ObjectiveTo investigate the condensate pollution in the pipeline of severe pneumonia patients undergoing mechanical ventilation.MethodsFrom January 2017 to January 2019, 120 patients with severe pneumonia treated by mechanical ventilation in our hospital were collected continuously. The lower respiratory tract secretions were collected for bacteriological examination. At the same time, the condensed water in the ventilator exhaust pipe was collected for bacteriological examination at 4, 8, 12, 16, 20 and 24 hours after tracheal intubation and mechanical ventilation. The bacterial contamination in the condensed water at different time points was analyzed and separated from the lower respiratory tract. The consistency of bacteria in secretion and drug resistance analysis of bacterial contamination in condensate water were carried out.ResultsOf the 120 patients with severe pneumonia after mechanical ventilation, isolates were cultured in the lower respiratory tract secretions of 102 patients. One strain was cultured in 88 cases, two strains were cultured in 10 cases, and three strains were cultured in 4 cases. The isolates were mainly Gram-negative bacteria (57.5%) and Gram-positive bacteria (42.5%). The most common isolates were Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii. The contamination rate of condensate water was 5.0% at 4 hours, 37.5% at 8 hours, 60.0% at 12 hours, 76.7% at 16 hours, 95.0% at 20 hours, and 100.0% at 24 hours, respectively. The bacterial contamination rate in condensate water at different time points was statistically significant (P=0.000). The pollution rate at 4 hours was significantly lower than that at 8 hours (P=0.000). Gram-negative bacteria accounted for 57.5% and Gram-positive bacteria accounted for 42.5%. The most common isolates were Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii. The consistency of bacteria in lower respiratory tract and condensate water was 83.3% in severe pneumonia patients undergoing mechanical ventilation. The overall resistance of Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus was higher, but the resistance to imipenem/cilastatin was lower.ConclusionsThe bacterial contamination in the condensate of patients with severe pneumonia during mechanical ventilation is serious. The pollution rate is low within 4 hours. It is consistent with the bacterial contamination in lower respiratory tract and the bacterial resistance is high.
目的：为临床合理应用抗生素提供依据。方法：采用VITEK 32及GNS--120药敏卡、GPS -107药敏卡进行细菌的鉴定及药敏实验。结果：320 株病原菌中，革兰氏阳性菌占28.75 %，革兰氏阴性菌占71.25 %，其中大肠埃希菌、铜绿假单胞菌、鲍曼复合醋酸钙不动杆菌、阴沟肠杆菌、金黄色葡萄球菌是临床上主要致病菌。结论：临床应科学合理选用抗生素，尽量减少和延缓耐药菌的发生及发展。
ObjectiveTo investigate the effects of antimicrobial management program on inpatients outcomes and antimicrobial resistance among clinical isolates in a large-scaled university hospital.MethodsThe antibiotics use density (AUD) and antimicrobial resistance rate of multi-drug resistant bacteria before (from January 2009 to December 2010) and after (from January 2012 to December 2016) the intervention of antimicrobial management program in a large-scaled university hospital (4 300 beds) were calculated and compared, and the correlations of AUD with average length of hospital stay and mortality rate were analyzed.ResultsThe AUD was significantly decreased after intervention (P<0.001). The resistance rate of Staphylococcus aureus to oxacillin decreased (P<0.001). Among Gram-negative bacteria, the resistance rates to carbapenems in Acinetobacter baumannii (P<0.001) and Klebsiella pneumoniae increased (P=0.011). AUD was not correlated with the average length of hospital stay (P=0.644), while positively correlated with the in-hospital mortality rate (r=0.932, P=0.001).ConclusionsThe implementation of antimicrobial management program can significantly reduce the antimicrobial use and do not worsen patient outcomes in the hospital. The impact of the program on resistance varies significantly depending on both the bacterium and the agent, and carbapenem-non-susceptible Gram-negative bacilli emerges as a major threat. It is still necessary to combine other infection control measures.
摘要:目的:了解细菌药物敏感性以指导临床合理选用抗生素。方法:采用VITEK32及GNS120药敏卡、GPS107药敏卡完成细菌的鉴定及药敏实验。结果:葡萄球菌占72.5%。青霉素对葡萄球菌敏感性几乎为0,葡萄球菌的产酶率均在95%以上。结论:临床应了解细菌对抗生素的耐药特点,掌握好适应症,科学合理选用抗生素
ObjectiveTo study the clinical distribution and the change of drug resistance of Acinetobacter baumannii from different inpatient specimens sources during 2008 to 2012, and to provide guidance for rational use of antibiotics. MethodsThe identification of Acinetobacter baumannii was conducted by VITEK-2 based on clinical and laboratory standards institute (CLSI) guideline between January 2008 and December 2012. The susceptibility of antibiotics was determined by K-B test, and data analysis was conducted by Excel and SAS. ResultsA total of 3 139 stains of Acinetobacter baumannii were isolated from 2013 patients during this period. The Acinetobacter baumannii was mainly obtained from the Burn ward, Intensive Care Unit ward and Thoracic ward. Sputum was the most specimens of Acinetobacter baumannii, accounting for 48.4%. The drug resistance rates of Acinetobacter baumannii to most of the antimicrobial agents were more than 55%. Compound antibacterial is more effective than the single drug ingredient. Compared with other antimicrobial agents, β-lactams/β-lactamase inhibitor compound and carbapenems antimicrobial agents were more sensitive. ConclusionThe drug resistance of Acinetobacter baumannii is serious and has differences among hospitals. Clinicians should monitor the drug resistance of Acinetobacter baumannii timely and choose proper antibiotics according to the results of drug sensitivity.
The issue of bacterial drug resistance has remained unresolved, and in recent years, biomimetic nanostructured surfaces inspired by nature have garnered significant attention due to their bactericidal properties demonstrated through mechanical mechanisms. This article reviewed the main research progress in the field of nanostructured mechanical bactericidal surfaces, including various preparation methods for nanostructured surfaces with mechanical bactericidal properties, as well as the basic mechanisms and related physical models of the interaction between bacteria and nanostructured surfaces. In addition, the application of nanostructured surfaces in biomedicine was introduced. Finally, the article proposed the major challenges faced by mechanical bactericidal research and the future development direction.
Objective To investigate the characteristics of the pathogens causing bloodstream infection after general surgery in infant and young children patients, and to provide the references for disease treatment and nosocomial infection control. Methods The clinical and laboratory examination data after general surgery in infant and young children patients, who were admitted to our hospital from January 2012 to March 2017, were retrospectively collected. The pathogens and drug resistance were analyzed by SPSS 18.0 software. Results In this study, 109 cases were included, and 117 strains of the pathogens were isolated, including 53 isolates (45.3%) of gram negative bacteria, 41 isolates (35.0%) of gram positive bacteria, and 23 isolates (19.7%) of fungi. Escherichia coli (16/117, 13.7%), Enterococcus faecium (13/117, 11.1%), Candida parapsilosis (12/117, 10.3%), Klebsiella pneumoniae (9/117, 7.7%) and Enterococcus faecalis (8/117, 6.8%) were the top 5 species. Strains producing extended-spectrum beta-lactamase accounted for 87.5% of E. coli (14/16) and 44.4% (4/9) of K. pneumoniae isolates. Both E. faecium and E. faecalis were susceptible to vancomycin. C. parapsilosis showed the susceptibility to the antifungal agents. Conclusion Gram negative bacteria are predominant pathogens causing bloodstream infection after general surgery in infant and young children patients, and infection caused by resistant isolates should be prevented and controlled.
【Abstract】Objective To review the advances in overcoming multidrug resistance of tumors caused by mdr1 gene.Methods Different ways of overcoming multidrug resistance of tumors caused by mdr1 gene in the literatures were reviewed. Results One of the important reasons causing multidrug resistance was due to the overexpression of mdr1 gene and its product Pglycoprotein. There were two ways to overcome multidrug resistance of tumors through mdr1 genes mRNA and its product Pglycoprotein effectively.Conclusion The clinical test of the unitary way to overcome multidrug resistance of tumors is unsatisfactory, combining different ways to overcome multidrug resistance of tumors will be the hot spot of tumors research in the future.
ObjectiveTo systematically review the health economic evaluation studies in which externalities of antibacterial drug uses were identified.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect health economic evaluation studies in which externalities of antibacterial drug uses were identified from inception to December 31st, 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Descriptive analysis was then performed.ResultsA total of 14 studies were included. Negative externalities and their impacts on costs and/or effectiveness were examined in 13 literature, and positive externalities in terms of an improvement in disease control were included in only one study. No study was found in which both negative and positive externalities were included. The methods used to quantify negative externalities included: only costs associated with drug resistance per prescription or per unit were calculated; both costs and health impacts associated with the second/third line treatments followed a treatment failure (due to drug resistance) were calculated using a decision tree. In one study in which positive externalities were measured, both health gain and cost reduction from an improvement in disease control (as a benefit of antibacterial drug uses) were calculated by constructing a dynamic model at the population level.ConclusionsWe propose that both the positive and negative externalities should be included in health economic evaluation. This can be achieved by measuring the relevant costs and health impacts in a broader perspective, using a disease-transmission dynamic model. In addition, to achieve an improved health utility measurement, disability-adjusted-life years rather than quality-adjusted-life years should be encouraged for use. Finally, both costs and effectiveness should be discounted.
Antimicrobial resistance is a rigorous health issue around the world. Because of the short turn-around-time and broad pathogen spectrum, culture-independent metagenomic next-generation sequencing (mNGS) is a powerful and highly efficient tool for clinical pathogen detection. The increasing question is whether mNGS is practical in the prediction of antimicrobial susceptibility. This review summarizes the current mNGS-based antimicrobial susceptibility testing technologies. The critical determinants of mNGS-based antibacterial resistance prediction have been comprehensively analyzed, including antimicrobial resistance databases, sequence alignment tools, detection tools for genomic antimicrobial resistance determinants, as well as resistance prediction models. The clinical challenges for mNGS-based antibacterial resistance prediction have also been reviewed and discussed.