Objective To evaluate systematically the effectiveness and safety of procalcitonin ( PCT) -guided therapy in comparison with standard therapy in patients with suspected or confirmed severe bacterial infections in intensive care unit ( ICU) . Methods Five randomized controlled trials ( 927 patients) were included for statistical analysis by the cochrane collaboration′s RevMan5. 0 software. Results PCT-guided therapy was associated with a significant reduction in duration of antibiotic therapy [ MD =- 2. 01, 95% CI ( - 2. 37, - 1. 64) , P lt;0. 00001] , but the mortality [ OR =1. 11, 95% CI ( 0. 83, 1. 49) ,P =0. 47] and length of ICU stay[ MD = 0. 49, 95% CI( - 1. 44, 2. 42) , P = 0. 62] were not significantly different. Conclusions An algorithmbased on serial PCT measurements would allow a more judicious use of antibiotics than currently traditional treatment of patients with severe infections in ICU. It can reduce the use of antibiotics and appears to be safe.
Objective To retrospectively analyze and classify 23 open fractures that resulted in severe infection, in order to provide evidence that can be used in future disaster scenarios. Methods Based on medical records of 23 cases of open fracture and subsequent bacterial infection, we analyzed the clinical diagnosis, treatment, laboratory tests, bacterial smear of wound secretion, and the bacterial culture of the wound secretion. We then analyzed which antimicrobial agents were used and how they were applied, and the subsequent effect on controlling the serious infection.? Results All cases were related to seismic injury and belonged to class VI open fracture. Eight cases were male and 15 were female. All cases had similar symptoms such as chills, fever, large scale muscle necrosis, and severe infection. A direct smear of the wound showed that the number of cases with one bacterial infection was 6 (26.09%), the number that had double bacterial infections was 12 (52.18%), and the number with multiple bacterial infections was 5 (21.74%).There were 18 strains of 11 types of bacteria recovered from wound samples. Conclusion Early treatment with the joint application of multiple antibacterial agents, early debridement, and adequate drainage all helped to control the infection and avoid nosocomial infection. Employing these strategies in the future will control infection in disaster situations.
ObjectiveTo systematically review the efficacy and safety of extended or continuous intravenous infusion (EI/CI) versus short-term intravenous infusion (STI) of imipenem/meropenem in adult patients with severe lung infection. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 6, 2015) and CBM from inception to June, 2015, to collect random controlled trials (RCTs) about EI/CI versus STI of imipenem/meropenem for severe infection. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 6 RCTs involving 442 patients were included. The results of meta-analysis showed that, compared with the STI group, the EI/CI could significantly improve the microbiological success rate (RR=1.16, 95%CI 1.02 to 1.32, P=0.02) without increasing adverse drug reaction (RR=0.99, 95%CI 0.65 to 1.52, P=0.97). There were no significant differences in clinical effective rate (RR=1.12, 95%CI 0.97 to 1.28, P=0.13), survival rate (RR=1.03, 95%CI 0.92 to 1.16, P=0.62) and hospital stays (MD=-0.43, 95%CI-1.29 to 0.42, P=0.32) between the two groups. Conclusions There is no significant difference in clinical effect between EI/CI and STI for severe lung infection. While, the infections caused by gram-negative bacteria with high MIC could benefit more from EI/CI. Due to the limited quantity and quality of the included studies, the above conclusion still need to be further verified by more high quality studies.