ABSTRACT
Objective:To analyze the differences and similarities of pre-treatment and post-treatment lung microbiome of acute respiratory distress syndrome (ARDS) and find out the change rules of the lung microbiome in the progression of ARDS according to different prognosis.Methods:A retrospective study was conducted. Patients with ARDS caused by severe pneumonia admitted to intensive care unit (ICU) of Jiangmen Central Hospital from February 2019 to January 2020 were enrolled as the study subjects. The patients were divided into pre-treatment (ARDS-preT) group (24 cases), post-treatment survival (ARDS-poT-Survival) group (17 cases), and post-treatment death (ARDS-poT-Dead) group (7 cases). ICU patients with mild pulmonary infection and non-ARDS admitted to ICU during the same period were enrolled as control group (25 cases). The similarities and differences of lung microbiome in four groups were analyzed and compared, and the possible pathogenic bacteria (potential risk factors for death) and probiotics (potential survival and protective factors) related to death caused by ARDS were screened.Results:In terms of pathogenic microorganisms, the positive rates of Escherichia coli and Candida albicans in the ARDS-poT-Dead group were significantly higher than those in the ARDS-poT-Survival group [57.1% (4/7) vs. 5.9% (1/17) and 57.1% (4/7) vs. 0% (0/7), both P < 0.05]. In the screening of background bacteria, the decrease of bacteria in the ARDS-preT group compared with the ARDS-poT-Survival group, the ARDS-poT-Dead group compared with the ARDS-poT-Survival group, the ARDS-poT-Dead group compared with the control group, the reduced bacteria might be pulmonary probiotics (potential protective factor for ARDS). The screening result was Hydrobacter [ARDS-preT group vs. ARDS-poT-Survival group: 62.5% (15/24) vs. 94.1% (16/17); ARDS-poT-Dead group vs. ARDS-poT-Survival group: 14.3% (1/7) vs. 94.1% (16/17); ARDS-poT-Dead vs. control: 14.3% (1/7) vs. 96.0% (24/25), all P < 0.05]. In the screening of background bacteria, the increase of bacteria in the ARDS-poT-Dead group compared with the ARDS-preT group, the ARDS-poT-Dead group compared with the ARDS-poT-Survival group, the ARDS-poT-Dead group compared with the control group, and the increased bacteria might be potential pulmonary pathogen (potential risk factor for death of ARDS), which belonged to Enterobacteria: Edwardsiella, Enterobacteriaceae, Escherichia, Klebsiella, Kluyvera, Lelliottia, Pantoea, Raoultella. Conclusions:The results revealed the increase of Escherichia coli or Candida albicans in pulmonary pathogenic microorganisms, or the increase of Enterobacteria in background bacteria may be the risk factors for the death of ARDS. Additionally, background bacteria Hydrobacter probably is a protective factor for the survival of ARDS. Whether it can be used as a novel treatment for ARDS is worth further investigation.
ABSTRACT
Objective To evaluate clinical efficacy of tigecycline alone or in combination with other antimicrobials in treating infection caused by carbapenem-resistant Acinetobacter baumannii (CRAB).Methods Patients with hos-pital-acquired pneumonia (HAP)and/or bloodstream infection in the intensive care unit of a hospital between Janu-ary 2013 and June 2014 were selected,efficacy of tigecycline treatment was analyzed.Results Of 25 patients with CRAB infection,21 were with HAP,2 with bloodstream infection,and 2 with both HAP and bloodstream infec-tion.13 cases were multidrug-resistant Acinetobacter baumannii (MDRAB), 10 cases were extensively drug-resistant Acinetobacter baumannii (XDRAB).The susceptibility rate of 25 CRAB isolates to tigecycline was 84%. After treated with tigecycline,white blood cell count(WBC),C-reactive protein (CRP),and procalcitonin (PCT) all significantly decreased (all P<0.01).The clinical effective rate,bacterial clearance rate,and 30-day mortality were 68.00% (17/25),66.67%(14/21),and 28.00% (7/25)respectively;effective rate of 21 cases of HAP was 76.19% (16/21),1 case of bloodstream infection was effective,2 cases of HAP combined bloodstream infection died.Conclusion Tigecycline is effective in the treatment of HAP caused by CRAB,but the therapeutic effect on bloodstream remains uncertain,further research is needed.
ABSTRACT
Objective To study the mierovessel density (MVD) marked by CD105 and expression of survivin gene in pathologic scar, and to investigate the function of oncogenes in tumorigenic process and abnormal scarring. Methods In situ hybridization and immunohistoehemical methods (SP technique) were used to detect survivin mRNA, CD105-MVD in 40 pathologic scar cases, 20 normotrophic scar cases, and 20 normal skin cases, respectively. The relationship between the expression of survivin mRNA and CD105-MVD in 40 pathologic scar cases were analyzed. Results Compared with normotrophic scar and normal skin cases, the expression of survivin mRNA, CD105-MVD were significant difference in pathologic scar cases (P<0.05). In pathologic scar tissue, the expression of survivin had significant correlation with MVD marked by CD105 (P<0.05). Conclusion survivin is up-regulated in pathologic scar, which may contribute to the vascular formation.