Identification of the bacteria strain and its antibiotic resistance in an epidemic of cholera / 上海预防医学

Objective The present study was conducted to identify the Vibrio cholera type and to analyze its antibiotic resistance in an epidemic of cholera in Haiyan County in 2018, which would provide the references for prevention and control of cholera. Methods Stool samples of the patient and his close contacts as well as the food and environmental samples were collected for identification of the type of Vibrio cholerae and the toxin gene. The resistance of identified Vibrio cholerae to 20 different common antibiotics were tested. Results A total of 176 samples were collected, including 101 stool samples from the case and his close contacts, 35 environmental samples and 40 food samples. Among those samples, only one strain of V. cholerae, O139, was isolated from the patient's first feces sample. It was detected as a toxin gene of ctxA positive by real-time fluorescence PCR. Antibiotic resistance test showed that the strain was sensitive to norfloxacin, levofloxacin, ciprofloxacin, cefotaxime, cephalothin, ampicillin, and amoxicillin. It was 100% resistant to tetracycline, doxycycline, neomycin, kanamycin, streptomycin, and rifampicin. Conclusion V. cholerae O139 strain with ctxA is detected in an epidemic of cholera. Norfloxacin, levofluoxacin and some other antibiotics could be used for clinical treatment and prevention. It should pay attention to this strain of V. cholera regarding the multiple drug resistance and the change of antibiotic resistance.

Hyperoxygenated solution for improved oxygen supply in patients undergoing lung lavage for pulmonary alveolar proteinosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>At present, the most effective treatment for pulmonary alveolar proteinosis (PAP) remains whole-lung lavage in spite of the usually accompanying severe hypoxemia, which is expected to be prevented by hyperoxygenated solution improving oxygen supply during lavage. In this study, the efficacy and safety of the effect of hyperoxygenated solution were evaluated.</p><p><b>METHODS</b>Five patients underwent whole-lung lavage over a 28-month period. Each lung was lavaged with hyperoxygenated (HO) and normal saline solution (plain lactated Ringer's solution, NO) randomly and alternatively until the reclaimed fluid was clear. Random number was generated by computer before every cycle of lavage. If the number was odd, the patient was assigned to receive a lavage cycle with hyperoxygenated solution (HO group, n = 109); if the number was even, normal saline solution was used (NO group, n = 115). Data of saturation of peripheral oxygen (SPO(2)), mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR) and end-tidal carbon dioxide tension (P(ET)CO(2)) were taken down at 0, 30, 60, 90, 120, 150, 180, 210 and 240 seconds from the beginning of the instillation of solution, and frequency and volume of unilateral lung lavage were also recorded. Time interval between the left and the right lung lavage was 1 week.</p><p><b>RESULTS</b>No patient was withdrawn from the study due to low SPO(2) or leakage. Oxygen pressure was (730.21 +/- 7.43) mmHg in the hyperoxygenated solution against (175.73 +/- 5.92) mmHg in the normal saline solution (P < 0.01). Compared with baseline, SPO(2) increased significantly as the instillation of solution began (P < 0.01), leveled for about 30 seconds (P > 0.05), and then decreased significantly to the lowest at the time of drainage (compared with 120 seconds or peak, P < 0.01). SPO2 was higher in HO group than in NO group (P < 0.01). There were no significant differences in MAP, HR, CVP and P(ET)CO(2) between HO group and NO group (P > 0.05) and also among different time points (P > 0.05).</p><p><b>CONCLUSION</b>During the lung lavage for pulmonary alveolar proteinosis, hyperoxygenated solution could significantly improve oxygen supply in comparison with normal saline solution without obvious side effects.</p>

Lung lavage with hyperoxygenated fluid in patients with pulmonary alveolar proteinosis / 中华麻醉学杂志

Bilateral lung lavage was performed under general anesthesia with muscle relaxation in 3 patients with pulmonary alveolar proteinosis(PAP)aged 43-57 yrs weighing 48-68 kg.Left lung lavage was performed first and the right lung was lavaged one week later.Left radial artery and right internal jugular vein were cannulated for MAP,HR and CVP monitoring.SpO_2 and P_(ET) CO_2 were monitored during lavage.Left-sided Robertshaw double-lumen tube was used for both right and left lung lavage.After proper placement of the double- lumen tube was verified both lungs were ventilated with 100% O_2 for 10 min to wash out N_2.Hyperoxygenated lavage fluid was made by aerating the lactated Ringer's solution with 100% O_2 at 1 L?min~(-1) flow rate for 30 seconds.The tidal aliquot of lavage was 700 ml which was kept in the lung for 50 seconds and then drained.Each lung was lavaged with hyperoxygenated and plain lactated Ringer's solution 10 times each alternatively.While one lung was being lavaged the contralateral lung was mechanically ventilated with 100% O_2.SpO_2,MAP,HR,CVP and P_(ET)CO_2 were recorded immediately before lavage and at 10,20,30,40,50,60,70 and 80 seconds after the lung was filled with lavage fluid.SpO_2 was significantly higher during lavage with hyperoxygenated fluid than with ordinary lactated Ringer's solution,but there was no significant difference in MAP,HR,CVP and P_(ET)CO_2.The PaO_2 of the 3 patients breathing room air was 46-52 mm Hg before lung lavage and increased to(72.3?2.1) mm Hg one week after left lung lavage and to(83.5?4.8)mm Hg 3d after right lung lavage.During the lung lavage,hyperoxygenic significantly improve oxygen supply in patients with pulmonary alveolar proteinosis compared with lactated Ringer's solution.