Expert Consensus on Polymyxin Antimicrobial Susceptibility Testing and Clinical Interpretation

The polymyxins are important antimicrobial agents against antibiotic-resistant gram-negative bacilli.In 2020,the Clinical and Laboratory Standards Institute modified the clinical breakpoints for polymyxin susceptibility test by eliminating the"susceptible"interpretive category,only reporting intermediate(≤2 mg/L)and resistant(≥4 mg/L).However,the European Committee on Antimicrobial Susceptibility Testing recommended the use of clinical breakpoints of W2 mg/L as susceptible and>2 mg/L as resistant.The first-line laboratorians and clinicians in China have been perplexed by the inconsistence of international polymyxin clinical breakpoints and discouraged by the difficulty of conducting polymyxin susceptibility testing.Therefore,it is urgently needed to make it clear for the laboratorians in China to know how to accurately carry out polymyxin susceptibility testing and standardize the interpretation of susceptibility testing results.To this end,the experts from relevant fields were convened to formulate this consensus statement on the testing and clinical interpretation of polymyxin susceptibility.Relevant recommendations are proposed accordingly for laboratorians and clinicians to streamline their daily work.

Effects of Imidapril on Venous Blood Gas Values in Broiler Chickens Exposed to Low Ambient Temperature

ObjectiveThis study was designed to evaluate the effects of imidapril on blood gas parameters in broiler chickens. MethodTwenty-four chickens were randomly divided into three groups (n=8), control group, low temperature group and imidapril group. Chickens in low temperature group and imidapril group were exposed to low ambient temperature (12-18 ℃) from age at 14 d to 45 d, whereas the control group was exposed to 24-30 ℃; chickens in imidapril group were gavaged with imidapril (3 mg/kg) once daily for 30 d. At age of 45 d, blood was taken from wing vein and blood gas parameters were evaluated by blood gas analyzer in Luoyang Central Hospital Affiliated to Zhengzhou University. ResultImidapril significantly increased hematocrit (HCT) and total hemoglobin content (T HBC ) and blood Na concentration in broiler chickens exposed to low ambient temperature. No significant differences were observed in pH, P CO 2 , P O 2 , K + , Ca 2+ , HCO 3-, HCO 3std , T CO 2 , BE and SO 2c . ConclusionImidapril increases hematocrit, total hemoglobin content and blood Na + concentration in chickens exposed to low ambient temperature.

Chinese consensus guidelines for therapeutic drug monitoring of polymyxin B,endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society

Polymyxin B,which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections,became available in China in Dec.2017.As dose adjustments are based solely on clinical experience of risk toxicity,treatment failure,and emergence of resistance,there is an urgent clinical need to perform therapeutic drug monitoring(TDM)to optimize the use of polymyxin B.It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use.We report a consensus on TDM guidelines for polymyxin B,as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society.The consensus panel was composed of clinicians,pharmacists,and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations,sample collection,reporting,and explanation of TDM results.The guidelines provide the first-ever consensus on conducting TDM of polymyxin B,and are intended to guide optimal clinical use.

HAT therapy for sepsis:A review of the therapeutic rationale and current clinical evaluation status

Vitamin C-based cluster therapy,which involves the combined application of hydrocortisone,vitamin C,and thiamine(HAT),is a recently proposed new treatment option for sepsis on top of conventional treatment.This therapy has a strong theoretical basis,but its clinical efficacy remains inconclusive.This review summarizes the rationale for HAT therapy for sepsis and describes the evaluation of its efficacy in clinical observational studies and randomized controlled trials,with the aim of providing a reference for the future clinical practice application of HAT therapy in sepsis.

Adjunctive sepsis therapy with aminophylline(STAP):a randomized controlled trial

Background:Sepsis is a serious disease caused by infection.Aminophylline has anti-asthma and anti-inflammatory effects.We aimed to explore the safety and effect of aminophylline in sepsis.Methods:We conducted a clinical randomized controlled trial involving 100 patients diagnosed with sepsis within 48 h after intensive care unit(ICU)admission in two sites.All patients were randomized in a 1:1 ratio to receive standard therapy with or without aminophylline.The primary clinical outcome was all-cause mortality at 28 days.Results:From September 27,2018 to February 12,2020,we screened 277 septic patients and eventually enrolled 100 patients,with 50 assigned to the aminophylline group and 50 to the usual-care group.At 28 days,7 of 50 patients(14.0%)in the aminophylline group had died,compared with 16 of 50(32.0%)in the usual-care group(P=0.032).Cox regression showed that the aminophylline group had a lower hazard of death(hazard ratio=0.312,95%confidence interval:0.129–0.753).Compared with the usual-care group,patients in the aminophylline group had a longer survival time(P=0.039 by the log-rank test).The effects of aminophylline on vasopressor dose,oxygenation index,and sequential organ failure assessment score were timedependent with treatment.There were no significant differences in total hospitalization days,ICU hospitalization days,and rates of serious adverse events(all P>0.05).No adverse events were observed in the trial.Conclusions:Aminophylline as an adjunct therapy could significantly reduce the risk of death and prolong the survival time of patients with sepsis.Trial registration:ChiCTR.org.cn,ChiCTR1800019173.