ABSTRACT
Polymyxin B, which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections, became available in China in Dec. 2017. As dose adjustments are based solely on clinical experience of risk toxicity, treatment failure, and emergence of resistance, there is an urgent clinical need to perform therapeutic drug monitoring (TDM) to optimize the use of polymyxin B. It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use. We report a consensus on TDM guidelines for polymyxin B, as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society. The consensus panel was composed of clinicians, pharmacists, and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations, sample collection, reporting, and explanation of TDM results. The guidelines provide the first-ever consensus on conducting TDM of polymyxin B, and are intended to guide optimal clinical use.
Subject(s)
Humans , Anti-Bacterial Agents/therapeutic use , China , Drug Monitoring/methods , Polymyxin B , Practice Guidelines as TopicABSTRACT
Objective:To Investigate the correlation of eosinophil count and stroke-associated pneumonia (SAP) in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke within 24 h after onset admitted to the Department of Encephalopathy, Suzhou Integrated Traditional Chinese and Western Medicine Hospital from August 2016 to September 2018 were enrolled prospectively. Their general clinical data and eosinophil counts were collected. National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of stroke. Multivariate logistic regression analysis was used to determine the independent risk factors for SAP. Results:A total of 521 patients were enrolled, including 106 (20.35%) SAP. Univariate logistic analysis showed that SAP was associated with the classification of eosinophil count (odds ratio [ OR] 0.37, 95% confidence interval [ CI] 0.20-0.68; P=0.001), and tended to be associated with eosinophil count ( OR 0.08, 95% CI 0.01-1.01; P=0.051). Multivariate logistic regression analysis showed that both eosinophil count and eosinophil count classification were not the independent risk factors for SAP, and advanced age ( OR 1.077, 95% CI 1.045-1.109; P< 0.001), chronic obstructive pulmonary disease ( OR 6.931, 95% CI 1.295-37.106; P=0.024) and high baseline NIHSS score ( OR 1.148, 95% CI 1.003-1.314; P=0.045) were significantly independently associated with SAP. Conclusions:Eosinophil count was not an independent predictor of SAP in patients with acute ischemic stroke.
ABSTRACT
Objective To investigate the relationship between cytochrome P 450 (CYP)2C19*2 / *3 gene polymorphism and antiplatelet effect of clopidogre in patients with ischemic stroke. Methods A total of 102 consecutive patients with acute ischemic stroke admitted to the Suzhou Integrated Traditional and Western Medicine Hospital from November 2012 to February 2014 were enrolled. The patients allergic to clopidogre,intolerant to clopidogrel,and recently using clopidogre were excluded. The patients were divided into a strong metabolic type group (n = 39),a moderate metabolic type group (n = 54),and a week metabolic type group (n = 9)according to the conditions of CYP2C19*2 and *3 locus mutation. The genotypes of the CYP2C19*2 and *3 were detected by the direct gene sequencing method in all patients. The maximum aggregation ratio (MAR)of platelet and platelet reactivity index (PRI)were detected beforeand 7 d after taking clopidogre 75 mg. Results (1)According to the CYP2C19*2 and CYP2C19*3, the genotyping was performed. The strong metabolic type group included *1 / *1 type 39 cases (38. 2%);the moderate metabolic type group included *l / *2 type 44 cases (43. 1%);*l / *3 54 cases, 10 (9. 8%);and the week metabolic type group included *2 / * type 27 cases (6. 9%);*2 / *3 type 2 cases (2. 0%). No *3 / *3 type was detected. (2)There were no significant differences in MAR before taking clopidogrel among the 3 groups (all P > 0. 05). After taking clopidogrel for 7 days,MAR and PRI were detected from strong to weak,followed by the week metabolic type group (49 ± 12% vs. 64 ± 15%), the moderate metabolic type group (42 ± 13% vs. 56 ± 14%),and the strong metabolic type group (33 ± 10% vs. 43 ± 12%);MAR was detected from high to low,followed by the strong metabolic type group (20 ± 12%),the moderate metabolic type group (10 ± 8%),and the week metabolic type group (7 ± 3%). Comparing the moderate metabolic type group and the week metabolic type group with the strong metabolic type group,there were significant differences between MAR,the decreased MAR and PRI (all P 0. 05). Conclusion The CYP2C19*2 and *3 gene polymorphisms may affect MAR and PRI after taking clopidogrel in patients with ischemic stroke.
ABSTRACT
ObjectiveTo understand anorectal diseases in health in the crowd incidence,clinical and prevention work for anus bowel division provides scientific basis.Methods7102 cases of physical examination for the anus bowel specialized examination,on examination results,statistics,and with the anus bowel disease census results were compared and analyzed.Results7102 cases were detected in anus bowel disease was 4758 cases,the total incidence of 67.0％,including 4119 cases of hemorrhoids,1138 cases of anal papilla,227 cases of rectal polyp,201 cases of anal fissure,113 cases of perianal skin disease,94 cases of anal fistula and one case with rectal cancer.male anus bowel disease(62.3％ ) were less than women(73.2％ ) ( x2 =93.4,P ＜ 0.01 ),young group of incidence of a disease(59.0％ ) in the lower than the elderly group(77.7％ ) ( x2 =274.4,P ＜ 0.01 ).ConclusionAnorectal diseases in normal higher incidence in the crowd,carry out standardized anus bowel disease census of disease prevention and cure had relatively positive significance.