Enterogenous infection of Candida albicans in immunocompromised rats under severe acute pancreatitis

BACKGROUND:Opportunistic infection of Candida albicans(C.albicans) has become a serious problem in immunocompromised patients.The study aimed to explore the mechanism of enterogenous infection of C.albicans in immunocompromised rats under severe acute pancreatitis(SAP).METHODS:Sprague Dawley(SD) rats(n=100) were randomly assigned into 5 groups as the following:blank group,cyclophosphamide+ceftriaxone+SAP group,cyclophosphamide+ceftriaxone group,cyclophosphamide+SAP group,and cyclophosphamide group.The rats were sacrificed at 5and 10 days,and their jejunum,colon,mesenteric lymph nodes,pancreas,intestinal content,and blood were quickly collected to detect C.albicans.A region of the 25 S rRNA gene was chosen and amplified by polymerase chain reaction(PCR) to differentiate C.albicans genotypes.The amplified products were further sequenced and compared to judge their homology.RESULTS:Compared with the Cyclophosphamide group,the combination of immunosuppressants and broad-spectrum antibiotics significantly increased the colonization of C.albicans in intestine in 5 and 10 days.Pure SAP stress did not increase the opportunistic infection of C.albicans.The PCR products of C.albicans isolates all belonged to the genotype A family,and sequence alignment showed that the amplified fragments were homologous.CONCLUSION:The damage of immune system and broad-spectrum antimicrobial agents are important risk factors for opportunistic fungal infection.Intestinal tract is an important source for genotype-A C.albicans to translocate and invade into bloodstream.

Antibiotics De-Escalation in the Treatment of Ventilator-Associated Pneumonia in Trauma Patients： A Retrospective Study on Propensity Score Matching Method

Background： Antimicrobial de-escalation refers to starting the antimicrobial treatment with broad-spectrum antibiotics, followed by narrowing the drug spectrum according to culture results. The present study evaluated the effect of de-escalation on ventilator-associated pneumonia （VAP） in trauma patients. Methods： This retrospective study was conducted on trauma patients with VAP, who received de-escalation therapy （de-escalation group） or non-de-escalation therapy （non-de-escalation group）. Propensity score matching method was used to balance the baseline characteristics between both groups. The 28-day mortality, length of hospitalization and Intensive Care Unit stay, and expense of antibiotics and hospitalization between both groups were compared. Multivariable analysis explored the factors that influenced the 28-day mortality and implementation of de-escalation. Results： Among the 156 patients, 62 patients received de-escalation therapy and 94 patients received non-de-escalation therapy. No significant difference was observed in 28-day mortality between both groups （28.6% vs. 23.8%, P = 0.620）. The duration of antibiotics treatment in the de-escalation group was shorter than that in the non-de-escalation group （11 [8-13] vs. 14 [8-19] days, P = 0.045）. The expenses of antibiotics and hospitalization in de-escalation group were significantly lower than that in the non-de-escalation group （6430 ± 2730 vs. 7618 ± 2568 RMB Yuan, P = 0.043 and 19,173 ± 16,861 vs. 24,184 ± 12,039 RMB Yuan, P = 0.024, respectively）. Multivariate analysis showed that high Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） score, high injury severity score, multi-drug resistant （MDR） infection, and inappropriate initial antibiotics were associated with patients＇ 28-day mortality, while high APACHEⅡ score, MDR infection and inappropriate initial antibiotics were independent factors that prevented the implementation of de-escalation. Conclusions： De-escalation strategy in the treatment of trauma patients with VAP could reduce the duration of antibiotics treatments and expense of hospitalization, without increasing the 28-day mortality and MDR infection.