Curative efficacy of multimodality therapy for severe pulmonary infection in kidney transplantation patients (57 cases report) / 中华器官移植杂志

Objective To evaluate the curative efficacy of multimodality for severe pulmonary infection (SPI) following kidney transplantation (KT).Methods Fifty-seven cases of SPI following KT were treated with multimodality therapy in our hospital between Jan.2014 and Jan.2017.The outcome and data were analyzed and evaluated retrospectively.Results Of these 57 patients,45 cases were cured (41 cases were alive with functioning grafts,and 4 cases had grafts loss).The pulmonary lesions in 4 cases of pulmonary fungal infection were improved and oral anti-fungal drugs were continuously given after discharge.The symptoms in one case of tuberculosis were obviously improved and anti-tuberculosis treatment was given continuously after discharge.There were 5 deaths,including 2 deaths due to functioning grafts loss.Two cases abandoned treatment during therapy because of financial problem.Pathogens could be detected in only 29 cases.Conclusion SPI after KT is an acute important complication with rapid progression.Early and prompt treatment with combined antibiotics,antifungal drugs as well as antivirus is essential.The keys to successful rescue for SPI should also include immunosuppressant reduction,intravenous immunoglobulin and nutrition support.The combined therapy is successful and could reduce mortality of SPI obviously.

Therapeutic and preventing effect of probiotics for antibiotic-associated diarrhea in elderly severe lung infection / 中国生化药物杂志

Objective To observe clinical efficacy of probiotics agents in the prevention and treatment of severe pulmonary infection in elderly patients with antibiotic-associated diarrhea (AAD).Methods 60 cases of elderly patients with severe pulmonary infection (more than or equal to 60 years old) were randomly divided into the treatment group ( 31 cases ) and control group ( 29 cases ) , the control group received broad-spectrum antibiotics or using two linked above anti-infection treatment, the treatment group were added with probiotic agent ( lactobacillus complex capsules).The diarrhea, the use of antibiotics and the stool routine, bacteria before and after 5, 10, 15 days of group were observed.Results After 15 days treatment, the number of Escherichia coli in treatment group was lower than that in control group (P<0.05), the number of Bacterium lacticum and Bifidobacterium bifidum in treatment group were higher than those in control group ( P<0.05 ) .The AAD rate in treatment goup was 12.90%, which was lower than 41.38% in control group (P<0.05).There were significant differences in beginning time and duration of diarrhea between two groups (P<0.05). Conclusion The intestinal probiotics reduced induced by antibiotics in elderly patients with severe pulmonary infection , the probiotics agents could redress intestinal flora imbalance, keep the steady state of intestinal flora, and prevent and cure the antibiotic-associated diarrhea.

Efficacy Observation of Xuebijing Combined with Bronchoalveolar Lavage in the Adjunctive Therapy of Severe Pulmonary Infection / 中国药师

Objective: To observe the efficacy and safety of Xuebijing combined with bronchoalveolar lavage in the adjunctive therapy of severe pulmonary infection.Methods: Totally 110 patients with severe pulmonary infection were randomly divided into the control group and the observation group according to the admission odd or even number with 55 ones in each.The control group was treated with bronchial lavage on the basis of the conventional therapy.The observation group was treated with Xuebijing combined with bronchoalveolar lavage.The treatment efficacy and adverse reactions were observed, and the degree of lung infection and prognosis were evaluated by the clinical application of pulmonary infection score (CPIS) and acute physiology and chronic health Ⅱ (APACHE-Ⅱ) before and after the treatment.The treatment time or symptom improvement time was recorded, and the serum levels of inflammatory cytokines before and after the treatment were detected.Results: The effective rate of the observation group was 60.00%, which was higher than that of the control group (43.64%, P0.05).Conclusion: Xuebijing combined with bronchoalveolar lavage shows better clinical efficacy in the adjunctive therapy of severe pulmonary infection with improved prognosis, shorter treatment time, decreased levels of inflammatory factors and promising security.

Experience of treatment on delayed graft function complicated with severe pulmonary infection / 器官移植

Objective To sum up the experience in the treatment on delayed graft function (DGF) complicated with severe pulmonary infection. Methods Clinical data of 15 patients undergoing renal transplantation and suffering delayed graft function (DGF)complicated with severe pulmonary infection in Chengdu Military General Hospital from January 2008 to November 2014 were retrospectively studied.The treatment course and prognosis were studied.Results Continuous renal replacement therapy was adopted and dosage regimen was adjusted according to the dosage adjustment table for continuous veno-venous hemofiltration.Antibiotic de-escalation therapy was adopted.Immunosuppressive agents were adjusted and low-dose adrenocortical hormone and other comprehensive treatment were applied.Of the 15 patients,8 cases underwent tracheal intubation,2 cases underwent mechanical ventilation after tracheotomy and 5 cases underwent noninvasive ventilator-assisted breathing.Through positive rescue treatment,11 patients were cured and 4 patients died.The cure rate was 73% and the fatality rate was 27%.All died patients were complicated with acute respiratory distress syndrome.Conclusions DGF complicated with severe pulmonary infection after renal transplantation is characterized by severe condition and fast progression. Once cases confirmed, continuous renal replacement therapy shall be ‘fully’applied ‘as early as possible’,and dosage regimen shall be adjusted according to the dosage adjustment table for continuous veno-venous hemofiltration.And other comprehensive treatments shall be combined in order to improve the cure rate.

Evaluation the clinical significance of procalcitonin levels detection on the diagnosis and treatment for elderly patients with severe pulmonary infection / 中国基层医药

Objective To evaluate the diagnostic and prognostic evaluation of Procalcitonin (PCT)levels detection for elderly patients with severe pulmonary infection.Methods 60 elderly patients with severe pulmonary infection were selected,as the infected group,wherein 45 cases with bacterial infection,15 cases with non -bacterial infections.Another 60 cases elderly patients excluded infectious diseases were selected as the control group.PCT,CRP and WBC levels in two groups were detected and compared.The infection group was randomly divided into two groups,each of 30 cases,the control group received conventional anti -infection treatment,while the observation group developed solutions to optimize antimicrobial drugs by detecting changes in PCT and CRP.Antibiotic course,antimi-crobial drug costs,superinfection and adverse reaction rates in two groups were recorded and compared.Results PCT,CRP levels and WBC in the infected group were (17.4 ±11.3)ng/mL,(43.5 ±18.7)mg/L and (10.4 ± 7.3)×109 /L,which in the control group were (0.4 ±0.2)ng/mL,(6.3 ±3.6)mg/L and (5.4 ±1.4)×109 /L,the difference was statistically significance (t =7.369,9.570,3.295,all P <0.05 ).PCT levels of bacterial infection group was (27.2 ±14.7)ng/mL,which in non -bacterial infection group was (8.2 ±2.7)ng/mL,the difference was statistically significant (t =7.369,9.570,3.295,all P <0.05).Antibiotic course,antimicrobial drug costs,superin-fection and adverse reactions in the observation group were significantly lower than those in the control group,the difference statistically significant (t =6.994,27.71,χ2 =6.171,6.984,all P <0.05).Conclusion PCT detection has an important value of infection diagnosis especially in elderly patients with severe pulmonary infection,and can be used as the basis for antibiotic treatment.