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Objective To investigate the clinical distribution and drug resistance of carbapenemsresistant Klebsiella pneumoniae (CRKP).Methods A total of 134 clinical strains of CRKP were collected from inpatients in our hospital from January 2014 to December 2016.VITEK-2 compact automatic microbiological analyzer was used to identify the bacteria and the supporting gram-negative bacterial drug susceptibility card was used for susceptibility testing.The sensitivity of other clinical commonly used antimicrobial agents was measured by K-B method.And the clinical distribution of CRKP and its resistance to antimicrobial agents were investigated and analyzed.Results The clinical strains of CRKP were isolated mainly from urine (n=70,52.2％) and sputum (n=38,28.4％).Klebsiella pneumoniae was identified in samples from the department of neurosurgery,including neurosurgery ICU (47.8％,64/134),ICU (23.9％,32/134),department of hepatobiliary surgery (8.2％,11/134) and department of urology (6.0％,8/134).Among all 22 antimicrobial agents tested,the resistant rates of CRKP to 16 antimicrobial agents were ＞90％,especially for ampicillin it was 100％,and those to 19 antibiotics were ＞80％,only for tigecycline it was 23.1％.There were 16 strains of CRKP with positive extended spectrum β-lactamases (ESBLs) (11.9％).All the CRKP strains were resistant to more than three kinds of antimicrobial agents,except one strain that was resistant to two kinds.Conclusion There is a wide range of clinical distribution of CRKP,which is resistant to most of antimicrobial agents,while tigecycline still has a strong antibacterial activity to CRKP.
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Objective To investigate the clinical features of patients with bacterial liver abscess.Methods The clinical data of patients with liver abscess during January 2014 to December 2016 were retrospectively analyzed.Results There were 93 cases enrolled,26.88％ were accompanied by diabetes mellitus (DM),60.22％ were accompanied liver,gall bladder,pancreas diseases or had history of liver,bile duct or gastrointestinal surgery.The most common symptoms were fever (94.62％) and gastrointestinal symptoms (50.54％),while 15.05％ for shock;91.40％ were single abscess,and 73.12％ were in the right lobe.The white blood cell count (WBC),neutrophil (N),hypersensitive C-reactive protein (hsCRP),procalcitonin (PCT),alanine aminotransferase (ALT),and aspartate aminotransferase (AST) were elevated in 60.22％,65.59％,97.85％,82.93％ (34/41),47.31％,and 46.24％ of patients,respectively.12/62 (19.35％) were positive by blood culture and 32/54 (59.26％) were positive by pyogenic fluids or bile culture,the top two pathogenic bacteria were Klebsiella pneumonia (52.27％) and Escherichia coli (27.27％).Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores were between 0-25 points,72.04％ cases were (0-10) points,26.88％ case were (11-20) points and one patient was more than 20 points.Among the 93 cases,82.79％ were underwent antibacterial by carbapenem,penicillin enzyme compound preparation or combined with levofloxacin,and 45.16％ were underwent liver puncture of drainage treatment.A percentage (96.77％) of patients was cured or recovered.Conclusions Biliary retrograde infection is the main cause of hepatic abscess.In the early experiential antibacterial therapy,the first-line choices of antibiotics are those effective to extended spectrum 3-lactamase (ESBL) positive enterobacteriaceae bacteria.Liver puncture of drainage treatment may be effective and safety.APACHE Ⅱ score may be useful to assess the prognosis of live abscess.
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Objective To investigate the clinical efficacy and safety of high-frequency electric snare for the treatment of main airway neoplasm through bronchoscopy. Methods The clinical datas of 18 patients from July 2013 to April 2016, who had main airway neoplasm and were treated with high-frequency electric snare through bronchoscopy, were retrospectively analyzed. Meanwhile, the interventional bronchoscopic techniques partly included argon plasma coagulation and cryoablation. After operarion, the relief of symptoms and complications were observed. Results After operarion, the clinical symptoms, shortness of breath, dyspnea index score and the degree of airway stenosis were improved significantly. No serious complications such as massive hemoptysis occurred in all patients. Conclusion High-frequency electric snare is an effective and safe approach for the treatment of main airway neoplasm.
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<p><b>OBJECTIVE</b>To explore the effect and mechanism of electroacupuncture (EA) for Z syndrome without organic lesion (metabolic syndrome combined with obstructive sleep apnea hypopnea syndrome).</p><p><b>METHODS</b>Fifty-eight patients with Z syndrome were divided into three groups according to mild,moderate and severe degree. Acupuncture and EA were used at Daimai (GB 26), Zhongwan (CV 12), Xiawan (CV 10), Zusanli ST 36), Qihai (CV 6) and Huaroumen (ST 24), etc., once a day and five times a week. The treatment of ten times was a course, and two courses were acquired continuously. Sleep respiration monitoring (PSG) was done before EA and in one week after treatment respectively. Triacylglycerol (TG) fasting blood glucose (FBG) fasting insulin (INS) and serum leptin (Lep) were tested before and after treatment in the three groups.</p><p><b>RESULTS</b>After treatment apnea hypopnea index (AHI) and the percentage of the time of arterial oxygen saturation (SaO₂) less than 90% taken in the total sleep time (SLT 90%) were improved apparently than those before treatment in the three groups (all P < 0.05). The levels of TG, FPG, INS and Lep were decreased after treatment in all groups (all P < 0.05).</p><p><b>CONCLUSION</b>EA can improve AHI and nocturnal hypoxia of Z syndrome, and the mechanism may be related to decreasing the indices of metabolism syndrome and leptin.</p>