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Objective:To analyze the clinical characteristics, therapeutic options and risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection, and to provide evidence for clinical treatment option and prognosis evaluation of CRAB bloodstream infections. Methods:A retrospective study was carried out in 224 patients with confirmed diagnosis of CRAB bloodstream infection during the period from January 2012 to December 2017 in West China Hospital, Sichuan University. The patients were divided into the death group and the survival group according to the survival status 28 days after collecting blood samples. The clinical features and therapeutic options of antibacterial drugs were reviewed. Student′s t test was used for analyzing normally distributed data and Mann-Whitney U test for non-normal data.Chi-square test was used for categorical variables. Univariate and multivariate logistic analysis were used to analyze the risk factors of mortality associated with CRAB bloodstream infection. Results:Among 224 cases of CRAB bloodstream infection, 121 cases died (54.02%). These patients were mainly in intensive care unit (ICU) and hematology department. The common underlying diseases were severe acute pancreatitis and severe cardiovascular events. The interleukin (IL)-6 level (median (interquartile range)) in the death group (480.40 ng/L (1 432.95 ng/L)) was higher than that of the survival group (107.05 ng/L (263.08 ng/L)), the difference was statistically significant ( Z=4.526, P<0.01). The procalcitionin (PCT) levels in the death group and the survival group were 3.81 μg/L (17.26 μg/L) and 2.12 μg/L (12.74 μg/L), respectively, with no difference between the two groups ( P>0.05). The death rate of empirical treatment with a single or more non-active antimicrobial agents was 57.14% (64/112), that of monotherapy with active agent was 45.68% (37/81), and that of combination therapy with at least one active drug was 64.52% (20/31). The differences had no statistical significance ( P=0.130). The logistic regression analysis showed that the risk factors of mortality associated with CRAB bloodstream infection were renal dysfunction (odds ratio ( OR)=2.181, P=0.024) and multiple organ dysfunction syndrome (MODS; OR=20.376, P<0.01). Conclusions:The fatality rate of patients with CRAB bloodstream infection is high. These patients with renal dysfunction or MODS have poor prognosis. In addition to early effective antibacterial therapy, individual comprehensive treatment should be implemented in order to improve the curative effect.
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Gram-negative bacteria are the common pathogens causing nosocomial infections.The drug resistance of gram-negative bacteria has become increasingly serious in last two decades.Carbapenems were once considered as the last line of defense against serious infections of gram-negative pathogens.As carbapenemase-producing strains are spreading, the incidence of infections caused by carbapenem-resistant isolates is increasing worldwide.The pathogens are usually multiple drug resistant strains or extensively drug resistant strains, and effective treatment options are limited, even there are no more drugs in certain conditions.This article focuses on appropriate antibiotics and therapeutic strategies for effective control of infections with carbapenem-resistant gram-negative pathogens.
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Objective To analyze the clinical characteristics of patients with L isteria septicemia for better clinical diagnosis and management of the disease .Methods A retrospective study was carried out in 13 patients with confirmed diagnosis of Listeria septicemia from July 2009 to November 2013 in West China Hospital of Sichuan University .The clinical features ,laboratory tests ,treatments and clinical outcomes were reviewed and analyzed . Results The vast majority of the 13 patients were immunocompromised or with critical organ dysfunction . The in vitro antimicrobial susceptibility testing indicated that penicillin ,ampicillin and levofloxacin were the most active agents against Listeria ,followed by imipenem ,erythromycin , ciprofloxacin and tetracycline .Only 33 .3% of the 13 Listeria isolates were sensitive to oxacillin .Eight patients were cured ,2 improved ,2 died after therapy .The remaining one patient gave up therapy .Conclusions The incidence of Listeria septicemia was associated with advanced age and presence of underlying diseases .Early etiology diagnosis and appropriate antibacterial therapy can improve the outcome of such patients .Actively treating underlying diseases helps reduce the mortality rate .
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Objective:To explore yhe therapeutic effect of Shenfu injection on patients of hepatic cirrhosis with seroperitoneum(yang de ciency of spleen and kidey synndrome).Methods:The 84 patients were divided into treatment group and control group,the patients in treatment group were treated with western medicine and Shenfu injection,only western medicine were used in control group,they were all treated for twenty-eight days.Results:The curative e ect,extinction time of seroperitoneum,amelioration of hepatic function and blood routine of the treatment group were better than those of control group.And there were statistical signi canc between two groups(P