ABSTRACT
Objective:To investigate the related risk factors for the prognosis of hospital-acquired carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections in elderly patients with critical illness.Methods:Clinical data of elderly patients with nosocomial CRKP bloodstream infection in intensive care unit (ICU) from Jan. 2010 to Dec. 2016 were retrospectively analyzed. Patients were divided into the death and survival groups according to the prognosis. Clinical characteristics were compared between the two groups. Influencing factors for the prognosis of nosocomial CRKP bloodstream infections in elderly ICU patients were screened by multivariate Logistic regression analysis.Results:A total of 119 elderly ICU patients with nosocomial CRKP bloodstream infection were enrolled. The overall ICU mortality rate was 62.2% (74/119 patients), among which the ICU mortality was lower in patients treated with tigecycline than without tigecycline treatment (50.0% or 25/50 vs. 71.0% or 49/69, χ2=4.770, P=0.029). And the ICU mortality was lower in patients with combination therapy than with mono-therapy (54.9% or 39/71 vs. 72.9% or 35/48, χ2=3.940, P=0.047). Multivariate Logistic regression analysis revealed that the administration of vasoactive drugs ( OR=25.545, 95% CI: 9.743-52.242, P=0.001), and the resistance to tigecycline ( OR=8.990, 95% CI: 0.957-24.488, P=0.049) were independent risk factors for ICU mortality. While the early initiated appropriate antibiotics treatment, which was defined as using at least one susceptible antibiotic within 48 hours ( OR=0.081, 95% CI: 0.014-0.463, P=0.005), and appropriate antibiotics and adequate duration ( OR=0.785, 95% CI: 0.631-0.977, P=0.030), were protective factors for the good outcome. Conclusions:Nosocomial CRKP bloodstream infection in elderly ICU patients leads a high ICU mortality rate. The early initiated appropriate antibiotics treatment and optimum antibiotics duration could reduce the risk for death.
ABSTRACT
Objective To evaluate the role of spinal nicotinamide-adenine dinucletide phosphate (NADPH) oxidase in the development and maintenance of neuropathic pain (NP) in rats.Methods Twenty-four pathogen-free healthy male Sprague-Dawley rats,aged 200-250 g,were divided into 3 groups (n =8 each) using a random number table:sham operation group (S group),NP group and NADPH oxidase inhibitor group (NI group).The left sciatic nerve was exposed but not ligated in group S.The left sciatic nerve was exposed and 4 loose ligatures were placed on the sciatic nerve at 1 mm intervals with 4-0 silk thread to establish the NP model in group NP.In group NI,the NP model was established at 3 days after intrathecal catheterization,and NADPH oxidase inhibitor 5 μg/10 μ1 was injected intrathecally once a day for 7 consecutive days starting from 30 min before operation.The mechanical paw withdraw threshold (MWT) was measured at 1 day before operation and 1,3,5 and 7 days after operation.The rats were sacrificed at 8 days after operation,and the spinal cord was removed for determination of NeuN positive cells (by immuno-histochemistry) and expression of NADPH oxidase (by Western blot).Results Compared with group S,the MWT at each time point after operation and ratio of NeuN positive cells at 8 days after operation were significantly decreased in NP and NI groups,the expression of NADPH oxidase was upregulated in group NP,and the expression of NADPH oxidase was down-regulated in group NI (P＜0.05).Compared with group NP,the MWT at each time point after operation and ratio of NeuN positive cells at 8 days after operation were significantly increased,and the expression of NADPH oxidase was down-regulated in group NI (P＜0.05).Conclusion Up-regulated expression of spinal NADPH oxidase is involved in the development and maintenance of NP in rats.