Distribution and drug resistance profiles of pathogenic bacteria isolated from patients with nosocomial infection in intensive care unit / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the distribution and drug sensitivity of pathogenic bacteria isolated from patients with nosocomial infection in intensive care unit.</p><p><b>METHODS</b>The clinical data were collected from 229 hospitalized patients with nosocomial infection in intensive care unit from 2009 to 2011.</p><p><b>RESULTS</b>Gram-negative bacteria were the main pathogens (68.25%) in the intensive care unit. From 2009 to 2011, the annual isolation rate of multidrug-resistant baumannii showed a significant reduction with time (39.13%, 18.18%, and 15%, respectively, P<0.05), while the prevalence of multidrug-resistant Pseudomonas aeruginosa, ESBLs-producing Escherichia coli and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, coagulase-negative staphylococci methicillin-resistant strains showed no significant changes in the 3 years (P>0.05). The overall sensitivity of gram-negative bacilli to the antimicrobial agents tended to increase with time. The Gram-negative bacilli remained highly sensitive to carbapenems, tigecycline, amikacin and piperacillin/tazobactam; the Gram-positive bacilli were highly sensitive to vancomycin, quinoline Nupu Ting/dalfopristin, linezolid, and tigecycline with sensitivity rates all reaching 100%.</p><p><b>CONCLUSION</b>Adherence to the principles of antibiotic use and effective monitoring and preventive measures are encouraged to reduce antibiotic resistance rates of the bacteria and the incidences of hospital infection.</p>

Clinical application of the modified Epworth Sleepiness Score in the gestation women combined with obstructive sleep apnea-hypopnea syndrome / 中国基层医药

Objective Screening OSAHS patients on pregnancy with Modified Epworth Sleepiness Scale( Epworth sleepiness scale,ESS)and to assess its effect. Methods 22 patients underwent the pregnancy,and pregnancy with OSAHS( mild in 23 cases,22 cases of moderate and severe in 19 cases)group were 64 people, By ESS and modified ESS score, EP and modified EP values was derived. The neck circumference ( NC), body mass index (BMI) was measured. Conduct of polysomnography ( PSG), apnea hypopnea index ( AHI ) and lowest oxygen saturation ( LSaO2 )ESS and modified ESS correlation with the AHI was analyzed and ROC curves was drawn. Results The EP value of pregnancy with mild OSAHS group has no significant difference between normal pregnancy group( P ＞ 0.05) ;the rest of pregnancy OSAHS group modified EP, EP values and the normal pregnancy group were significantly different ( all P＜0.05) ;modified EP, EP, NC, BMI values positively correlated with the AHI value, the correlation coefficient r were :0.876,0.748,0.671,0.670 ( all P ＜ 0.001 ) ;modified EP, EP, NC, BM I of the A UC values were 0.901,0.819,0.750, 0.779; when the modified EP = 8.5, had higher sensitivity ( 84.4% ) and specificity ( 90.9% ).Conclusion Modified ESS on pregnancy OSAHS patients had better clinical value of screening.

Analysis of the cause and clinical characteristics of maternal cardiac arrest / 中华妇产科杂志

Objective To analyze the cause and clinical characteristics of maternal cardiac arrest.Methods The data of all cases of maternal cardiac arrest from January 2005 to December 2009 in Third Affiliated Hospital of Guangzhou Medical College was retrospectively studied.Results ( 1 ) A total of 41 maternal cardiac arrests (6 in prenatal period,2 in the first stage of labor,7 in the third stage of labor,26 in postpartum period ) were included.All patients regained spontaneous circulation after basic life support.Twelve (29％) mothers survived.Twelve cardiac arrests occurred in the hospital,and the totaldelivery number from January 2005 to December 2009 was 17101,with occurrence rate of 1:1425.(2) Thecauses of arrest were hemorrhagic shock (12,29％),amniotic fluid embolism (7,17％),severepreeclampsia/eclampsia (7,17％),septic shock (6,15％),cardiac disease (2,5％),unidentified cause (2,5％ ) and other occasional causes.(3) Thirty-seven (90％) in-hospital maternal cardiac arrest occurred in operation room (16,39％ ),ICU (7,17％ ),maternity wards (6,15％ ),delivery room (5,12％ ) and the emergency room (3,7％ ).Three (7％) arrest occurred out of hospital and one in the ambulance.Matemal survival rate was 2/3 in the emergency room,8/16 in the operation room,1/5 in the maternity wards,and 1/6 in the delivery room.No mother survived in ICU,ambulance or out of hospital.(4) Five of the 12 survived women showed ischemic encephalopathy after cardiac arrest and one of them developed cerebral infarction in the right corona radiate.(5) In 4 of the 8 cases of cardiac arrest in pregnancy,perimortem caesarean section (PMCS) was performed.In the four PMCS,2 mothers and 2 children survived.In the 4 cases that PMCS was not carried out,no infant survived.Conclusions Hemorrhagic shock,severe preeclampsia and eclampsia,amniotic fluid embolism are the major obstetric causes of maternal cardiac arrest.Septic shock and cardiac diseases are the major non-obstetric causes.Cardiac arrests occurred in emergency room and operation room has a higher maternal survival rate than those occurred in the delivery room and maternity wards.Timely PMCS may ensure the optimal outcome for mothers and fetuses.

Re-exploration after peripartum hysterectomy in postpartum hemorrhage / 中华围产医学杂志

Objective To analyse the causes and clinical characteristics of re-exploration after peripartum hysterectomy due to postpartum hemorrhage. Methods Clinical data was analysed retrospectively including 88 critically ill obstetric patients who underwent peripartum hysterectomy due to postpartum hemorrhage in the Obstetric Critical Care Center of Guangzhou from January 1999 to July 2009, which were divided into re-explored group (n= 14) and non-re-explored group (n=74)depending on whether the patient underwent re-exploration after peripartum hysterectomy. The main demographic data and clinical details were compared between the two groups, including mode of delivery, indication and type of hysterectomy, interval from hysterectomy to re-exploration, surgical intervention, complications, blood loss, blood transfusion,Glasgow Coma Score(GCS), the need for mechanical ventilation, intensive care unit stay and hospital stay. Results Fourteen out of the 88 (15.91%) patients underwent re-exploration due to internal bleeding after peripartum hysterectomy.Removal of cervical stump was performed in five patients and stump hemostasis in eight cases.Significant difference was found between the re-exploration and non-re-explored group on thepercentage of patients complicated with disseminated intravascular coagulation(92.9% vs 43.2%,x2=11.598,P=0.001) and amniotic fluid embolism (28.6% vs 2.7%, x2 =8.663, P=0.003).0.000], blood transfusion [(8163.6± 3903.1 ) ml vs (2958.8± 2323.0) ml, P = 0.000], intensive care unit admission rate (100.0% vs 41.9%, x2 = 15.909, P= 0.000), the need for mechanical ventilation (100.0% vs 24.3%,P=0.000), the number of patients with GCS≤8 score (71.4% vs 25.7% ,x2 = 9.179, P = 0.002 ), the number of multiple organ dysfunction syndrome ( 71.4% vs 14.9%, x2 = 17.735, P = 0.000), intensive care unit stay [ ( 11.4 ± 10.0 ) d vs ( 1.3 ± 2.3 ) d, P =0.000] and hospital stay[(24.0±13.1) d vs (12.7±7.0) d, P=0.000]. Allof the 14 cases were clinical recovered before discharge. Conclusions The rate of re-exploration after peripartum hysterectomy is not low, and internal bleeding is the most common causes. The re-exploration after peripartum hysterectomy might be associated with coagulopathy and the mode of hysterectomy, and patients may experience more severe complications.

Clinical outcomes and characteristics of concurrent eclampsia and hemolysis, elevated liver enzymes,and low platelets syndrome / 中华妇产科杂志

Objective The purpose was to describe the outcomes and characteristics of the obstetric patients with concurrent eclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP) syndrome. Methods We retrospectively collected the materials between December 1999 and December 2008 in Obstetric Critical Care Center of Guangzhou. There were 76 patients in rolled then they were divided into two groups according to with or without HELLP syndrome. All the patients were injected Magnesium Sulfate to control seizure and to prevent the recurring of seizure. We analyzed the characteristics (such as age, gestational weeks, blood pressure after seizure), complications, biochemistry markers, the rate for intensive care unit (ICU) admittion, the need for mechanical ventilation, the Glasgow coma score (GCS) when admitted into ICU, computed tomography scan (CT) or magnetic resonance imaging (MRI),death rate of maternal and others, then compared between the two groups. Results ( 1 ) General data:There were 17 patients admitted with both eclampsia and HELLP syndrome, and 59 patients admitted eclampsia without HELLP syndrome. The incidence of eclampsia with HELLP syndrome was 22% (17/76).In eclampsia with HELLP syndrome group, the systolic blood pressure was higher and the rate of preterm also was higher [ (182 ± 20) mm Hg (1 mm Hg=0. 133 kPa)vs. (159± 21 ) mm Hg, P ＜ 0. 05 ]. But in regard to the age, gestational weeks, the rate of regular prenatal care and diastolic blood pressure, there were no differences between the two groups. (2) Biochemistry markers: the aspartate transaminase (AST), lanine transaminase (ALT), blood urea nitrogen and creatinine were significantly increased in eclampsia with HELLP syndrome group than eclampsia without HELLP syndrome group [ (879 ± 337) U/L vs. (90 ± 27)U/L, (344 ±83) U/Lvs. (43 ±11)U/L, (2245 ±294) U/L vs. (485 ±61)U/L, (14 ±9) mmol/L vs.(7 ± 3) mmol/L, ( 140 ± 92) μmol/L vs. (83 ± 28 ) μmol/L, P ＜ 0. 01, P ＜ 0. 05 ], and the platelet was lower in eclampsia with HELLP syndrome group [ (38 ± 13) × 109/L vs ( 172 ±46) × 109/L, P ＜0. 01 ].(3) Clinical outcomes: The maternal death rate was 35% (6/17) in eclampsia with HELLP syndrome patients, and significantly higher than the rate in eclampsia without HELLP syndrome group (3%, 2/59)(P ＜ 0. 05 ). There were more patients admitted to ICU and more patients who need mechanical ventilation in eclampsia with HELLP syndrome (13/17 vs. 34%, 9/17 vs. 24/, P ＜0. 05), also more patients with GCS ≤8 in eclampsia with HELLP syndrome when admitted to ICU ( 8/17 vs. 7/59, P ＜ 0. 05 ), compared to the eclampsia without HELLP syndrome group. There were more patients complicated with cerebral venous thrombosis and cerebral hemorrhage in eclampsia with HELLP syndrome group than other group (8/17 vs.7%, P ＜ 0. 05 ). Five of six patients died of cerebral hemorrhage in eclampsia with HELLP syndrome group,while other two missing cases in eclampsia without HELLP syndrome group all died of cerebral hemorrhage.The all missing cases were performed CT or MRI and seven (7/8) of them showed cerebral hemorrhage.Conclusion The incidence of concurrent eclampsia and HELLP syndrome was not rare, it happened seriously and with more mortalities, such as cerebral hemorrhage, and also the maternal mortality rate was significantly higher. It should be warning that the obstetrician should take great attention for these women,and consider life support treatment for them.