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OBJECTIVE： To provide reference for the formulation of primary medication regimen for antibacterial drug treatment of ICU patients with Escherichia coli infection. METHODS： Based on the surveillance report on E. coli resistance in hospitals issued by CHINET China bacterial drug resistance surveillance network in 2016， 19 third class A hospitals in China were collected as E. coli clinically isolated from ICU wards. Antibiotics with resistance rate of less than 40％ to E. coli and with high utilization rate in clinical practice were selected as the research objects， and a simulated drug delivery scheme was formulated. Monte Carlo simulation method was used to simulate the clinical effect of different dosage regimens on 10 000 cases among “patients with E. coli infection” in ICU wards. The target thresholds were ％fT＞MIC＞50％ （piperacillin/tazobactam， cefoperazone/sulbactam），％fT＞MIC＞40％ （meropenem）， fcmax/MIC＞10 （amikacin）. The cumulative response percentage （CFR） to the target threshold requires that CFR be greater than 90％ for the optimal regimen. The results were compared with those of 275 clinical ICU pationts. RESULTS： Four antibiotics were identified， namely cefoperazone/sulbactam， piperacillin/tazobactam， meropenem and amikacin； sixteen medication regimen were simulated， including 1 kind of cefoperazone/sulbactam “3.0 g， q8 h”； 3 kinds of piperacillin/tazobactam “2.25 g， q6 h” “3.375 g， q8 h” and “3.375 g， q6 h”； 2 kinds of meropenem “0.5 g， q8 h” “1.0 g， q8 h”； 3 kinds of amikacin “0.4 g， q24 h” “0.6 g， q24 h” and “0.8 g， q24 h”. Their CFR values were higher than 90％， all of them could be regarded as primary medication regimen. The clinical results were basically consistent with the simulation results. CONCLUSIONS： Above medication regimen of piperacillin/tazobactam， cefoperazone/sulbactam， meropenem and amikacin can be used as initial empirical drug selection for patients with E. coli infection in ICU.
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Objective To analyze the prevalence and clinical characteristics of brucellosis in Liuzhou that is a non-pasture area,and to provide a basis for diagnosis and treatment of brucellosis.Methods Time distribution,population distribution,main symptoms,onset time,serum procalcitonin (PCT),C reactive protein (CRP) and blood routine were analyzed in 20 patients with brucellosis at the Fourth Affiliated Hospital of Guangxi Medical University from January 2013 to December 2016,and the results were compared with those of 35 cases of sepsis.Results A total of 20 cases brucellosis was conformed,13 cases (65.0％,13/20) occurred in 2016,and the incidence was increased year by year.Sixteen cases (80.0％,16/20) had a history of exposure to cattle and sheep.The ages of patients in brucellosis group were younger than those in sepsis group [(46.6 + 10.4) years vs (59.4 + 17.0) years,t =-3.49,P ＜ 0.05],the onset time in brucellosis was longer than those in sepsis group [24.5(14.3-39.8) d vs 7.0 (6.0-12.0) d,U =90.00,P ＜ 0.05].Eight cases (100.0％,8/8) of brucellosis showed that the PCT ＜ 0.5 μg/L,while only 3 cases (8.6％,3/35) in sepsis group,the difference was significant statistically between the two groups (x2 =23.99,P ＜ 0.05).Majority of brucellosis showed that white blood cells (70.0％,14/20),neutrophils (85.0％,17/20),lymphocytes (90.0％,18/20),neutrophil ratio (80.0％,16/20) and lymphocyte ratio (55.0％,11/20) were normal.Compared with the sepsis group,the levels of PCT [0.30(0.19-0.38) μg/L vs 4.70 (1.30-18.28) μg/L,U =0.00,P ＜ 0.05],CRP [24.43 (12.78-45.06) mg/L vs 101.60 (62.63-163.58) mg/L,U =100.00,P ＜ 0.05],white blood cells [5.76 (4.76-7.99) × 109/L vs 12.34 (8.50-16.12) × 109/L,U =91.50,P ＜ 0.05] and neutrophils [3.22(2.49-4.65) × 109/L vs 10.40(7.76-14.05) × 109/L,U =58.00,P ＜ 0.05] in brucellosis were lower,while lymphocytes [1.80(1.26-2.69) × 109/L vs 0.91(0.52-1.36) × 109/L,U =121.50,P ＜ 0.05] were higher.Conclusion The number of patients with brucellosis is increased in a non-pasture area these years,and the PCT,CRP and blood routine are different from those in sepsis,so physicians should pay much more attention to the disease in early diagnosis and treatment.
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OBJECTIVE:To compare anesthesia effects of 3 anesthesia methods,to investigate anesthesia improvement method for bronch fiber oscope. METHODS:315 patients undergoing bronch fiber oscope were randomly divided into group A(106 cas-es),group B(104 cases)and group C(105 cases). Group A was treated with traditional bronch fiber oscope lidocaine atomization local anesthesia,group B was treated with modified bronch fiber oscope pethidine combined with lidocaine atomization local anes-thesia and group C was treated with three-limb tube connected with laryngeal mask and target-controlled propofol and remifentanil general anesthesia. SaO2,SBP,DBP,heart rate,breathing rate,excellent anesthesia rate,compliance rate,the rate of bodymove-ment and choking,pain recalling rate were compared among 3 groups before and during examination,and ADR was observed. RE-SULTS:Compared with before examination,SaO2 of group A was decreased significantly during examination,with statistical sig-nificance(P<0.05);that of group B and C had no obvious change before and during examination. Blood pressure,heart rate and breathing rate of 3 groups had no obvious change before and during examination. The excellent anesthesia rate and compliance rate of group A were significantly lower than those of group B and C,but the rate of bodymovement cough and pain recalling rate were significantly higher than group B and C,with statistical significantly(P<0.05). The excellent anesthesia rate and compliance rate of group B were significantly lower than those of group C,but the rate of bodymovement cough and pain recalling rate were signifi-cantly higher than group C,with statistical significance (P<0.05). No ADR was found in 3 groups. CONCLUSIONS:Modified bronchoscope atomization local anesthesia and modified painless bronchoscope are better than traditional bronch fiber oscope atomi-zation local anesthesia in anesthesia effect,safety,degree of comfort and acceptability. Modified bronchoscope atomization local an-esthesia was best but most expensive,so these methods can be chosen according to patient’s condition.
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Objective To explore the difference of C-reactive protein(CRP)in non-smokers,ex-smokers,and smokers with chronic obstructive pulmonary disease experiencing exacerbations(AECOPD)and the relation of blood white cells in order to study the role of smoking to CRP.Methods Five hundreds and sixty-eight patients with AECOPD were enrolled in the retrospective case-study.Patients were divided into three groups:non-smokers,ex-smokers,and smokers.CRP and WBC were measured to compare their changes.Results Serum CRP levels of three groups were 5.7 mg/L,5.6 mg/L and 5.8 mg/L,respectively;there was no significant difference among them;cigarette smoking had no effect on the raised serum CRP levels;similarity,WBC of theirs were 8.6?109/L,9.1?109/L and 8.5?109/L,respectively;there was also no significant difference among them(P=0.299).There was little relationship between CRP and WBC.Conclusion Serum CRP levels in non-smokers,ex-smokers,and smokers with AECOPD are raised and are independent of cigarette smoking.Maybe CRP is related to infection.