Objective To analyze the species distribution and resistance of the pathogens isolated fromblood cultures of the patients in intensive care unit ( ICU) , and provide a basis for prevention and control of bloodstream infections in critically ill patients. Methods The data of blood cultures of the patients in ICUduring January 2009 to December 2011 was investigated retrospectively.Results In the last 3 years, positive rate of blood cultures of ICU patients was 15. 4% , 15. 7% , and 17. 6% respectively. Among the isolates, Gram-positive bacteria were predominant ( 52. 3% ) , followed in order by gram-negative bacteria ( 33. 1% ) and fungi ( 14. 7% ) . Aerobe and facultative anaerobe were the predominant bacterial isolates ( 99. 7% ) . Enterococcus faeciumand Staphylococcus spp. were the most common gram-positive bacteria, and 4. 5% of E. faecium isolates were resistant to vancomycin. Rate of methicillin-resistance for S. aureus and S. epidermidis was 73. 5% and 93. 7% respectively. In terms of gram-negative bacteria, Acinetobacter calcoaceticus- A. baumannii complex were the leading species, 96. 9% of the isolates had multi-drug resistance and 14. 1% of the isolates had extra-drug resistance. Klebsiella pneumonia and Escherichia coli isolates were less frequently isolated and those producing extended spectrum beta-lactamases accou ted for 70. 3% and 80. 0% of the isolates respectively. Candida spp. was the most common fungi isolates ( 96. 7% )with an annual change of species distribution and declining susceptibility to azoles.Conclusions Gram-positive bacteria should be the major target for prevention and control of bloodstream infections in critically ill patients. Whereas, more attention should be paid to the infection caused by candida spp. and multidrug resistant gram-negative bacteria.
Objective To introduce the research progress in the effect of chemotherapeutic resistance of metabolic enzymes of gemcitabine to pancreatic cancer.Methods Recent literatures about metabolic enzymes that played key roles in mediating gemcitabine chemotherapeutic resistance of pancreatic cancer were collected and reviewed. Results The metabolic enzymes of gemcitabine, such as hENT1, dCK, RRM1 and CDA, were closely related to chemotherapeutic resistance of pancreatic cancer. The relationship between the single nucleotide polymorphism of metabolic enzymes and the resistance to gemcitabine remained to be clarified. Conclusion Multiple factors are involved in the mechanism of chemotherapeutic resistance of pancreatic cancer to gemcitabine, which needs further research.
ObjectiveTo explore the risk factors for neonatal nosocomial infection and the pathogen resistance, in order to provide the basis for hospital infection control. MethodsSurveillance of hospital infection in newborns hospitalized for more than 48 hours were carried out from January to December 2012, and the risk factors for hospital infection were analyzed. ResultsThere were 54 newborn cases with neonatal nosocomial infection, and the infection rate of newborns was 1.25%. The major infection sites were respiratory tract (66.7%), gastrointestinal tract (18.5%), skin and soft tissues (9.2%). Birth weight (χ2Trend=126.88, P<0.001), hospitalization days (χ2Trend=106.89, P<0.001), invasive operation (χ2=5.338, P=0.021) were the major risk factors. A total of 54 strains of pathogenic bacteria were isolated from 54 newborn cases with neonatal nosocomial infection. Twenty-three strains of gram-positive bacteria accounted for 42.6%, which were generally resistant to penicillin and large ring lactone class antibiotic drugs. Thirty-one strains of gram-negative bacteria accounted for 57.4%, which were mainly resistant to the three generations of cephalosporins. ConclusionThe hospital infection rate of newborns is low. Birth weight, hospitalization days and invasive operation are the major risk factors for neonatal nosocomial infection.
Objective To assess the improvement of different resistance training regimens on blood lipid metabolism and insulin resistance in patients with type 2 diabetes mellitus (T2DM). Methods PubMed, ProQuest, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases were searched to collect randomized controlled trials of resistance training intervention to improve blood lipids and insulin resistance in patients with T2DM. The search time range was from the establishment of the databases to May 2023. Two reviewers assessed the risk of bias of the included studies using the Physiotherapy Evidence Database scale, and performed a network meta-analysis of the extracted data using Stata 16.0 software. Results In the end, 24 articles were included, and a total of 983 participants were enrolled. The result of network meta-analysis showed that high-frequency and moderate-intensity resistance exercise significantly improved the levels of insulin resistance [standardized mean difference=−1.71, 95% confidence interval (CI) (−2.75, −0.67)], triglycerides [weighted mean difference (WMD)=−0.27 mmol/L, 95%CI (−0.51, −0.04) mmol/L], and total cholesterol [WMD=−0.16 mmol/L, 95%CI (−0.20, −0.12) mmol/L], but had no significant effect on improving the level of high-density lipoprotein [WMD=0.05 mmol/L, 95%CI (−0.02, 0.11) mmol/L] or low-density lipoprotein [WMD=−0.20 mmol/L, 95%CI (−0.42, 0.03) mmol/L]. The results of cumulative probability ranking showed that high-frequency and moderate-intensity resistance exercise was the best in improving insulin resistance, triglycerides, high-density lipoprotein and low-density lipoprotein levels. Conclusion Based on current evidence, high-frequency and moderate-intensity resistance exercise may be the best resistance exercise regimen to improve insulin resistance and lipid metabolism in patients with T2DM.
ObjectiveTo analyze and summarize the clinical characteristics, risk factors, pathogenic bacteria type, and drug tolerance of diabetes complicated with hospital-acquired pulmonary infection, in order to reduce the incidence of hospital-acquired pulmonary infection in patients with diabetes. MethodsThe clinical data of diabetic patients with hospital-acquired pulmonary infection from 2011 to 2013 were taken for retrospective clinical analysis. ResultsA total of 78 diabetic patients had hospital-acquired pulmonary infection among all the 572 hospitalized patients with diabetes. Age, complications of diabetes, chronic underlying disease, duration of hospital stay, glycated hemoglobin and invasive procedures were all correlated with the incidence of hospital-acquired infection (P<0.05). Through sputum culture and throat culture, 59 strains of pathogens were found, and they were mainly multidrug-resistant Gram-negative bacteria, accounting for 71.2%. ConclusionThe rate of acquired pulmonary infection in diabetic patients is particularly high, and the pathogens are mostly Gram-negative and multidrug-resistant. Glycemic control, rational use of antimicrobial drugs, shorter hospital stay, effective prevention and treatment of diabetes complications and chronic underlying diseases, and aseptic techniques can be effective in preventing acquired pulmonary infection for diabetic patients.
ObjectiveTo investigate the distribution and drug resistance of Acinetobacter baumannii (AB) in a women and children's hospital. MethodsStrains of AB isolated from clinical specimens between January 2011 and December 2013 were identified with Vitek2-compact microbiology analyzer; antimicrobial susceptibility test was performed by Kirby-Bauer disk diffusion method. The resistant rate, intermediate rate and susceptibility rate of drugs were calculated according to the criteria in guidelines of Clinical and Laboratory Standards Institute. WHONET 5.6 software was used to analyze the data. ResultsA total of 167 strains of AB were isolated and tested. Neonatal ward had the highest detection proportion. Most strains of AB were isolated from sputum. The drug resistance rate of AB to piperacillin tazobactam, cefepime and carbapenem was<25%. ConclusionThe drug sensitivity rate of AB to piperacillin/tazobactam, cefepime and carbapenems was high, but drug resistence to antimicrobial drugs increased continuously in three years. Medical institutions should strengthen the monitoring of AB resistance, implement rational use of antibiotics, and carry out hand hygiene education, to reduce the generation and dissemination of AB resistant strains.
Objective To evaluate the influence on the estimation of respiratory mechanics with dynamic signal analysis approach during noninvasive positive pressure ventilation (NPPV) under different inspiratory effort conditions. Methods The Respironics V60 ventilator was connected to a ASL5000 lung simulator, which simulate lung mechanics in healthy adults with body weight from 65 to 70 kg, and patients with chronic obstructive pulmonary disease (COPD) and acute respiratory distress (ARDS). Each lung models was subjected to 4 different muscle pressures (Pmus): 0, 5.0, 10.0, and 15.0 cm H2O. Inspiratory pressure support level was adjusted to maintain tidal volume (VT) achieving 7.0 mL/kg outputted by ventilator respectively. Positive end expiratory pressure was set at 5.0 cm H2O and back-up rate was 10 beats per minute. Measurements were conducted at system leaks with 25 to 28 L/min. The respiratory system compliance (Crs), inspiratory and expiratory resistance (Rinsp and Rexp) were estimated by special equations, which was derived from the exhaled VT, flow rate and airway pressure. Results The driving pressure (DP) was decreased with Pmus increasing, and was 1.0 cm H2O after Pmus exceeding 10.0 cm H2O and the VT was larger than 7.0 mL/kg in normal adult model. The estimated value of Crs was affected by the changes of Pmus in all three lung models. The significant underestimation of Raw and the overestimation of Crs were observed when Pmus level exceed 10.0 cm H2O. The measured errors of Crs and Rexp were within 10% in COPD and ARDS model when Pmus was at 5.0 cm H2O. The underestimation of Rinsp was always existed in all Pmus level (P<0.01). Conclusions Using dynamic signal analysis approach, the real-time estimation of respiratory mechanics (Crs and Raw) is no need to interrupt the spontaneous breathing during NPPV. Excessive effort will increase the patient’s inspiratory workload, which is not benefit to accurate estimation of respiratory mechanics.
ObjectiveTo understand the clinical distribution and drug resistance of Klebsiella pneumoniae in Yibin during 2011 to 2014 so as to provide evidence for clinical rational use of antimicrobial drugs. MethodsKlebsiella pneumoniae isolated from all types of clinical specimens were collected from the First People's Hospital and the Second People's Hospital of Yibin during 2011 to 2014. VITEK2 Compact and its supporting identification card GP and drug sensitivity test card AST-GP67 were used for detection, and the results were analyzed and summarized. ResultsMost Klebsiella pneumoniae were detected from the Department of Respiratory Medicine, the proportion for each year was 48.15%, 46.24%, 45.44%, and 44.97% during 2011 to 2014. Klebsiella pneumoniae isolated were mainly from sputum samples, the proportion for each year was 81.01%, 89.18%, 87.80%, and 83.52% between 2011 and 2014. Imipenem and piperacillin/tazobactam resistance rates were lower, but the overall trend was rising. Ampicillin/sulbactam, and sulfamethoxazole resistance rates were higher. Levofloxacin, ciprofloxacin increased year by year. Aztreonam, cefepime, and amikacin rate declined. ConclusionKlebsiella pneumoniae is one of the main infection pathogen in the Department of Respiratory Medicine. Klebsiella pneumoniae resistance rates are higher. Klebsiella pneumoniae were sensitive to enzyme inhibitors β-lactam antimicrobial agents and carbapenem antibiotics.
Objective To study the distribution and drugresistance of pathogens isolated from patients who suffered from lower respiratory infections after thoracotomy and provide basis for rational use of antibiotics in clinical practice. Methods A total of 118 patients suffered from lower respiratory infections after thoracotomy in Beijing Lung Cancer Center and the Thoracic Surgery Department of Xuanwu Hospital between January 1,2006 and December 31, 2009. We performed a retrospective study on pathogens from their lower respiratory tract. Of these patients, 89 are male and 29 are female with a mean age of 64.6 years. Sputum specimens were obtained by sterile sputum collectors or bronchofibroscopes, and then were sent to microorganism laboratory immediately. Cytological screening was carried out before specimen inoculation. Bacterial culture, identification and drug sensitivity test were performed with routine methods. Results A total of 201 strains of pathogens from the lower respiratory tract were identified. There were 126(62.7%) strains of gramnegative bacilli, 66(32.8%) strains of grampositive cocci, and 9(4.5%) strains fungi. The four prevalent gramnegative bacilli strains with the highest isolating rate between 2006 and 2009 included 34(27.0%) strains of acinetobacters, 28(22.2%) strains of verdigris Pseudomonas, 19(15.1%) strains of Klebsiellas and 19(15.1%) strains of Escherichia coli. Verdigris Pseudomonas ranked first in isolating rate among prevalent gramnegative bacilli strains from 2006 to 2008, but it was replaced by cinetobacters (9 strains, 40.9%) in 2009. The most prevalent strains of grampositive cocci were staphylococcus aureus (35 strains, 53%) from 2006 to 2009. Gramnegative bacilli were most sensitive to imipenem and no grampositive cocci were resistant to vancomycin. Conclusion Gramnegative bacilli are the most common pathogens in lower respiratory infections after thoracotomy and show extremely high drugresistance rate. Drugresistance monitoring of pathogens should be promoted. It may contribute to rational antimicrobial therapy and effective control of infections.
Objective To investigate the characteristics of the pathogens isolated from the cerebrospinal fluid (CSF) and the prognosis of the adult patients with central venous system (CNS) infection, and to provide the basis for disease treatment. Methods The clinical data and findings of the laboratory examination of the patients, who were admitted to West China Hospital of Sichuan University from January 2014 to September 2016, and suffered from CNS infection with the positive results of CSF culture, were retrospectively analyzed. The species distribution and in-vitro susceptibility of the pathogens and hospital mortality were analyzed. Results A total of 157 cases, involving 87 (55.4%) community-acquired cases and 70 (44.6%) hospital-acquired cases, were included. One hundred and fifty-eight strains of the pathogens were isolated from the CSF specimens of these patients, including 73 isolates (46.2%) of gram negative bacteria, 64 isolates (40.5%) of fungus, and 21 isolates (13.3%) of gram positive bacteria. In terms of species distribution,Cryptococcus neoformans was the predominant (62/87, 71.3%) species isolated from the patient with community-acquired infection, whileAcinetobacter calcoaceticus-A. baumannii complex (31/71, 43.7%) was the predominant specie from the patients with hospital-acquired infection. Analysis of the resistance phenotypes showed that all theC. neoformans isolates were susceptible to the antifungal agents. More than 90% ofA. calcoaceticus- A. Baumannii complex isolates were resistant to the regular antibiotics. The resistant rates ofK. pneumoniae isolates to the regular antibiotics were no more than 25%. The hospital mortality of the groups infected by gram-negative bacteria, fungi, and gram-positive bacteria were 52.3% (38/72), 32.8% (21/64), and 19.0% (4/21), respectively. There was statistical difference for the hospital mortality among these groups (P=0.006). Conclusion In our hospital,C. neoformans are the common species isolated from CSF of the patients with community-acquired CNS infection. Gram negative bacilli are commonly isolated from CSF of the hospital-acquired cases. The mortality of patients with gram negative bacilli is high.