Objective To investigate the species distribution and antibiotic resistance among the bloodstream infections in intensive care unit ( ICU) . Methods A retrospective analysis was performed to review the microbiological and susceptibility test data of all bloodstream infections in ICU from January 2004 to September 2009. The patterns of antibiotic resistance among the top five bacteria were compared. Results 89 cases of bloodstream infection were detected with 112 strains, including 55 Gram-positive ( G+ ) bacteria( 49. 1% ) , 55 Gram-negative ( G- ) bacteria ( 49. 1% ) , and 2 fungi ( 1. 8% ) . The main pathogens causing bloodstream infection were Burkholderia spp. ( 33, 29. 5% ) , S. epidermidis( 31, 27. 7% ) , Klebsiella pneumoniae ( 7, 6. 3% ) , S. aureus ( 7, 6. 3% ) , S. hominis ( 6, 5. 4% ) , Acinetobacter baumannii ( 6,5. 4% ) , Pseudomonas aeruginosa( 5, 4. 5% ) and S. haemolyticus( 5, 4. 5%) , suggesting that Burkholderia spp. was predominant pathogenic G- bacteria, and coagulase-negative staphylococcus was predominant G+ bacteria. The antibiotic resistance tests demonstrated that isolated G- bacillus was highly sensitive to carbopenem, while vancomycin-resistant G+ cocci were not found. Conclusions Within the latest 5 years,the prevalence of G+ bacteria infection is almost equivalent to G- bacteria in blood stream infection.Coagulase-negative staphylococcus is the mainly G+ bacteria and Burkholderia spp. is predominant in G- bacteria. Carbopenemand glycopeptides still remain to be the first choice.
侵袭性真菌感染(IFI)不仅可发生在恶性血液病、恶性肿瘤、器官移植和AIDS等经典免疫功能缺陷患者中，近年来ICU的重症患者由于严重的基础疾病、外科手术指征和范围的扩大、各种导管的体内介入与留置，以及广谱抗生素和糖皮质激素的广泛应用等，IFI发病率也迅速增加。据统计，IFI占医院获得性感染的8％-15％。IFI病情进展快速、凶险，已13益成为导致ICU危重病患者死亡的重要原因之一。引起ICU IFI的病原体包括念珠菌、曲霉、隐球菌、镰刀霉、接合菌、肺孢子菌等，其中以念珠菌和曲霉最多见，占90％ 以上。由于ICU危重症患者多数属非经典IFI高危人群，临床表现缺乏特异性，临床诊治极为困难。本文就ICU内侵袭性念珠菌感染(Ic)和侵袭性曲霉感染(IA)的流行病学、诊断和治疗进展进行阐述，以期对临床有所裨益。
Objective To evaluate the clinical features and complications of bedside tracheal intubation in intensive care unit ( ICU) , and explore the suitable strategy of intubation. Methods In this retrospective study,42 patients who underwent bedside tracheal intubation in ICU during September 2008 and March 2009 were divided into a schedule group ( n =24) and an emergency group ( n =18) . The time to successful intubation, number of intubation attempts, and complications were recorded. The schedule group was defined as those with indications for intubation and fully prepared, while the emergency group was defined as those undergoing emergency intubations without full preparation due to rapid progression of disease and accidental extubation. Results The success rate for all patients was only 57. 1% on the first attempt ofintubation. The main complications during and after induction were hypotension ( 45. 2% ) and hypoxemia ( 50. 0% ) . Compared with the emergency group, the schedule group had fewer attempts to successful intubation ( 1. 71 ±1. 12 vs. 2. 67 ±1. 75) , higher success rate on the second attempt ( 87. 5% vs.61. 1%) , and lower ypoxemia incidence ( 29. 1% vs. 77. 8%, P lt; 0. 05) . Conclusions The tracheal intubation in ICU is a difficult and high risk procedure with obvious complications. Early recognition ofpatients with indications and well preparation are critical to successful bedside intubation.
Objective To investigate the characteristics of ventilator associated pneumonia (VAP)caused by Stenotrophomonas maltophilia(Sm)in ICU。Methods The clinical data of 39 patients with VAP caused by Sm，from Jan 2001 to Dec 2006，were retrospectively investigated．Results In 15 kinds of antibiotics sensitivity test，all cases showed 100％ resistance to 12 kinds of antibiotics except sulfamethoxazole／trimethoprim。ticarcillin／clavulanic acid and ciprofloxacin with sensitivity rate of 46．2％ ， 30．8％ and 12．8％ ．respectively．92．30％ of Sm VAP were CO—infected with other microorganisms and 79．5％ of VAP were late-onset．The use of broad-spectrum antibiotics．especially carbapenem．and prolonged mechanical ventilation more than 7 days were risk factors for Sm VAP．Morbidity of Sm VAP was 87．2％ ．Conclusions Sm VAP has an important role in ICU infections with high morbidity and CO-infection rate．It should be alerted to the possibility of Sm VAP in the case of when prolonged ventilation (gt;7 days)or carbapenem is used．
Objective To analyze morbility，risk factors，etiology，treatment and outcome of nosocomial pulmonary fungal infections in respiratory intensive care unit（RICU）.Methods Forty-seven respiratory RICU patients with nosocomial pulmonary fungal infections between July 2000 and June 2005 were retrospectively analyzed.Results All of the 47 cases were clinically diagnosed as probable nosocomial pulmonary fungal infections，with the morbidity of 10.8% significantly higher than general wards（1.8%，Plt;0.005）.COPD and bacterial pneumonia were the major underlying diseases of respiratory system with a percent of 38.30% and 36.17%，respectively.Forty-one patients (87.2%) had risk factors for fungal infections.Compared with general wards，the proportion of Aspergillosis was higher in RICU without significant difference (Pgt;0.1)；the proportions of Candida glabrata and Candida tropicalis were higher too，but that of Candida krusei was relatively low.The effective rate of antifungal treatment was 79.1% and fluconazol was the most common used antifungal agents.The mortality of fungal infection in RICU was higher than that of general wards but without significant difference（Pgt;0.1）.Conclusion The morbidity of nosocomial pulmonary fungal infection in respiratory RICU is higher than that in general wards.The proportions of infection caused by Aspergilli and some Candida resistant to fluconazol is relatively high.Early and effective treatment is needed in these patients considering the poor prognosis.
Objective To investigate the role and mechanisms of trimetazidine (TMZ) in intensive care unit-acquired weakness (ICU-AW). Methods Seventy wild-type male C57BL/6 mice were selected and the ICU-AW mouse model was constructed by intraperitoneal injection of different concentrations of lipopolysaccharide (LPS). The body weights, grip strengths, and 96-hour survival rates of each group were observed, and the optimal concentration of LPS and time of sampling were screened out, the mRNA and protein expression of the gastrocnemius muscle atrophic proteins Atrogin-1 and muscle-specific RING finger protein 1 (MuRF1) were further detected to verify the success of modelling, and LPS (12 mg/kg) was used as the subsequent modelling concentration according to the preliminary results. After successful modelling, another 70 mice were randomly divided into normal control group (Normal group), LPS solvent (Vehicle) group, LPS group, LPS+TMZ solvent group, LPS+TMZ group, LPS+TMZ+AC-YVAD-CMK (AC) solvent group, and LPS+TMZ+AC group, with 10 mice in each group. The Normal group did not have any intervention; the Vehicle group was injected intraperitoneally with an equal volume of saline with LPS; the remaining groups were injected intraperitoneally with LPS (12 mg/kg); after the completion of the LPS injection, the LPS+TMZ group, the LPS+TMZ+AC solvent group, and the LPS+TMZ+AC group were given TMZ (5 mg/kg) by gastric gavage once a day for 4 days. The LPS+TMZ solvent group was given TMZ equivalent saline gavage once a day for 4 days. The LPS+TMZ+AC group was injected intraperitoneally with the cysteinyl aspartate specific proteinase 1 (Caspase-1) inhibitor AC-YVAD-CMK (AC, 6.5 mg/kg) 1 h before LPS injection, and the LPS+TMZ+AC solvent group was injected with an equal amount of AC solvent phosphate buffer. At the end of TMZ treatment, body weight, grip strength, 96-hour survival rate, mRNA and protein expression of MuRF1, Atrogin-1, Caspase-1, and gasdermin D (GSDMD) in gastrocnemius muscle, as well as serum IL-1β and IL-18 concentrations in mice were detected in each group, and the gastrocnemius muscle was stained with HE to observe histopathological changes. Results Compared with the Normal group, mice in the LPS (12 mg/kg) and LPS (14 mg/kg) groups showed significant decreases in body weight and grasping strength and the weakening was most obvious at 3 - 5 d (P<0.05), but the survival rate of the LPS (12 mg/kg) group was higher than that of the LPS (14 mg/kg) group (P<0.05), the HE staining of gastrocnemius muscle showed that the mice in the LPS (12 mg/kg) group was significantly atrophied compared with that of the Normal group, and the gene and protein expression of MuRF1 and Atrogin-1 were significantly elevated (P<0.05), and the mice injected with LPS (12 mg/kg) for 4 days (96 h) were finally selected as the conditions for subsequent experimental modelling and sampling.The mRNA and protein expression of Caspase-1 and GSDMD in skeletal muscle was significantly higher in the LPS group compared with the Normal and Vehicle groups (P<0.01), and the concentrations of serum IL-1β and IL-18 were significantly higher(P<0.01). Mice in the TMZ group showed significant improvement in body weight, grip strength, survival rate, and degree of muscle atrophy compared with the LPS and TMZ solvent groups (P<0.05); gene and protein levels of MuRF1, Atrogin-1, Caspase-1, and GSDMD in the gastrocnemius muscle were significantly reduced (P<0.05); and levels of serum IL-1β and IL-18 were significantly reduced (P<0.05) ); the mice in the LPS+TMZ+AC group had significantly improved body weight, grip strength, survival rate, and muscle atrophy compared with the LPS+TMZ group and the LPS+TMZ+AC solvent group (P<0.05), and the gene and protein contents of MuRF1, Atrogin-1, Caspase-1, and GSDMD in the gastrocnemius muscle were reduced (P<0.05), and the serum IL-1β and IL -18 concentrations were reduced (P<0.05). Conclusion TMZ is able to exert a skeletal muscle protective effect by inhibiting Caspase-1/GSDMD-mediated pyroptosis, which is an important reference for the prevention and treatment of ICU-AW.
Objective To investigate the differences in bacteria distribution and drug resistance of pathogens in patients with lower respiratory tract infection between respiratory general wards and respiratory intensive care unit ( RICU) .Methods All the clinical isolates fromsputumor secretion of lower respiratory tract from2007. 1-2010. 10 were analyzed retrospectively. Antibiotic susceptibility was tested by Kirby-Bauer method. Results The total number of isolated strains was 3202. Among 1254 strains isolated from respiratory general wards, Gram-positive bacteria accounted for 2. 63% , Gram-positive bacteria accounted for 42. 42% , and fungi accounted for 54. 95% . Streptococcus pneumoniae ranked first place among Gram-positive bacteria, accounting for 51. 52% . Haemophilus parainfluenzae bacillus ranked first place among Gramnegative bacteria, accounting for 21. 99% . Both were sensitive to the most commonly used antibiotics. Among 1948 strains isolated from RICU ward, Gram-positive bacteria accounted for 4. 52% , Gram-positive bacteria accounted for 37.73% , and fungi accounted for 57. 75% . Staphylococcus aureus ranked first place among Gram-positive bacteria, accounting for 52. 27% . Acinetobacter baumannii ranked first place in Gramnegative bacteria, accounting for 27. 35% . Both were resistant to most commonly used antibiotics. Pseudomonas aeruginosa had a higher rate of infection both in the general wards and RICU, and was resistant to most commonly used antibiotics.Conclusions In lower respiratory tract infection of respiratory general ward, Gram-positive bacteria with Streptococcus pneumoniae mainly and Gram-negative bacteria with Haemophilus parainfluenzae mainly are both sensitive to the most commonly used antibiotics. While in the RICU ward, Gram-positive bacteria infections with Staphylococcus aureus mainly and Gram-negative bacteria infections with Acinetobacter baumannii mainly are both resistant to most commonly used antibiotics.
Objective To investigate the species distribution and antibiotic resistance of pathogens fromcatheter-related bloodstream infections ( CRBSI) in intensive care unit( ICU) , to provide evidence for the guidance of clinical rational administration.Methods A retrospective analysis was performed to review the microbiological and susceptibility test data of all CRBSI patients in ICU from January 2009 to December 2011. The patterns of antibiotic resistance among the top seven bacteria were compared. Results 67 cases of CRBSI were detected with 81 strains, including 40 Gram-positive ( G+ ) bacteria( 49.4% ) , 38 Gram-negative( G- ) bacteria ( 46.9% ) , and 3 fungi ( 3.7% ) . The main pathogens causing CRBSI were coagulase negative Staphylococci ( 27 strains, 33.3%) , Acinetobacter baumannii ( 12 strains, 14.8% ) , Klebsiella pneumoniae( 9 strains, 11. 1% ) , Staphylococcus aureus ( 8 strains, 9. 9% ) , Pseudomonas aeruginosa ( 7 strains, 8. 6% ) , Escherichia coli ( 6 strains, 7.4% ) , suggesting that Staphylococcus epidermidis was predominant pathogenic G+ bacteria, and Acinetobacter baumannii was predominant G- bacteria. The antibiotic resistance tests demonstrated that isolated G- bacillus was highly sensitive to carbopenem, while vancomycin-resistant G+ bacteria were not found. Conclusions Within the latest 3 years, the predominant pathogens of CRBSI in ICU are Staphylococcus epidermidis and Acinetobacter baumannii. Acinetobacter baumannii exhibited high drug resistance to all antibiotics.
ObjectiveTo investigate the application value of noninvasive ventilation (NIV) performed in patients with unplanned extubation (UE) in intensive care unit (ICU).MethodsThis was a retrospective analysis. The clinical data, application of NIV, reintubation rate and prognosis of UE patients in the ICU of this hospital from January 2014 to December 2018 were reviewed, and the patients were assigned to the control group or the NIV group according to the application of NIV after UE. The data between the two groups were compared and the application effects of NIV in UE patients were evaluated.ResultsA total of 66 UE patients were enrolled in this study, including 44 males and 22 females and with an average age of (64.2±16.1) years. Out of them, 41 patients (62.1%) used nasal catheter or mask for oxygenation as the control group, 25 patients (37.9%) used NIV as the NIV group. The Acute Physiology andChronic Health EvaluationⅡ score of the control group and the NIV group were (18.6±7.7) vs. (14.8±6.3), P=0.043. The causes of respiratory failure in the control group and the NIV group were as follows: pneumonia 16 patients (39.0%) vs. 7 patients (28.0%), postoperative respiratory failure 7 patients (17.1%) vs. 8 patients (32.0%), chronic obstructive pulmonary disease 8 patients (19.5%) vs. 6 patients (24.0%), others 5 patients (12.2%) vs. 4 patients (16.0%), heart failure 3 patients (7.3%) vs. 0 patients (0%), nervous system diseases 2 (4.9%) vs. 0 patients (0%), which showed no significant difference between the two groups. Mechanical ventilation time before UE were (12.5±19.8) vs (12.7±15.2) d (P=0.966), PaO2 of the control group and the NIV group before UE was (114.9±37.4) vs. (114.4±46.3)mm Hg (P=0.964), and oxygenation index was (267.1±82.0) vs. (257.4±80.0)mm Hg (P=0.614). Reintubation rate was 65.9% in the control group and 24.0% in the NIV group (P=0.001). The duration of mechanical ventilation was (23.9±26.0) vs. (21.8±26.0)d (P=0.754), the length of stay in ICU was (34.4±36.6) vs. (28.5±25.8)d (P=0.48). The total mortality rate in this study was 19.7%. The mortality rate in the control group and NIV group were 22.0% and 16.0% (P=0.555).ConclusionPatients with UE in ICU may consider using NIV to avoid reintubation.