Antibiotic Resistance among Gram-negative Bacilli in Intensive Care Unit Patients with Lower Respiratory Tract Infection / 中华医院感染学杂志

OBJECTIVE To investigate the antimicrobial resistances of Gram-negative bacilli isolated from patients with lower respiratory infection in intensive care unit(ICU),so as to provide reasonable selections for antibiotic in clinical treatment.METHODS The phlegm specimens from ICU inpatients with lower respiratory tract infection were collected from 2004 to 2007,and drug sensitivity test was performed according to NCCLS standards.RESULTS Gram-negative bacilli were accounted for 75.2% of total strains.The most predominant pathogens were Pseudomonas aeruginosa(42.7%),Acinetobacter baumannii(16.3%),Sternotrophomonas maltophilia(10.4%),Escherichia coli(10.0%),and Klebsiella pneumoniae(6.7%).The prevalence of ESBLs in E.coli and K.pneumoniae increased from 54.5% and 37.5 % in 2004 to 65.6 % and 52.7% in 2007.ESBLs non-producing strains showed lower resistance rates to the aminoglycosides,quinolones and the third and fourth generation cephalosporin than those of ESBLs producing strains.Nonfermentative Gram-negative bacilli were very highly resistant to most antimicrobial agents.CONCLUSIONS The drug resistance rates of Gram-negative bacilli of lower respiratory tract are serious.It is important to investigate the antimicrobial resistances of pathogenic bacteria and rationally use of antibiotics.

A clinical study of mechanical ventilation in the treatment of acute respiratory failure following abdominal surgery / 中国普通外科杂志

Objective To explore the predisposing factors in the development of acute respiratory failure after abdominal surgery and the factors affecting the therapeutic effect of mechanical ventilation. Methods A (retrospective) study was undertaken for acute respiratory failure after abdominal surgery in 91 patients. The (underline) diseases, introducing causes and efficacy of mechanical ventilation were retrospectively analysed. (Results) Postoperative pneumonia was the cause of acute respiratory failure in 53 cases and ARDS caused by severe abdominal infection and severe acute pancreatitis in 38 cases. Of the 91 cases, complicated with COPD in 38 cases, severe malnutrion 32 cases, and hypokalemia 14 cases. Respiratory failure occurred at(4.08?2.45)days after operation. The duration of mechanical ventilation was(21.66?21.42)days; 33 cases died, and 58 cases were successfully recovered with mechanical ventilation.Conclusions The (management) of acute respiratory failure after abdominal asurgery should be rational use of mechanical (ventilation), adjustment of weaning strategy and avoidance of dependance on mechanical ventilation. Timely treatment of the primary disease, effective control of abdominal infection and aggressive symptomatic and (supportive) treatment are factors that affect the success or failure of mechanical ventilation.

Effect of total parenteral nutrition with glutamine on the plasma endotoxin in the MODS patients / 肠外与肠内营养

Objective:To determine the effect of total parenteral nutrition(TPN) supplemented with glutamine(Gln) on the concentration of plasma lipopolysaccharide(LPS)of the multiple organ dysfunction syndrome(MODS) patients.Methods:40 MODS patients in the ICU were randomly divided into routine group(Group A,n=20),the Gln+TPN treatment Group (Group B,n=20).The two groups of patients received treatment of parenteral nutrition with equal nitrogen and equal calorie.Group A were given routine TPN,and Group B were given routine TPN and Gln 0.27 g/(kg?d)[i.e.dipeptiven 0.4 g/(kg?d)] for seven days.The concentration of plasma Gln and LPS were checked before the treatment of TPN and on the first,the third and the seventh day after the treatment of TPN.At the same time 20 healthy blood donators were chosen as the healthy control group(Group C).Results:Before treatment the concentration of plasma Gln of the two patient groups were both lower than that of Group C(P0.05).On the first,the third and the seventh day of the treatment of TPN,the concentration of plasma Gln of Group A was lower than that of Group B(P0.05).After the treatment of Gln plus TPN,the concentration of plasma LPS of Group B was lower than that of Group A(P0.05).Conclusion:The Gln(dipeptiven) can help to decrease the concentration of plasma LPS and the TPN treatment time of the MODS patients.

Analysis of central venous catheter related sepsis / 肠外与肠内营养

Objectives: To investigate the distribution of common pathogens and their antibiotic resistance from patiens with catheter related sepsis (CRS).Methods: Catheter bacteria cultrure and antibiotic sensitivity test were performed from 69 patiens with CRS.Results: The common pathogens in CRS were fungi (41.1%),Gram-positive cocci (35.6%)and Gram-negtive bacilli (23.3%). Non-C. albicans species were major pathogen (19/30 stranins).The most strains were staphylococcus epidermidis in Gram-positive cocci and the most of them were Methicillin resistant.No vancomycin resistant strains were found. The Gram negative bacilli were often resistant to third generation cephalosporens.Conclusions: The dorminant pathogens of CRS are fungi and gram positive cocci and we should pay more attention to pathogens of resistence to antibiotics. In order to control CRS, CVC must be used reasonably and shorten the duration of retention.