ABSTRACT
Objective To explore the value of the variation of clinical pulmonary infection score (CPIS) and serum procalcitonin (PCT) in diagnosis and treatment evaluation in patients suffering from active pulmonary tuberculosis with complication of ventilator-associated pneumonia (VAP).Methods A retrospective analysis was carried out in 58 VAP patients from June 1,2009 to December 30,2014 in the respiratory intensive care unit.According to the patient suffering from tuberculosis or not,patients were divided into two groups.The PCT and CPIS score changes were observed in the two groups of patients with intra-tracheal intubation 1,3 and 7 days after VAP onset.Comparisons of CPIS and PCT scores were carried out between two groups at different intervals after VAP onset.Data were statistically processed by SPSS 19.0.Count data were tested by x2,and measurement data were expressed by mean ± standard deviation (x-±s).The comparison within the groups was made by t test,whereas the comparison between the groups was by means of repeated measure analysis of variance and Bonferroni test;Pearson linear correlation analysis was used,and P ＜ 0.05 was considered statistically significant.Results At the same observation interval in two groups of patients with VAP,there was no significant difference in the serum levels of PCT and CPIS score (P ＞ 0.05);there were significant differences in PCT and CPIS scores between VAP occurred at the first day,the third day and at time of intra-tracheal intubation in two groups (P ＜ 0.05).However,comparison of PCT and CPIS scores at the seventh day,the differences were not statistically significant (P ＞ 0.05).In addition,at the 7 days the correlation coefficient between PCT and survival patients' mechanical ventilation,days in ICU and total length of hospital stay were 0.92,0.83,and 0.71,respectively,yet the 7-day CPIS score correlation coefficients were 0.83,0.74 and 0.70,(both P ＜ 0.05).Conclusions Early monitoring of serum PCT and CIPS score of pulmonary tuberculosis patients can judge the incidence of VAP,and the variations of PCT and CIPS score can predict the severity and prognosis of the disease as well.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the distribution and drug-resistance of bacteria in the lower respiratory tract in patients with tuberculosis and severe pneumonia receiving invasive mechanical ventilation.</p><p><b>METHODS</b>The clinical data, lower respiratory tract infection pathogens and bacterial drug sensitivity were analyzed in 208 patients receiving invasive mechanical ventilation for tuberculosis and severe pneumonia.</p><p><b>RESULTS</b>A total of 355 pathogenic microbial strains were obtained from the patients, among which 281 (79.2%) strains were Gram-negative bacteria, 62 (17.5%) were fungi, and 12 (3.4%) were Gram-positive bacteria. Mixed infections were found in 68 cases (19.2%). The sensitivity rates of meropenem, imipenem and amikacin were over 60% for Gram-negative bacteria, and those of teicoplanin, vancomycin, and fusidic acid were 100% for Gram-positive bacteria.</p><p><b>CONCLUSION</b>The main pathogenic bacteria are Gram-negative bacteria, fungi and Gram-positive bacteria in the lower respiratory tract of patients with tuberculosis and severe pneumonia receiving mechanical ventilation. Meropenem, imipenem and amikacin are effective antibiotics for lower respiratory tract infections, and multi-drug resistance is frequent in these patients, which urges appropriate use of the antibiotics.</p>