Clinical Features of Infection in Newly Diagnosed Patients with Myelodysplastic Syndrome and Its Correlation with Curative Effect / 中国实验血液学杂志

OBJECTIVE@#To explore the characteristics of infection in patients with myelodysplastic syndromes (MDS), risk factors of serious infection, and their correlation with curative effect.@*METHODS@#The clinical data of 92 newly diagnosed MDS patients with nosocomial infection from January 2016 to June 2020 in our hospital were retrospectively analyzed.@*RESULTS@#A total of 306 courses of treatment were completed in 92 newly diagnosed MDS patients. The infection rate was the highest in the first course of treatment (84.8%, 78/92), and then decreased gradually. The top three infection sites were lung, upper respiratory tract, and gastrointestinal tract. A total of 90 strains of pathogenic bacteria were detected, of which 33.4% (30/90) were gram-negative bacilli, 23.3% (21/90) were gram-positive cocci, 23.3% (21/90) were fungi, and 20.0% (18/90) were viruses. The serious infection rate among 92 patients with MDS was 22.8% (21/92). Multivariate analysis showed that neutrophil deficiency>7 days (OR=10.875, 95%CI: 2.747-43.051, P=0.001) was an independent risk factor for serious infection in MDS patients. Compared with non-severe infection group, the total effective rate of severe infection group was lower (90.9% vs 63.6%, χ2=4.393, P<0.05).@*CONCLUSION@#The infection rate of MDS patients is high in the first course of treatment, and the most common infection site is the lung. Gram-negative bacteria is the most common pathogen. MDS patients with neutrophil deficiency>7 days have a high risk of serious infection and poor efficacy.

Value of heparin-binding protein in the diagnosis of severe infection in children: a prospective study / 中国当代儿科杂志

OBJECTIVES@#To study the value of heparin-binding protein (HBP) in the diagnosis of severe infection in children.@*METHODS@#This study was a prospective observational study. The medical data of children who were admitted to the pediatric intensive care unit due to infection from January 2019 to January 2020 were collected. According to the diagnostic criteria for severe sepsis and sepsis, the children were divided into a severe sepsis group with 49 children, a sepsis group with 82 children, and a non-severe infection group with 33 children. The three groups were compared in terms of related biomarkers such as plasma HBP, serum C-reactive protein, serum procalcitonin, and platelet count. The receiver operating characteristic (ROC) curve was plotted to investigate the value of plasma HBP level in the diagnosis of severe infection (including severe sepsis and sepsis).@*RESULTS@#The severe sepsis and sepsis groups had a significantly higher plasma HBP level on admission than the non-severe infection group (P<0.05). Compared with the sepsis and non-severe groups, the severe sepsis group had significantly higher serum levels of C-reactive protein and procalcitonin and a significantly lower platelet count (P<0.05). Plasma HBP level had an area under the ROC curve of 0.590 in determining severe infection, with a sensitivity of 38.0% and a specificity of 82.4% (P<0.05).@*CONCLUSIONS@#There is an increase in plasma HBP level in children with severe infection, and plasma HBP level has a lower sensitivity but a higher specificity in the diagnosis of severe infection and can thus be used as one of the markers for the judgment of severe infection in children.

A case of severe hookworm infection / 中南大学学报(医学版)

With the improvement of sanitation, the infection rate of hookworm is greatly reduced and the severe infected case is rarely reported. Combined morphological and molecular biological examinations, a severe hookworm infection patient was diagnosed in Department of Laboratorial Examination, Quanzhou First Affiliated Hospital of Fujian Medical University. The morphological methods such as direct fecal smear microscopy, saturated brine flotation and hookworm larvae culture methods were used to identify the eggs and larvae from stool samples of the patient. There were a large number of hookworm eggs in patient's stool samples, and the average count was 60 840 per gram by modified Kato method, which belonged to severe hookworm infection. Meanwhile, to distinguish the hookworm species, the semi-nested RT-PCR assay was employed to detect hookworm internal transcribed spacer series from eggs in patient's stool samples, and the result showed that the hookworm species was confirmed to be Necator americanus.

Clinical study of acute lower respiratory tract infection caused by respiratory syncytial virus in neonates / 中华实用儿科临床杂志

Objective:To investigate the clinical characteristics of acute lower respiratory tract infection (ALRTI) in neonates caused by respiratory syncytial virus (RSV), and to analyze the factors associated with the severe infection.Methods:Clinical data of 399 ALRTI neonates with positive nucleic acids or antigen of RSV admitted to Shenzhen Children′s Hospital from January 2014 to December 2020 were retrospectively analyzed for their clinical cha-racteristics.They were divided into mild-to-moderate group and severe group according to the severity index (SI), and the clinical data of the 2 groups were compared.Relevant factors of severe ALRTI of RSV in neonates were analyzed by multivariate Logistic regression. Results:(1) A total of 399 ALRTI neonates with RSV infection were included, involving 239 males (59.9%) and 160 females (40.1%) with a male-to-female ratio of 1.49∶1.00.There were 349 cases (87.5%) and 50 cases (12.5%) in the mild-to-moderate group and severe group, respectively.The disease mainly occurred from March to October.(2) There were significant differences in the preterm delivery [15 cases (4.3%) vs.9 cases (18.0%)], low birth weight [11 cases (3.2%) vs.6 cases (12.0%)], previous hospitalization history [12 cases (3.4%) vs.5 cases (10.0%)], and breastfeeding [167 cases (47.9%) vs.16 cases (32.0%)] between the mild-to-moderate group and severe group ( χ2=14.524, 8.394, 4.616 and 4.426, respectively, all P<0.05). (3) There were significant differences in fever [78 cases (22.4%) vs.18 cases (36.0%)], shortness of breath [156 cases (44.7%) vs.36 cases (72.0%)], poor appetite [48 cases (13.8%) vs.15 cases (30.0%)], wheezing [20 cases (5.7%) vs.10 cases (20.0%)], cyanosis [30 cases (8.0%) vs.16 cases (32.0%)] and mental status (irritability/malaise) [20 cases (5.7%) vs.8 cases (16.0%)], and duration of cough[(8.1±2.6) days vs.(9.4±2.9) days ] between the mild-to-moderate group and severe group ( χ2=4.460, 13.057, 8.682, 12.806, 23.486 and 7.068, t=-3.054, all P<0.05). Moist rales in the lungs [29 cases (58.0%) vs.114 cases (32.7%)] and three concave signs [14 cases (28.0%) vs.20 cases (5.7%)] were commonly found in the severe group, while pulmonary phlegm sounds [168 cases (48.1%) vs.14 cases (28.0%)]was commonly found in the mild-to-moderate group, and the differences were statistically significant ( χ2=12.208, 27.823 and 7.149, respectively, all P<0.05). (4) Multifactorial analysis showed that premature delivery was an independent risk factor for the development of severe ALRTI caused by RSV in neonates ( OR=3.717, 95% CI: 1.257-10.987), and shortness of breath ( OR=2.216, 95% CI: 1.061-4.629), cyanosis ( OR=3.621, 95% CI: 1.638-8.004) and three concave signs ( OR=2.688, 95% CI: 1.077-6.711) may be early warning factors for the severe condition. Conclusions:Preterm infants with RSV infection are prone to develop into severe disease, and neonates with RSV infection with shortness of breath, cyanosis and three concave signs as symptoms of severe infection should be well concerned for a close monitoring.

Acute necrotizing fasciitis complicated with multiple organ dysfunction: one case report / 中华危重病急救医学

The treatment of acute necrotizing fasciitis consists of early and aggressive incision and drainage, together with effective antibiotics and active organ support. On January 4th, 2018, a 50-year-old man admitted to intensive care unit (ICU) of Peking University Third Hospital was diagnosed with acute necrotizing fasciitis in the right lower extremity caused by group A Streptococcal infection complicated with multiple organ dysfunction. The disease progressed rapidly. The lesion rapidly spread from the right calf to the entire right lower limb and was associated with septic shock and multiple organ dysfunction within a few hours after admission. The treatment included surgical debridement and amputation of his right lower extremity, multiple antimicrobials combination therapy, gamma globulin-assisted anti-infection, anti-shock, bedside continuous hemofiltration and other comprehensive treatment. The patient was successfully cured. The key to successful treatment of this patient is that when the acute necrotizing fasciitis progresses rapidly, amputation should be done to debride the infected lesions, together with early empirical broad-spectrum antibiotics combination therapy and active organ function support treatment.

Acute necrotizing fasciitis complicated with multiple organ dysfunction: one case report / 中华危重病急救医学

The treatment of acute necrotizing fasciitis consists of early and aggressive incision and drainage, together with effective antibiotics and active organ support. On January 4th, 2018, a 50-year-old man admitted to intensive care unit (ICU) of Peking University Third Hospital was diagnosed with acute necrotizing fasciitis in the right lower extremity caused by group A Streptococcal infection complicated with multiple organ dysfunction. The disease progressed rapidly. The lesion rapidly spread from the right calf to the entire right lower limb and was associated with septic shock and multiple organ dysfunction within a few hours after admission. The treatment included surgical debridement and amputation of his right lower extremity, multiple antimicrobials combination therapy, gamma globulin-assisted anti-infection, anti-shock, bedside continuous hemofiltration and other comprehensive treatment. The patient was successfully cured. The key to successful treatment of this patient is that when the acute necrotizing fasciitis progresses rapidly, amputation should be done to debride the infected lesions, together with early empirical broad-spectrum antibiotics combination therapy and active organ function support treatment.

Cefoxitin plus levofloxacin for prevention of severe infection after transrectal prostate biopsy / 中华男科学杂志

<p><b>Objective</b>To evaluate the effect of cefoxitin prophylactic in reducing the incidence of severe infection after transrectal prostate biopsy (TRPB).</p><p><b>METHODS</b>This retrospective study included 155 cases of TRPB with a 5-day administration of oral levofloxacin at 200 mg bid (the control group) and another 167 cases with a 3-day administration of oral levofloxacin at the same dose plus intravenous cefoxitin at 2.0 g 2 hours before TRPB (the experimental group) according to the distribution characteristics of drug-resistance bacteria in our department. The patients of the control and experimental groups were aged (68.68 ± 8.12) and (68.72 ± 7.51) years, with PSA levels of (19.78 ± 21.57) and (21.15 ± 42.63) μg/L, involving (11.68 ± 1.44) and (11.77±1.02) biopsy cores, respectively. Comparisons were made between the two groups of patients in the incidence rate of severe infection, which was defined as lower urinary track symptoms plus the systemic inflammatory response syndrome (SIRS) within 7 days after TRPB.</p><p><b>RESULTS</b>The incidence rate of postoperative severe infection was significantly lower in the experimental group than in the control (0.6% ［1/167］ vs 5.8% ［9/155］, P < 0.05). Blood cultures revealed positive E-coli strains in 6 cases in the control group, including 5 ESBL-positive and 4 quinolone-resistant and amikacin-sensitive cases, all sensitive to cefoxitin, cefoperazone/sulbactam and imipenem. The only one case of severe infection was shown to be negative in blood culture.</p><p><b>CONCLUSIONS</b>Preoperative intravenous administration of cefoxitin according to the specific distribution characteristics of drug-resistance bacteria can significantly reduce the incidence of severe infection after TRPB.</p>

Clinical Observation of Xuebijing Injection in the Treatment of Moderate and Severe Infection of Stage Ⅲ-Ⅳ Pressure Ulcer / 中国药房

OBJECTIVE:To observe the clinical effect and safety of Xuebijing injection in the treatment of moderate and se-vere infection of stage Ⅲ-Ⅳ pressure ulcer. METHODS:A total of 130 cases of moderate and severe infection of stage Ⅲ-Ⅳ pres-sure ulcer admitted to our hospital from Jul. 2011 and Jun. 2016 were randomly divided into observation group and control group, with 65 cases in each group. Control group was treated with 0.5%Iodophor disinfectant to disinfect the sore surface,given wet ster-ile gauze soaked with 0.5% Iodophor disinfectant to compress sore surface for 30 min,and then given Aikangfu absorptive silver ion antibacterial healing dressing to fill wound,changed dressing after 2/3 was soaked. Observation group was additionally given Xuebijing injection 50 mL added into normal saline 100 mL intravenously for 30-40 min,2-3 times a day,for consecutive 7 days,on the basis of control group. Treatment course of both groups lasted for 4 weeks. The clinical efficacy,the score of pres-sure ulcer scale for healing(PUSH),debridement time,the time of local symptom and SIRS disappearance as well as the occur-rence of ADR were compared between 2 groups. RESULTS:The total response rate of observation group(93.85%)was signifi-cantly higher than that of control group (80.00%),and debridement time,the time of local symptom and SIRS disappearance were all significantly shorter than control group,with statistical significance(P0.05). After 1-4 weeks of treatment,PUSH score of 2 groups was de-creased significantly compared to before treatment,and the score of observation group was significantly lower than that of con-trol group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:For moderate and severe infection of stage Ⅲ-Ⅳ pressure ulcer,Xuebijing injection effectively reduces inflammatory exudation,improves the ab-sorption of necrotic tissue,relieves local symptom and systematic inflammatory reaction,promotes the healing of pressure ulcers and has good clinical effect and safety.

Effect of meropenem on children with severe infection and treatment effect on the level of PCT / 中国生化药物杂志

Objective To explore the effect of meropenem on the treatment of children with severe infection and the effect on the level of PCT.MethodsThe clinical data of patients with infectious diseases treated in our hospital from December 2013 to February 2016 were retrospectively analyzed.According to the anti infective drugs were divided into control group and observation group, the control group was given routine antibiotic treatment, the observation group was given meropenem treatment.The treatment effect of the two groups were observed, the difference of serum PCT, cytokine level and blood gas indexes before and after treatment in the two groups were compared, correlation analysis with PCT level and serum levels of inflammatory cytokines and blood indexes of severe infection.ResultsIn the control group, 50 cases were successful, the observation group was successful in the treatment of the patients, there were no significant differences in the success rate between the two groups.Two groups of patients before treatment PCT and inflammatory cytokines level no difference, after treatment, the observation group PCT, IL-18, IL-6 and hs-CRP levels were lower than the control group;Two groups of children before treatment blood gas index no difference, after treatment, the observation group SpO2 level higher than the control group, P ETCO2 level was lower than the control group.PCT levels in children with severe infection were positively correlated with IL-18, IL-6, hs-CRP and P ETCO2 levels and negatively correlated with SpO2 levels.ConclusionMeropenem has better therapeutic effect in the treatment of children with severe infection, can significantly reduce the serum PCT level, has the value of clinical application.

Severe infection related liver disease in children / 中华实用儿科临床杂志

Because of anatomical and physiological characteristics and imperfect of function in liver,children are more susceptible to liver injury and even severe liver disease after severe systemic infection or extra-hepatic viscera infections.This kind of liver injury is recommended called as severe infection related liver disease in children.At present,there is lack of a large sample clinical research for the incidence of children.This paper will show the ana tomical and physiological characteristics of liver in children and extend to the major pathogenesis and liver pathology of this disease,and highlight the clinical diagnosis and classification,as well as comprehensive treatment,which expected to help clinicians in understanding the disease and clinical management.

The diagnostic value of PCT in children with severe infection / 中国生化药物杂志

Objective To investigate the value of PCT in the diagnosis of severe infection in children.Methods The clinical data of patients with infectious diseases treated in our hospital from December 2013 to February 2016 were retrospectively analyzed.According to the degree of infection,the patients were divided into local infection group and severe infection group,At the same time,the clinical data of 50 children with non infectious diseases were selected as control group.The differences of serum PCT and cytokine levels were observed between the three groups,at the same time,according to the prognosis of patients with severe infection group were divided into improvement group and deterioration group,The differences of serum PCT and inflammatory cytokines levels in the patients with severe infection in the improvement group and the worsening group,Analysis of the correlation between PCT levels and serum inflammatory cytokines levels in children with severe.Results There were significant differences in the levels of PCT,IL-18,IL-6 and hs-CRP between the three groups,which were from high to low: severe infection group,local infection group and control group; Deterioration of PCT,IL-18,IL-6,hs-CRP and levels were higher than the improvement group(t=-10.099,-8.949,-10.827,-2.088,P<0.05); The level of PCT were positively correlated with IL-18,IL-6 and hs-CRP levels in children with severe infection(r=0.385,0.412,0.408,P=0.012,0.008,0.017).Conclusion PCT has a good diagnostic value in children with severe infection,and it is closely related with the level of inflammatory cytokines in children with severe infection.

Meta-analysis of Procalcitonin-guided Antibiotics Therapy in Patients with Sepsis / 中国药房

OBJECTIVE:To systematically review the procalcitonin(PCT)-guided therapy in patients with sepsis. METHODS:Retrieved from PubMed,Cochrane Library,EMBase,CJFD,Wanfang Datebase,related trails about PCT-guided therapy(test group)versus conventional treatment group(control group)in the treatment of sepsis were collected. Meta-analysis was performed by using Rev Man 5.3 software after data extraction and quality evaluation. RESULTS:Totally 5 studies were enrolled,involving 826 patients. Results of Meta-analysis showed,use time of antibiotics in test group was significantly shorter than control group, with statistical significance [MD=-2.52,95%CI(-3.07,-1.98,P<0.001];there were no significant differences in the mortality rate [OR=1.14,95%CI(0.83,1.56),P=0.42],ICU treatment days [MD=-0.22,95%CI(-1.40,0.96),P=0.72] and total hospi-talization [MD=-1.81,95%CI(-4.37,0.76),P=0.17]. CONCLUSIONS:PCT-guided therapy can effectively reduce the use of antibiotics and shorten treatment time in the treatment of patients with sepsis.It can be considered as inflammatory markers for guid-ing rational use of antibiotics in clinic.

Investigation on tigecycline therapy for severe infections in children / 临床儿科杂志

Tigecycline is a new class of antimicrobials called glycylcyclines,which has been reported to have a specific antibacterial mechanism with a wide spectrum and low resistance rate.In adults,tigecycline safety and efficacy data were widely known.However,its use in children has been extremely limited because of lacking experience on its effects on tooth development and other clinical data in children.When no other alternative antibacterial agents could be chosen due to multidrugresistant bacterial infections,tigecycline would became an available approach to treat severe infections in children.This article offers an overview on tigecycline off-label uses,dosage and safety,and provides evidences for the choice of antibiotics in pediatric patients with severe infections.

Clinical efficacy of cefoperazone and Shubatan in the treatment of severe acute infection / 中国生化药物杂志

Objective To investigate and analyze the clinical efficacy of cefoperazone and Shubatan in the treatment of severe infection in emergency department. Methods 100 cases of severe infection were randomly divided into control group and experimental group, with 50 patients in each group. The control group received routine treatment, and the experimental group was treated with cefoperazone and Shubatan on this basis. Pay close attention to the related vital signs change of the experimental group and the control group, the relevant clinical indicators of the two groups of patients were compared and analyzed. Results After the corresponding treatment, the bacteria removal rate of the experimental group was 90.00%, significantly higher thant 60.00 % of the control group (P<0.05). The effective rate of the experimental group was 90.00%, which was significantly higher than that of the control group (74.00%), which was statistically significant (P<0.05). There were no obvious adverse reactions in the two groups. After treatment, the total score of quality of life in the experimental group was (75.2±11.2) points, and the total score of QOL in the control group was (64.2±9.3) points, which was statistically significant (P<0.05). Conclusion The clinical efficacy of cefoperazone and Shubatan in the treatment of emergency severe infection is satisfactory. It can significantly improve the clinical symptoms and improve the quality of life in patients with severe acute respiratory infection.

Clinical efficacy of cefoperazone and Shubatan in the treatment of severe acute infection / 中国生化药物杂志

Objective To investigate and analyze the clinical efficacy of cefoperazone and Shubatan in the treatment of severe infection in emergency department. Methods 100 cases of severe infection were randomly divided into control group and experimental group, with 50 patients in each group. The control group received routine treatment, and the experimental group was treated with cefoperazone and Shubatan on this basis. Pay close attention to the related vital signs change of the experimental group and the control group, the relevant clinical indicators of the two groups of patients were compared and analyzed. Results After the corresponding treatment, the bacteria removal rate of the experimental group was 90.00%, significantly higher thant 60.00 % of the control group (P<0.05). The effective rate of the experimental group was 90.00%, which was significantly higher than that of the control group (74.00%), which was statistically significant (P<0.05). There were no obvious adverse reactions in the two groups. After treatment, the total score of quality of life in the experimental group was (75.2±11.2) points, and the total score of QOL in the control group was (64.2±9.3) points, which was statistically significant (P<0.05). Conclusion The clinical efficacy of cefoperazone and Shubatan in the treatment of emergency severe infection is satisfactory. It can significantly improve the clinical symptoms and improve the quality of life in patients with severe acute respiratory infection.

Application of serum procalcitonin on patients with severe infection / 中国综合临床

Objective To evaluate the application of serum procalcitonin(PCT)eetection in patients with severe infection. Methods Seventy-six infectee patients in respiratory intensive care unit(RICU)of the First People′s Hospital of Shangqiu were selectee as our subjects. Patients were eivieee into A group(28 cases of general bacterial infection),B group(36 cases of severe bacterial infection ),C group(12 cases of viral infection). Serum PCT was eetectee at the 1st,3re,5th,7th,9th eays after hospitalization. Results PCT concentration in A,B,C groups were((2. 7 ± 0. 8),(18. 9 ± 5),(0. 6 ± 0. 2))μg/ L respectively,ane there was significant eifference between 3 groups(F = 213. 73,P = 0. 000). The PCT level in B group was higher than of A group,ane PCT in A group was higher than in C group( all P < 0. 05). In B group,PCT concentration at 1st,3re,5th,7th,9th eays after treatment were((18. 9 ± 5),(18. 3 ± 5. 7),(16. 4 ± 5. 5), (12. 2 ± 4. 1),(8. 5 ± 2. 8),(6 ± 2. 1))μg/ L. In A group,PCT concentration at before treatment,1st,3re,5th, 7th,9th eays after treatment were((2. 7 ± 0. 8),(2. 6 ± 0. 7),(2. 3 ± 0. 8),(1. 7 ± 0. 6),(1. 3 ± 0. 5),(0. 9 ± 0. 3))μg/ L respectively. There were significant eifferent between two groups(F between group = 626. 07,F inner group = 75. 21,F interaction = 43. 36,P < 0. 01). After 5 eay antibiotic treatment in two group,PCT concentration at post-treatment were significantly eecreasee comparee with pre-treatment( P < 0. 01). Conclusion The eetection of serum PCT is valuable for eiagnosis ane evaluation of the eegree of clinical bacterial infection. PCT monitor can be usee to evaluate the therapeutic effect,ane assist the clinician to juege the prognosis.

Cost-effectiveness analysis on Imipenem-Cilastatin Sodium and Meropenem for severe infection / 中国综合临床

Objective To evaluate the economic effects of Imipenem-Cilastatin Sodium and Meropenem for severe infection.Methods The therapeutic effects and costs of the two therapeutic schemes for severe infection were evaluated by using cost-minimization analysis.Results The total effective rates of Imipenemcilastatin group and Meropenem group in the treatment severe infection were 93.33％ (28/30) and 85.71％ (24/28),the difference were not statistically significant (x2 =4.89,P =0.082).The cost-effectiveness ratio (C/E) were 40.35 and 71.69 respectively.The cost of every unit increment of effectiveness for Meropenem group were 312.16 Yuan,more than that of the Imipenem-cilastatin group.Conclusion Cost-effectiveness ratio of Imipenem-cilastatin is superior to that of Meropenem,and Imipenem-cilastatin has obvious pharmacoeconomics advantage over Meropenem for severe infections.

The function of soluble form of CD163 in severe infection and sepsis / 中国小儿急救医学

CD163 is one of transmembrane glycoproteins expressed only in activated monocyte-macrophage cell membrane, which acts as a marker of activated macrophages. In sepsis, CD163 activates the intracellular signal transduction pathways in macrophages,regulates TNF-α, IL-10 and IL-6 expression, have antiinflammatory and antioxidant effects in the inflammatory process. Soluble CD163 (sCD163) is a soluble form of CD163 ,which could play anti-inflammatory and immunoregulatory effects by inhibiting T cells proliferation and activation. Serum concentration of sCD163 may be highly increased when severe infection. Detection of serum sCD163 is helpful to diagnose sepsis,and to evaluate the prognosis of severe infection and sepsis.

The clinical study of rhTPO used for the treatment of sepsis-associated thrombocytopenia / 中华急诊医学杂志

Objective To evaluate the efficacy and safety of rhTPO (recombinant human thromobopoietin) employed for the treatment of sepsis-associated thrombocytopenia. Method There were 47 patients with sepsis-associaiod thrombocytopcnia eligible for the prospective, randomized (random number) and controlled clinical study from January 2009 to November 2009 in ICU of the Tianjin First center Hospital. According to the principle of minimum distribution imbalance index, these patients were randomly divided into the rhTPO group (n = 21) and the IVIG (intravenous immunoglobulin) control group (n = 22). In the rhTPO group, rhTPO was given subcutaneously to patients in a dose of 300 U/kg/d for 2 ～ 8 d, and in the IVIG control group, IVIG was used instead of rhTPO in a dose of 400 mg/kg/d for 5 days. Laboratory tests included blood routine examination, hepatic function, kidney function, coagulation function. The amount of blood products used, bleeding events, the days of ICU and hospital stay, total therapy cost and 28-day mortality were compared between two groups. Results The maximal platelet count in the rhTPO group was significantly higer than that in the contral group (t = 2.21, P =0.032). The mean value of difference between minimal and maximal platelet counts in the rhTPO group was much higher than that in the control group (t =7.40, P ＜0. 001). The average platelet count was no statistical difference between two groups before treatment (t =0. 458, P ＞ 0.05), but the average platelet counts in the rhTPO group were significantly higer than those in the contral group on the second and third day after treatment(t = 2. 166 and t = 2. 132, P =0. 036 and P =0.041. There were no statistical differences in incidence of bleeding, length of ICU stay and mortality between two groups (χ2 =0.720, t =0.91 and χ2 =0.264, P ＞0.05) , but the amounts of plasma and platelet transfusion were significantly less in the rhTPO group than those in the control group (t = 2.038 and t =2.252, P=0.048 and P=0.030) and the medical cost was cut down significantly in rhTPO group (t = 16.93, P ＜ 0.001). There was no adverse reaction occurred during period of observation. Conclusions The rhTPO can significantly increase platelet count, and decrease the amount of blood transfused and the medical cost. The administration of rhTPO is safe and efficient for the treatment of sepsis-associated thrombocytopenia.

The impact of an algorithm of mandatory treatment of sepsis on the outcomes of patients suffering from severe sepsis and septic shock / 中华急诊医学杂志

Objective To study the impact of therapy strategy on outcomes of patients suffering from severe sepsis and/or septic shock. Method A total of 195 patients diagnosed as severe sepsis or septic shock were enrolled for prospective study from June 2008 to December 2009. Patient's clinical manifestation,treatments and outcomes were studied by using SSC database. Patients were divided into control group and treatment group. In control group, patients enrolled from June 2008 to December 2008, were treated with conventional medical care In treatment group, patients enrolled from January 2009 to December 2009 were treated with a novel algorithm of mandatory treatment for sepsis In-hospital mortality of two groups was compared. SPSS15.0 software was used for analysis of data. Chi-square test and unpaired t-test were used for comparisons between groups. Results Compared to the control group The need for blood lactate test was significantly grown in treatment group [98.2% (115/117) versus 2.56% (2/78), P ＜ 0.001]. Antibiotics was administered to 69.2% (81/117) patients of treatment group within 3 hours after their arrival at the emergency department compared to 35.8% (28/78) in the control group (P ＜ 0. 001). Blood cultures made before antibiotics given were 47.9% (56/117) in the treatment group compared to the control group 25.6%(20/78), P = 0. 003. The rate of fluid resuscitation was 80.3% (53/66) in the treatment group and 27%(10/37) in the control group, P ＜0.001. The rate of CVP (8 mmHg was 27.3% (18/66) in the treatment group and 8.1% (3/37) in the control group, P = 0. 023. In-hospital mortality was 29.1% (34/117) in the treatment group and 44.8% (35/78) in the control group, P =0. 032. Conclusions The algorithm of mandatory treatment for sepsis improved the therapeutic efficacy of the treatment for severe sepsis and septic shock, decreasing in-hospital mortality.