebrovascular disease, lower estimated glomerular filtration rate (eGFR), total protein and serum albumin, longer operation time and cardiopulmonary bypass (CPB) time, second operation in-hospital, exposure to extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), and proton pump inhibitor (PPI) use were independent risk factors for the occurrence of NI (all P < 0.01). Compared with noninfected patients, the intensive care unit (ICU) stay time and total hospital stay time were significantly prolonged after the occurrence of NI (all P < 0.001). The risks of other complications, such as acute kidney injury (AKI), acute upper gastrointestinal haemorrhage, new cerebral infarction, paraplegia or hemiplegia, and new cerebral haemorrhage, were significantly higher in patients with NI after AADS than in noninfected patients (all P < 0.001). The in-hospital mortality (46.1%) of NI after AADS was significantly higher than that of noninfected patients (3.5%, P < 0.001). Conclusions This study identified the high morbidity and mortality of NI after AADS. The most frequent infection types were HAP, VAP and BSI, and the most common microorganisms isolated were Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii. Meanwhile, many risk factors affect the occurrence and development of NI. Hence, clinicians should be reminded to identify high-risk patients early and develop individualized perioperative prevention and management programs to reduce the morbidity and mortality of NI and improve the prognosis of patients with AAD.

Background The emergence and prevalence of infections with multidrug-resistant organisms (MDROs) pose great challenges for clinical anti-infective therapy. Cardiac surgery is characterized by high surgical difficulty, strict aseptic operation requirements, and long operation time. Previous research data on postoperative MDR bacterial infection are limited. Therefore, it is of great clinical significance to understand the clinical characteristics of adult patients with MDRO infection after cardiac surgery and the risk predictors of infection. Methods The complete medical records of adult patients with MDR bacterial infection after cardiac surgery from January 2018 to October 2021 were collected to understand the clinical characteristics of MDR bacterial infection in a specific environment and to evaluate the risk predictors of MDR bacterial infection after surgery. Results From January 2018 to October 2021, a total of 176 adult patients suffered from MDR bacterial infection after cardiac surgery. A total of 306 strains of MDR bacteria were detected in clinical samples, and 97 patients (55.1%) suffered from multiple bacterial infections. The most common bacterial distribution was Acinetobacter baumannii (114/306, 37.3%). The main clinical manifestations were lower respiratory tract infection (51/176, 29.0%), followed by bloodstream infection (12/176, 6.8%), mediastinal infection (2/176, 1.1%), urinary tract infections (2/176, 1.1%) and skin soft tissue infections (1/176, 0.6%). Preinfection exposure to vancomycin (P<0.001), combined antibiotic administration (P<0.001), and glucocorticoid administration (P=0.029) were associated with prolonged hospital stay (P=0.003) and ICU stay (P < 0.001). The presence of preoperativehypoalbuminemia (P=0.003) was a risk factor for MDR bacterial infection after cardiac surgery. Undergoing a second surgery during hospitalization (OR=1.91, 95% CI=1.131-3.425, P=0.015) and preoperative exposure to linezolid (OR=3.70, 95% CI=1.291-10.629, P=0.015) were independent risk factors for developing MDR bacterial infections. Conclusion The incidence of MDR bacterial infection is high in adult patients undergoing cardiac surgery, and these organisms are highly resistant to commonly used antibiotics. Therefore, it is of great importance to strengthen perioperative management of inpatients in cardiac surgery, achieve early identification of risk factors for postoperative MDR bacterial infection, and ensure containment of the occurrence and spread of drug-resistant bacterial infection.