Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria

BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation(MV).The emergence of multidrug resistant bacteria(MDRB)has become a public health problem,creating a new burden on medical care in hospitals,particularly for patients admitted to the intensive care unit(ICU).AIM To describe risk factors for ventilator-acquired pneumonia(VAP)in patients with cancer and to evaluate the impact of MDRB.METHODS A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City,which included all patients who were admitted to the ICU and required MV≥48 h.They were classified as those who developed VAP versus those who did not;pathogens isolated,including MDRB.Clinical evolution at 60-d was assessed.Descriptive analysis was carried out;comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.RESULTS Two hundred sixty-three patients were included in the study;mean age was 51.9 years;52.1%were male;68.4%had solid tumors.There were 32 episodes of VAP with a rate of 12.2%;11.5 episodes/1000 ventilation-days.The most frequent bacteria isolated were the following:Klebsiella spp.[n=9,four were Extended-Spectrum Beta-Lactamase(ESBL)producers,one was Carbapenem-resistant(CR)];Escherichia coli(n=5,one was ESBL),and Pseudomonas aeruginosa(n=8,two were CR).One Methicillin-susceptible Staphylococcus aureus was identified.In multivariate analysis,the sole risk factor associated for VAP was length of ICU stay(OR=1.1;95%CI:1.03-1.17;P=0.003).Sixty-day mortality was 53%in VAP and 43%without VAP(P=0.342).There was not higher mortality in those patients with MDRB.CONCLUSION This study highlights the high percentage of Gram-negative bacteria,which allows the initiation of empiric antibiotic coverage for these pathogens.In this retrospective,single center,observational study,MDRB VAP was not directly linked to increased mortality at 60 days.

Antimicrobial resistance pattern in ventilator-associated pneumonia in an intensive care unit of Babol, northern Iran

Objective:To investigate antibiotic resistance pattern of ventilator-assiated pneumonia (VAP) generating microorganisms,and quantitative culture and determining antibiotic sensitivity.Methods:This cross sectional study was performed on 50 patients suffering from VAP in intensive care unit of Ayatollah Rouhani Hospital,Babol,Iran during 2014-2015.VAP was probable for them based on clinical signs and the criteria of Clinical Pulmonary Infection Score standards.Lower respiratory samples were given under bronchoalveolar lavage and quantitative culture was done on them.Afterwards by microdilution method,minimal inhibitory concentration based on respective microorganisms,considering clinical pulmonary infection score were determined.Results:From 50 investigated samples in this study,the most common microorganisms were Acinetobacter baumannii (A.baumannii) (70%) then Pseudomonas aeruginosa (12%),Staphylococcus aureus (8%) and Klebsiella pneumonia (3%).In our study A.baummannii showed approximate 100% resistance to all antibiotics,in a way that A.baumannii resistance to imipenem and meropenem and piperacillin/tazobactam each was 97.1%.The most resistance of Pseudomonas aeruginosa was 66.7% to each cefepime and ceftazidime and clavulanate/ticarcillin.Staphylococcus aureus showed 75% resistance to nafcillin,cloxacillin and resistance in case of vancomycin was not seen.Conclusion:In current study,A.baumannii had the most prevalence among VAP and this species is resistant to most of antibiotics.Using ceftazidime,cefepime and clavulanate/ticarcillin,in treatment of the patients suffering VAP is not reasonable.

Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain:Prevalence and antibiotics susceptibility pattern

BACKGROUND Ventilator-associated pneumonia(VAP)is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that.It is the most common infection encountered among intubated patients.VAP incidence showed wide variability between countries.AIM To define the VAP incidence in the intensive care unit(ICU)in the central gove-rnment hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020.It included adult and adolescent patients(>14 years old)admitted to the ICU and required intubation and mechanical ventilation.VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score,which considers the clinical,laboratory,microbiological,and radiographic evidence.RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155.Forty-six patients developed VAP during their ICU stay(29.7%).The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period,with a mean age of 52 years±20.Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96±6.55.Gram-negative contributed to most VAP cases in our unit,with multidrug-resistant Acinetobacter being the most identified pathogen.CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark,which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.

Analysis of Clinical Symptoms Improvement in Treatment of Severe Pneumonia Caused by Multi-drug Resistant Bacterial Infection by Bronchoscopy Alveolar Lavage

Objective:To explore the effects of bronchoscopy alveolar lavage in the treatment of severe pneumonia caused by multiple drug bacterial infection.Methods:A total of 84 patients with severe pneumonia infected by multi-drug resistant bacteria were randomly selected from Kunming Second People's Hospital,which is our hospital from January 2019 to December 2020 for this research.They were divided into a reference group and a study group using a digital table method,with 42 cases in each group.The reference group was given the routine treatment,the research group performed bronchoscopy alveolar lavage on this basis to observe the curative effect.Results:Before treatment,there was no significant difference in serum factor indexes and blood gas analysis indexes between the two groups of patients,P>0.05.After treatment,the time of fever,cough,moist rales disappearing and infection control time in the study group were shorter than those in the reference group,P<0.05.Serum tumor necrosis factorα(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)levels were lower than the reference group,and the arterial partial pressure of oxygen(PO2)and oxygen saturation(SO2)were both lower than the reference group,P<0.05.The effective rate of the treatment in the study group was higher than that in the reference group,P<0.05.Conclusion:Bronchoscopic alveolar lavage treatment can effectively improve the clinical symptoms of patients with severe pneumonia caused by multi-drug resistant bacterial infection,and the effects are significant.

Management of Multi-Drug Resistant Methicillin Resistant <i>Staphylococcus aureus</i>Induced Pneumonia with New Antibiotic Adjuvant Entity: A Retrospective Study

Aim/Objective: Increase in incidences of pneumonia due to multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA) in both community and health care settings is of great concern globally. Present study aims to retrospectively analyze the efficacy of new fixed dose combination with antibiotic adjuvant entity (FDC) in comparison with vancomycin to treat patients with multi-drug resistant MRSA pneumonia. Materials and Methods: During this retrospective study, case sheets of patients who were treated for MRSA pneumonia with vancomycin or fixed dose combination of vancomycin + ceftriaxone + adjuvant (FDC) between 20 March 2010 to 20 October 2014 at tertiary care center, were analyzed. Various demographic features, antibiotic therapy, length of treatment duration and the resulting efficacy were evaluated. Microbiological success was measured in terms of bacterial eradication, while clinical success was monitored in terms of complete omission of systemic signs and symptoms. Results: Among 136 patients analyzed, 113 cases were having positive culture for MRSA, and hence were further analyzed. Out of these 113 patients, empirical treatment with vancomycin was given in 59 patients and 54 patients were treated with FDC empirically. After initial culture reports, 22 patients showing resistance to vancomycin were shifted to FDC. Amidst all the patients, 24 (64.86%) of 37 from vancomycin group and 62 (81.57%) of 76 from FDC group achieved clinical success. 9 patients out of these failure cases were cured with FDC + colistin combination therapy. Failure rates in FDC treated patients were significantly low (6.57%) as compared to vancomycin group (13.51%). Conclusion: For the treatment of different types of multi-drug resistant MRSA pneumonia, the empirical intravenous FDC therapy was safe and well tolerated with higher efficacy than vancomycin. Most of the vancomycin failure cases responded to FDC therapy and were cured. This retrospective study also concludes that an alternative option of FDC + colistin is safe and effective to treat the patients which fail to respond to FDC monotherapy.

A Prospective Study on the Efficiency of Ciprofloxacin in Combination with Chloramphenicol against Multiple Antibiotics Resistant <i>Klebsiella pneumonia</i>

Pneumonia is the single largest infectious cause of death in children worldwide and also a form of an acute respiratory infection that affects the lung. The purpose of the study was to develop a new approach to treat antibiotic-resistant K. pneumoniae infection. This study aimed in quest of a drug to combine with ciprofloxacin, a broad spectrum antibiotic frequently used to treat lung infections. Methodology: A total of 23 lung infection bacterial samples were collected and studied against 14 antibiotics of different classes. The disk diffusion method was performed to determine synergy screening, MIC value, and qualitative toxicity analysis of ciprofloxacin and chloramphenicol combination. Results: After primary screening of antibiotic susceptibility, they were categorized into multidrug-resistant (MDR), extensively drug-resistant (XDR) and pan drug-resistant (PDR) pathogens where 9 isolates were MDR, 5 were XDR and 3 isolates were PDR. Furthermore, they were trialed in combination ciprofloxacin along with other 7 drugs in disk diffusion to explore the synergistic effect. The combination of ciprofloxacin and moxifloxacin, ciprofloxacin and chloramphenicol were found to be synergic. Then the MIC test was done for the combination ciprofloxacin and chloramphenicol. When the MIC result was generated, the MIC of the respective combination was analyzed. Furthermore, the fractional inhibitory concentration (FIC) was calculated and in accordance with the results of the FIC index, ciprofloxacin-chloramphenicol combination has shown value 0.4510 which revealed a synergistic effect against multi-drug resistant Klebsiella pneumoniae. Conclusion: Given these points, if the efficiency of this antibiotic can be accelerated from combination with other drugs, it might be lifesaving and cost effective as well.

Aerosolized Amikacin as Adjunctive Therapy of Ventilator-associated Pneumonia Caused by Multidrug-resistant Gram-negative Bacteria： A Single-center Randomized Controlled Trial

Background： Aerosolized amikacin （AA） is a current option for the management of ventilator-associated pneumonia （VAP） caused by multidrug-resistant Gram-negative bacteria （MDR-GNB）, as it is reported that AA could increase the alveolar level of the drug without increasing systemic toxicity. This study aimed to evaluate the efficacy and safety of AA as an adjunctive therapy for VAP caused by MDR-GNB. Methods： In this single-center, double-blind study conducted in a 36-bed general Intensive Care Unit （ICU） in a tertiary hospital from June 2014 to June 2016, 52 ICU patients with confirmed MDR-GNB VAP were randomized to two groups （AA group, n - 27 and placebo group, n = 25）. Amikacin （400 rag, q8h） or saline placebo （4 ml, q8h） was aerosolized for 7 days. The attending physician determined the administration of systemic antibiotics for VAP. Patients were tbllowed up for 28 days. Bacteriological eradication, clinical pulmonary infection score （CP1S）, and serum creatinine were assessed on day 7 of therapy. New resistance to amikacin, cure rate of VAP, weaning rate, and mortality were assessed on day 28. Results： The baseline characteristics of patients in both groups were similar. At the end of the treatment, 13 of the 32 initially detected bacterial isolates were eradicated in AA group, compared to 4 of 28 in placebo group （41% vs. 14%, P - 0.024）. As for patients, 11 of 27 patients treated with AA and 4 of 25 patients treated with placebo have eradication （41% vs. 16%, P = 0.049）. The adjunction of AA reduced CPIS （4.2 ± 1.6 vs. 5.8 ± 2.1, P = 0.007）. New drug resistance to amikacin and the change in serum creatinine were not detected in AA group. No significant differences in the clinical cure rate in survivors （48% vs. 35%, P = 0.444）, weaning rate （48% vs. 32%, P = 0.236）, and mortality （22% vs. 32%, P = 0.427） were detected between the two groups on day 28. Conclusions： As an adjunctive therapy of MDR-GNB VAP, AA successfully eradicated existing MDR organisms without inducing new resistance to amikacin or change in serum creatinine. However, the improvement of mortality was not found.

Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium's findings

AIM To report the results of the International Nosocomial Infection Control Consortium(INICC) study conducted in Quito, Ecuador.METHODS A device-associated healthcare-acquired infection(DAHAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units(ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network(CDC/NHSN) definitions and INICC methods. RESULTS We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection(CLABSI) rate was 6.5 per 1000 central line(CL)-days, the ventilator-associated pneumonia(VAP) rate was 44.3 per 1000 mechanical ventilator(MV)-days, and the catheterassociated urinary tract infection(CAUTI) rate was 5.7 per 1000 urinary catheter(UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9(CLABSI) and 5.3(CAUTI)] and higher than NHSN rates [0.8(CLABSI) and 1.3(CAUTI)]- although device use ratios for CL and UC were higher than INICC and CDC/NSHN's ratios. By contrast, despite the VAP rate was higher than INICC(16.5) and NHSN's rates(1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI. CONCLUSION DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates.

Impact of Polymyxin Resistance on Virulence and Fitness among Clinically Important Gram-Negative Bacteria

Humanity is facing an enormous and growing worldwide threat from the emergence of multi-drug-resistant(MDR)Gram-negative bacteria such as Escherichia coli,Klebsiella pneumoniae,and Acinetobacter baumannii.Polymyxin B and E(colistin)constitute the last-line therapies for treating MDR Gram-negative bacteria.Polymyxin is a cationic antibacterial peptide that can destroy the outer membrane of Gram-negative bacteria.With the increasing clinical application of polymyxin,however,there have been many reports of the occurrence of polymyxin-resistant Gram-negative bacteria.This resistance is mainly mediated by the modification or complete loss of lipopolysaccharide(LPS).LPS is also a virulence factor of Gram-negative bacteria,and alterations of LPS may correlate with virulence.Although it is generally believed that the biological costs associated with drug resistance may enable benign susceptible bacteria to overcome resistant bacteria when antibiotic pressure is reduced,some studies have shown that polymyxin-resistant bacteria are associated with higher virulence and greater fitness compared with their susceptible counterparts.To predict the development of polymyxin resis-tance and evaluate interventions for its mitigation,it is important to understand the relative biological cost of polymyxin resistance compared with susceptibility.The impact of polymyxin resistance mecha-nisms on the virulence and fitness of these three Gram-negative bacteria are summarized in this review.

Antimicrobial Resistance of Microorganisms Causing Pneumonia in Patients of a Public Hospital in Brazilian Pre-Amazon Region

Nosocomial infections have been common in health services in Brazil.Among them,pneumonia is very highlighted due to the comorbidity that usually affects intensive treatment unit(ITU)patients,and due to the need for endotracheal intubation.The aim of this study was to determine the resistance profile of bacteria isolated from ITU patients with pneumonia in a public hospital in S?o Luis,an important city in the Brazilian pre-Amazon region.Bacteria strains were obtained from tracheal aspiration and collected for diagnosis as well for phenotypic characterization.Standards culture media,such as blood and MacConkey agar,were used to isolate clinical strains.Automatized Vitek 2 method was used to identify strains and disc diffusion method(Kirby-Bauer)was performed to determine the antimicrobial susceptibility profile.During study,eighty-eight patients were diagnosed with pneumonia,caused by more than 20 different bacteria.Among them,P.aeruginosa(28%),Acinetobacter baumannii(20%),Coagulase-negative Staphylococci(19%),Staphylococcus aureus(8%)and Klebsiella pneumoniae(7%)were the most prevalent microorganisms.Regarding to the resistance,antimicrobial susceptibility test showed that majority of Gram-negative bacteria presented resistance to ampicillin.In Gram-positive bacteria there was a high resistance to ampicillin,penicillin,ciprofloxacin,clindamycin and erythromycin.This study showed a high prevalence of bacteria resistance in ITU patients in a public hospital.Although P.aeruginosa was the most frequent pathogen,it was possible to find other pathogens that were not recurrent,such as Enterobacter spp.,Proteus mirabilis and Providencia stuartii.Regarding antimicrobials,the results showed a high resistance to several antimicrobials.

Clinical efficacy of Buzhong Yiqi decoction(补中益气汤)in the treatment of hospital-acquired pneumonia with multi-drug resistant bacteria:a prospective,randomized,multicenter controlled trial

OBJECTIVE:To evaluate the efficacy and safety of Buzhong Yiqi decoction(补中益气汤,BZYQ)in the treatment of hospital-acquired pneumonia(HAP)with multi-drug-resistant bacteria(MDRB).METHODS:This 28-day study was conducted at 5 clinical centers in Shanghai.The eligible patients were randomly assigned(1∶1)into the intervention group(BZYQ plus conventional Western Medicine therapy)and control group(conventional Western Medicine therapy).The primary outcomes were the clinical response,clinical pulmonary infection score(CPIS),and microbiologic response.The secondary outcomes were the 28-day allcause mortality(ACM),Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,ventilator weaning rate,length of mechanical ventilation(MV),length of hospital stay,and changes of infection indicators.RESULTS:Altogether 83 subjects in the intervention group and 85 subjects in the control group were analyzed.The clinical success rate(48.2%)and the pathogen eradication rate(59.0%)of the intervention group were all better than those of the control group(32.9%and 38.9%,respectively)with statistically significant differences(P<0.05).The CPIS score of the intervention group(8.9±1.7)was lower than that of the control group(9.6±2.5)(P<0.05).The length of MV in the intervention group[(13.7±6.4)d]was significantly shorter than that of the control group[(17.2±7.2)d](P<0.05).The 28-day ACM of the intervention group(13.33%)was lower than that of the control group(21.2%)with no statistically significant difference(P>0.05).The differences between two groups in ventilator weaning rate,length of hospital stay,and APACHEⅡscore were not statistically significant(P>0.05).The intervention group displayed decreases in white blood cell count,C-reactive protein,neutrophil percentage,and procalcitonin at day 28 compared with baseline(P<0.05).No serious adverse events occurred in either group during the 28-day follow-up.CONCLUSION:BZYQ may be an effective therapeutic option for the management of HAP with MDRB.

宣肺解毒方对多重耐药铜绿假单胞菌肺炎的作用机制探讨

目的探究宣肺解毒方对多重耐药铜绿假单胞菌肺炎的机理研究。方法除空白组外,其余组采用气管插管的方法建立MDR-PA(9×10^(8) CFU/mL,0.5 mL)肺炎大鼠模型,造模成功后随机分为模型组、宣肺解毒方低剂量组、宣肺解毒方中剂量组、宣肺解毒方高剂量组以及亚胺培南西司他丁组,每组12只;以上除空白组与模型组外,剩余给药组统称为干预治疗组。造模1 d后,宣肺解毒方低、中、高剂量组分别给予相应剂量的宣肺解毒方(Xuanfei Jiedu Formula,XFJDF)灌胃,亚胺培南西司他丁组给予亚胺培南西司他丁(imipenem,IPM)腹腔注射,空白组和模型组给予生理盐水灌胃,每天2次,持续7 d。观察大鼠的一般状态、体重变化、肺湿重/肺干重(W/D),采用苏木素-伊红(HE)染色法于光镜下观察大鼠肺组织病理学改变,采用酶免疫吸附测定法检测大鼠血清中IL-1β、TNF-α、TGF-β、IL-6炎症因子水平,采用比色法检测大鼠血清中GSH含量与MPO活性,采用TBA法检测大鼠血清中MDA含量,试剂盒法检测总抗氧化能力T-AOC;采用免疫组化法对肺组织中TLR4、Myd88、NF-κBp65蛋白进行定位与半定量观察,采用qPCR和Western Blot技术检测大鼠肺组织中TLR4、Myd88、NF-κBp65 mRNA和蛋白表达水平。结果与空白组比,模型组大鼠反应迟缓,呼吸频率加快、呼吸杂音增多且出现不同程度寒颤,饮食饮水减少,体重下降;肺W/D(P<0.01)显著升高,肺组织的肺泡腔以及肺支气管周围存有大量炎性细胞浸润,部分肺泡壁出现断裂融合形成气腔并伴有炎性渗出,肺间质增厚,局部可见肺纤维形成等;血清中IL-1β、TNF-α、TGF-β、IL-6水平明显升高(P<0.01),MDA含量增加、MPO活性增强、GSH含量与T-AOC能力降低(P<0.01),肺组织中TLR4、Myd88、NF-κBp65 mRNA和蛋白表达显著升高(P<0.01)。与模型组相比,干预治疗组均不同程度改善上述指标变化(P<0.05,P<0.01),以宣肺解毒方高剂量组以及亚胺培南西司他丁组最为显著(P<0.05,P<0.01)。结论宣肺解毒方能够显著改善MDR-PA大鼠的一般状态、体重、肺W/D以及肺病理,降低炎症与氧化应激反应,其作用机制可能与宣肺解毒方抑制肺组织中TLR4/Myd88/NF-κB通路表达有关。

某院肺炎克雷伯菌的临床分布和耐药性分析

目的分析大连市友谊医院2017年—2022年分离肺炎克雷伯菌的临床分布特征以及耐药性,为临床治疗肺炎克雷伯菌感染提供理论依据。方法收集大连市友谊医院2017年—2022年间分离的1865株肺炎克雷伯菌临床株,采用Whonet 5.6软件分析肺炎克雷伯菌临床分布和药敏情况,采用SPSS22.0软件对细菌耐药率进行分析。结果肺炎克雷伯菌在痰液标本中的分离率最高(956株,51.26%);临床科室检出率最多的是重症医学科(734株,39.36%)。肺炎克雷伯菌对青霉素类、头孢菌素类和喹诺酮类药物耐药率相对较高,最高是头孢唑啉(69.8%);其次是氨基糖苷类、碳青霉烯类和四环素类药物,最低的是阿米卡星(17.6%)。所有20类监测药物的耐药率2019年较低(<60%),在2022年较高,耐药率大于70%有哌拉西林(75.6%)、氨苄西林/舒巴坦(72.8%)和环丙沙星(72.7%)。六年间有18种抗菌药物变化显著(P<0.05):2017年—2018年,有8类药物耐药率变化显著(P<0.05),头孢替坦和头孢他啶耐药率明显降低,哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢唑啉、环丙沙星、庆大霉素和妥布霉素耐药率明显升高;2020年耐药率增长明显的是米诺环素和左氧氟沙星;2021年米诺环素耐药率下降明显,庆大霉素耐药率增长明显;2022年有20类药物耐药率都增高,其中哌拉西林、哌拉西林/他唑巴坦、氨苄西林/舒巴坦、头孢哌酮/舒巴坦、头孢曲松、亚胺培南、美罗培南、左氧氟沙星、阿米卡星和妥布霉素10类药物耐药率增高明显(P<0.05)。结论本院近年分离肺炎克雷伯菌临床株对20类抗菌药物耐药率有普遍增高趋势,特别是疫情严重的2022年,加酶抑制剂药物、碳青霉烯类、喹诺酮类和氨基糖苷类药物耐药率上升显著。后疫情时代微生物室应加强细菌耐药性监测,特别注意耐加酶抑制剂、耐三代头孢和耐碳青霉烯类的药物的肺炎克雷伯菌;同时临床医师需控制广谱抗菌药物的使用,以减缓耐药现象。

老年重症肺炎患者支气管肺泡灌洗液细菌培养及药敏分析

目的 分析老年重症肺炎患者支气管肺泡灌洗液细菌构成及药敏情况。方法 纳入2022年3月至2023年8月收治的老年重症肺炎患者180例,对患者支气管肺泡灌洗液进行细菌培养和鉴定,采用最低抑菌浓度(MIC)法进行药物敏感试验分析。结果 180例老年重症肺炎患者支气管肺泡灌洗液共分离出217株病原菌,其中革兰阴性菌141株(64.98%),革兰阳性菌57株(26.27%),真菌19株(8.76%)。革兰阴性菌中肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌分布最广,肺炎克雷伯菌对阿米卡星、复方新诺明的敏感率较高,对哌拉西林、环丙沙星、氨苄西林/舒巴坦的耐药率较高;鲍曼不动杆菌对复方新诺明、妥布霉素的敏感率较高,对头孢他啶、头孢吡肟、头孢曲松的耐药率较高;铜绿假单胞菌对阿米卡星、哌拉西林/他唑巴坦、头孢吡肟的敏感率较高,对亚胺培南、哌拉西林、头孢他啶的耐药率较高。革兰阳性菌中肺炎链球菌、金黄色葡萄球菌分布最广,肺炎链球菌对万古霉素、利福平、青霉素的敏感率较高,对四环素、红霉素、克林霉素的耐药率较高;金黄色葡萄球菌对万古霉素、利福平、克林霉素的敏感率较高,对青霉素、庆大霉素、红霉素的耐药率较高。结论 老年重症肺炎患者支气管肺泡灌洗液的主要病原菌为革兰阴性菌,不同病原菌药敏分析结果差异较大,临床应根据药敏结果合理应用抗生素。

小儿呼吸机相关性肺炎病原菌分布及耐药性分析

目的分析小儿呼吸机相关性肺炎(VAP)病原菌分布情况及耐药性。方法回顾性分析2018年1月至2020年10月日照市中医医院收治的56例VAP患儿的临床资料,采集所有患儿气道分泌物进行病原菌培养及药敏试验,分析病原菌分布情况及耐药性。结果56例VAP患儿以晚发型为主,占比69.64%;共检出61株病原菌,其中革兰阴性菌47株(77.05%),以鲍曼不动杆菌(29.51%)、铜绿假单胞菌(22.95%)、肺炎克雷伯菌(14.75%)为主;革兰阳性菌12株(19.67%),以金黄色葡萄球菌(8.20%)、肺炎链球菌(6.56%)为主;真菌2株(3.28%)。主要革兰阴性菌鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌对头孢噻肟、头孢曲松、头孢唑林耐药性均>50.00%,对亚胺培南、美罗培南未产生耐药性。革兰阳性菌金黄色葡萄球菌、肺炎链球菌对青霉素、氨苄西林、红霉素耐药性均≥75.00%,对替考拉宁、万古霉素未产生耐药性。结论小儿VAP以晚发型为主,革兰阴性菌为主要致病菌,且整体致病菌对常规抗菌药物呈广谱耐药现象,需依据药敏结果选用针对性药物治疗,促进感染消退。

脑卒中相关性肺炎患者肺部多药耐药菌感染的影响因素

目的:分析脑卒中相关性肺炎患者肺部多药耐药菌感染的影响因素。方法:采用便利抽样的方法,回顾性分析2017年1月—2022年12月潍坊市人民医院接受治疗的168例脑卒中相关性肺炎患者的临床资料,包括性别、年龄、脑卒中类型、意识障碍情况、吞咽功能情况、合并糖尿病、合并高血压、肺部感染分型、预防性使用抗生素情况、胃管留置情况等,分析脑卒中相关性肺炎患者肺部多药耐药菌感染的独立影响因素。结果:168例脑卒中相关性肺炎患者中,有113例(67.26%)为脑卒中后肺部多药耐药菌感染。单因素分析结果显示,多药耐药菌感染组意识障碍、晚发型肺炎、预防性使用抗生素占比高于非多药耐药菌感染组,差异有统计学意义(P<0.001)。Logistic多因素分析结果显示,意识障碍、晚发型肺炎、预防性使用抗生素是脑卒中后肺部多药耐药菌感染的独立影响因素(P<0.05)。结论:意识障碍、晚发型肺炎、预防性使用抗生素是脑卒中后肺部多药耐药菌感染的独立影响因素。

基于伏邪理论的益气透邪方治疗老年多重耐药菌肺炎临床疗效观察

目的:评价在西医常规治疗基础上加用益气透邪方治疗重症医学科老年多重耐药菌肺炎患者的临床疗效。方法:将2017年2月-2021年10月收治于甘肃中医药大学附属医院重症医学科80例老年多重耐药菌肺炎患者随机分为中药治疗组与对照组,每组40例。对照组予以常规治疗,中药治疗组在常规治疗基础上加用益气透邪方加减,疗程为7 d。记录两组患者治疗前后中医证候积分、C反应蛋白(C-reactive Protein,CRP)、降钙素原(Procalcitonin,PCT)、白细胞介素-6(Interleukin-6,IL-6)、临床肺部感染评分(Clinical Pulmonary Infection Score,CPIS)、氧合指数(P/F)、耐药菌清除率及28 d病死率。结果:中药治疗组与对照组的临床总有效率分别为92.50%(37/40)和70.00%(28/40),中药治疗组疗效优于对照组(P<0.05)。与治疗前相比,两组患者治疗后中医证候积分、CPIS、CRP、PCT、IL-6均较治疗前下降,中药治疗组下降更明显(P<0.05)。与治疗前相比,两组患者P/F均升高,中药治疗组升高更为显著(P<0.05)。耐药菌清除率中药治疗组为37.5%,对照组为27.5%(P>0.05)。两组无显著差异;两组患者28 d病死率无显著差异(P>0.05)。结论:在常规西医治疗基础上运用益气透邪方加减治疗老年耐药菌肺炎能够显著缓解患者临床症状,降低炎症反应,改善氧合指数,临床疗效肯定。

污水中肺炎克雷伯氏菌噬菌体的分离及其生物学特征、基因组分析

为探究噬菌体作为治疗肺炎克雷伯菌感染的新型潜在疗法的可能性,本研究采用双层平板法将医院周边污水中3株肺炎克雷伯菌裂解性噬菌体进行分离纯化,透射电镜观察噬菌体形态结构,并进一步分析噬菌体裂解谱、最佳感染复数、生长曲线和酸碱耐受性等生物学特征,同时通过测序技术获得噬菌体全基因组信息并注释分析.实验结果表明,KP-ZS3为肌尾科噬菌体,KP-ZS4为短尾科噬菌体,KP-ZS6为长尾科噬菌体,且KP-ZS4的感染潜伏期稍长,KP-ZS3耐酸碱能力较强,KP-ZS6的裂解能力为3株噬菌体中最强、裂解谱较宽.3株噬菌体的外壳蛋白组分大小均在33~55 kD之间.此外全基因组分析发现KP-ZS3、KP-ZS62株噬菌体的基因组大小均在100 kb以上,噬菌体KP-ZS4的基因组相对较小(40608 bp).共线性分析显示噬菌体KP-ZS3与phiEap-3、Kp15高度相似;KP-ZS6与0507KN21、vB_EcoM_KWBSE43-6高度相似.KP-ZS4与Tyrion、TL-2011b相似度相对较低,序列一致性为76.77%、76.89%.以上结果表明,这3株噬菌体具有独特的生物学特性和基因组特征,它们在肺炎克雷伯菌感染治疗方面展现出不同的潜力和优势,特别是KP-ZS6因其裂解能力强和广泛的裂解谱,以及KPZS3因其强耐酸碱性,可能成为未来抗菌治疗的备用资源,这些发现为开发新型抗菌策略和治疗肺炎克雷伯菌感染提供了新的信息基础.

2022年广西某医院临床主要分离菌的分布特点及肺炎克雷伯菌耐药情况分析

目的探讨2022年广西某医院临床主要分离菌的分布特点及肺炎克雷伯菌的耐药情况。方法收集2022年1—12月广西某医院住院患者的血液、痰液、尿液、分泌物等临床标本,在对其进行病原菌分离培养后开展细菌鉴定和药敏试验,分析主要分离菌的临床分布特点及肺炎克雷伯菌耐药情况。结果共分离出细菌4349株,标本来源以清洁中段尿、痰液、伤口标本、全血、肺泡灌洗液等为主,分离菌占比较高的科室为重症医学科、呼吸与危重症医学科、移植医学中心、泌尿外科、内分泌科等。其中,革兰氏阴性菌占比为71.76%(3121/4349),分离率位居前5的依次为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌(复合群)、嗜麦芽窄食单胞菌;革兰氏阳性菌占比为28.24%(1228/4349),分离率位居前5的依次为金黄色葡萄球菌(复合群)、屎肠球菌、粪肠球菌、溶血葡萄球菌、表皮葡萄球菌。肺炎克雷伯菌对呋喃妥因、四环素、头孢唑啉等的耐药率较高,对替加环素、头孢他啶/阿维巴坦、多黏菌素耐药率较低。共检出91株耐碳青霉烯类肺炎克雷伯菌,主要来自康复医学科、重症医学科、移植医学中心、呼吸与危重症医学科等科室。结论肺炎克雷伯菌在临床上较为常见,其耐药形势较为严峻。临床上应加强肺炎克雷伯菌特别是耐碳青霉烯类肺炎克雷伯菌的监测,并合理使用抗菌药物,制订有针对性的预防控制措施,以避免因为耐药造成的疗效减弱。

多重耐药菌医院呼吸机相关性肺炎危险因素及预后分析

目的探讨多重耐药菌医院呼吸机相关性肺炎(VAP)的危险因素及预后。方法选取医院2020年1月至2021年12月收治的重症加强护理病房(ICU)机械通气患者100例,根据是否发生VAP分为VAP组(下呼吸道检出多重耐药菌并符合VAP临床诊断标准,50例)和非VAP组(下呼吸道未检出多重耐药菌且未诊断为VAP,50例)。比较两组患者住院时间和住院费用,并分析多重耐药菌VAP发生的危险因素。结果VAP组患者治疗费用和住院时间均显著高于非VAP组(P<0.05)。引起呼吸VAP的危险因素包括意识障碍,呼吸机相关性肺炎类型为晚发型,近3个月接受第3代头孢菌素、含酶抑制剂复合物和碳青霉烯类抗菌药物,呼吸机通气时间≥7 d,ICU住院时间≥7 d(P<0.05)。结论VAP可增加患者的治疗费用和延长住院时间。造成多重耐药菌医院VAP的危险因素较多,如意识障碍,呼吸机通气时间≥7 d、晚发型呼吸机相关性肺炎,ICU住院时间≥7 d,近3个月接受第3代头孢菌素、含酶抑制剂复合物和碳青霉烯类抗菌药物,应根据相关危险因素采取综合性防控措施,降低其发生风险。