Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study

In many traditional Chinese medicine （TCM） hospitals, most patients are elderly with chronic diseases. Nosocomial bloodstream infections （nBSIs） are an important cause of morbidity and mortality. A retrospective sur- veillance study was performed to examine the epidemiology and microbiology of nBSIs in a TCM hospital from 2009 to 2011. A total of 482 patients with nBSIs were included in the study period. The incidence rate was 5.7/1000 admissions Escherichia coli （25.5%） was the most common Gram-negative and coagulase-negative staphylococcus （CONS） （14.1%） was the most common Gram-positive organism isolated. One-third of the E. coli and Klebsie/la pneumoniae isolated from the nBSIs were the third-generation cephalosporin-resistant. Half of the Acinetobacter species isolates were resistant to imipenem. Of all the CoNS isolates, 90.7% were resistant to methicillin. Carbapenems and glyco- peptide were the most frequently used for nBSI therapy. Only about one-third of patients （157/482） received appro- priate empirical therapy. Septic shock, hemodialysis, Pitt bacteremia score 〉4, urinary tract infection, and appropriate empirical therapy were most strongly associated with 28-d mortality. The incidence of nBSIs was low in the TCM hospital but the proportion of nBSIs due to antibiotic-resistant organisms was high. A high Pitt bacteremia score was one of the most important risk factors for mortality in nBSIs. Therefore, the implementation of appropriate empirical therapy is crucial to improve the clinical outcome of nBSIs.

Anti-inflammation of Tripterygium wilfordii Polycoride on Macrophages and Its Regulation to Inflammation via TLR4/NF-κB

Objective To investigate the inhibitory effect of Tripterygium wilfordii polycoride（TWP） towards the pro-inflammatory factors（TNF-α and IL-1β） on the inflammatory reaction in macrophages induced by LPS and its regulatory effect and influence on the inflammation via TLR4/NF-k B. Methods The MTT method was adopted to test the effect of drugs, TWP, dexamethasone（DXM） and azathioprine（AZA） on cell growth and to select the appropriate concentration. LPS was used to induce the inflammatory reaction in RAW264.7 cell line of mice. Elisa kit was adopted to test the levels of TNF-α and IL-1β. Western blotting was adopted to test the protein expression of TNF-α and IL-1β. RT-PCR was adopted to test the expression of TLR4 and NF-κB. Results The inhibiting effect of TWP on the release of TNF-α and IL-1β in a dose dependent manner. The inhibitory effect of three different TWP dose groups is weaker than that in DXM group. However, TWP in high dose is better than AZA on TNF-α and is as strong as AZA on IL-1β. The dose dependent manner also exits in the effect on the expression of TLR4 and NF-κB, the effect is not weaker, but even stronger than that of DXM and AZA. Conclusion The research shows that down regulation of TLR4 and NF-k B p65 may be one of the mechanisms about the TWP inhibitory effect on TNF-α and IL-1β.