Prevalence and clinical prognosis of heteroresistant vancomycin-intermediate Staphylococcus aureus in a tertiary care center in China

Background The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus （hVISA） is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of hVISA is rare in China. This study summarizes the prevalence and clinical features associated with hVISA infections at our institution and the local impact they have on clinical outcome. Methods A total of 122 methicillin-resistant Staphylococcus aureus （MRSA） isolates which were of the causative pathogens were collected. One hundred and two patients for whom we had full information of MRSA pneumonia were included. Isolates of MRSA were collected using PCR to detect the mecA gene. Both Etest and macro Etest were performed to screen for hVISA. The Staphylococcal chromosome cassette mec （SCCmec） types were determined by multiplex PCR strategy. Logistic regression analysis was used to determine the risk factors. Results Among the 122 MRSA isolates collected, 25 （20.5%） strains were identified as hVISA. There were 119 （97.5%） SCCmec III isolates, two （1.6%） SCCmec II isolates, and one （0.8%） SCCmec V isolate. The 30-day mortality of MRSA-hospital acquired pneumonia （HAP） was 37.3%, and 62.5% for hVISA-HAP. Vancomycin treatment was the independent risk factor of hVISA. Factors independently associated with 30-day mortality in all patients were acute physiology and Chronic Health Evaluation （APACHE） II score 〉20, multiple lobe lesions, and creatinine clearance rate （CCR） 〈15 ml/min. Conclusions The prevalence of hVISA is 20.5% at our institution, hVISA-HAP patients had a poor clinical outcome. Vancomycin treatment was the independent predictors for hVISA infection. Factors independently associated with 30-day mortality in all patients were APACHE II score 〉20, multiple lobe lesions and CCR 〈15 ml/min.

COMPARISON OF RANITIDINE AND PANTOPRAZOLE FOR STRESS ULCER BLEEDING PROPHYLAXIS IN CRITICALLY ILL PATIENTS REQUIRING MECHANICAL VENTILATION

Objective To compare the efficacy of Ranitidine and Pantoprazole for the prevention of haemorrhage from stress ulcer among critical care patients. Methods A total of 121 critically ill patients were included in this retrospective study. The choice of pharmacologic stress ulcer prophylaxis were either Ranitidine or Pantoprazole. The primary outcome was the incidence of stress-related significant upper gastrointestinal bleeding, and the secondary outcome was the incidence of hospital acquired pneumonia (HAP). Results A total of 63 patients were given Ranitidine, and 58 patients were given Pantoprazole for stress ulcer bleeding prophylaxis. Nine patients (7.44%, 9/121) developed clinically-important upper gastrointestinal bleeding, including 5 (7.94%, 5/63) in the Ranitidine group, and 4 (6.90%,4/58) in the Pantoprazole group. The rate of HAP was 3.17% (2/63) in the Ranitidine group, and 15.52% (9/58) in the Pantoprazole group. Conclusion Ranitidine was associated with lower rates of HAP as compared with Pantoprazole, with no statistically significant difference in clinically-important gastrointestinal hemorrhage. Because of limited trial data, future well-designed and powerful randomized, clinical trials are warranted.

Evaluation value of lung ultrasound combined with CRP and PCT on the efficacy and prognosis of HAP

Objective To investigate the efficacy of lung ultrasound combined with serum C-reactive protein(CRP)and procalcitonin(PCT)in evaluating the efficacy and prognosis of hospital-acquired pneumonia(HAP).Methods A total of 308 HAP patients admitted to the emergency department and intensive care unit(ICU)of First Affiliated Hospital of Tsinghua University from January 2018 to December 2021 were selected and divided into effective group(n=276)and ineffective group(n=32)according to different treatment effects.The baseline data and the dynamic changes of lung ultrasound score(LUS),CRP and PCT were compared between the two groups before treatment,3 days and 7 days after treatment.Pearson correlation analysis was used to evaluate the correlation between LUS,CRP,PCT and Clinical Pulmonary Infection Score(CPIS)after 3 days and 7 days of treatment.Logistic regression equation was used to analyze the related influencing factors of curative effect.Receiver operating characteristic(ROC)curve and area under ROC(AUC)were used to analyze the efficacy of LUS,CPR,PCT and the combination of the three in predicting curative effect.Kaplan-Meier(K-M)survival curve was used to analyze the survival rate of patients with high-risk and low-risk LUS,CPR and PCT.Results In the effective group,the LUS,CPR and PCT after 3 days and 7 days of treatment were lower than those of the ineffective group.Pearson linear correlation analysis showed that LUS,CPR and PCT after 7 days of treatment were positively correlated with CPIS score(P<0.05),among which LUS after 7 days of treatment had the strongest correlation with CPIS(r=0.635).Logistic regression analysis showed that LUS,CPR and PCT were correlated with the efficacy of HAP after 3 days and 7 days of treatment(P<0.05).ROC curve analysis showed that the AUC of LUS,CPR and PCT predicting invalid HAP after 7 days of treatment was higher than that after 3 days of treatment.The AUC of LUS combined with CPR and PCT after 7 days of treatment to predict the efficacy is the largest(AUC=0.947).K-M curve analysis showed that there were statistically significant differences in LUS,CPR and PCT survival rates between high-risk and low-risk patients after 7 days of treatment(P<0.05).Conclusions There is a certain reference value for the dynamic monitoring of lung ultrasound combined with CPR and PCT in the evaluation of the efficacy and prognosis of HAP.