Objective To systematically review the effectiveness and safety of linezolid versus teicoplanin in patients with MRSA pneumonia. Methods Such databases as CBM, CNKI, WanFang Data, VIP, Science Direct, PubMed, Ovid, SciFinder, The Cochrane Library (Issue 3, 2013) and EMbase were electronically searched for published articles (randomized controlled trials or non-randomized prospective trials with comparable baseline between groups) at home and abroad on the clinical effectiveness and safety of linezolid versus teicoplanin in patients with MRSA pneumonia from January 2003 to March 2013. Using the Cochrane methods, two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software in clinical cure rates, clinical effective rates, microbiologic eradication rates, and adverse reaction incidences. Results Finally, 7 studies were included involving 637 patients. The results of meta-analysis were clinical effective rates (RR=1.17, 95%CI 1.04 to 1.32, P=0.009), clinical cure rates (RR=1.06, 95%CI 0.94 to 1.19, P=0.37), bacterial clearance rates (RR=1.32, 95%CI 1.03 to 1.68, P=0.03), and adverse events rates (RR=1.24, 95%CI 0.78 to 1.97, P=0.37). The results of Begg test and Egger test were not significant (Pgt;0.05). Conclusion Current evidence shows that, in treating MRSA pneumonia, linezolid is better than teicoplanin in clinical effective rates and bacterial clearance rates. However, they are alike in clinical cure rates and bacterial clearance rates.
Based on review and practice of literature search of clinical economic evaluation, We have discussed the source and search strategy of literatures of clinical economic evaluation. A sample on antibiotics in the treatment of community-acquired pneumonia was shown concurrently.
Objective To investigate the recent studies about the relationship between Chlamydia pneumoniae and abdominal aortic aneurysm. Methods The current literatures about the relationship between Chlamydia pneumoniae and abdominal aortic aneurysm were reviewed. Results Chlamydia pneumoniae is one of the most important factors for the formation of abdominal aortic aneurysm since Chlamydia pneumoniae can cause abdominal aortic aneurysm through the metabolism of matrix metalloproteinases, the apoptosis of smooth muscle cells in the vessels and the chronic infection of the wall of the aneurysm. Conclusion There maybe a distinguishingly close relationship between Chlamydia pneumoniae and abdominal aortic aneurysm, and Chlamydia pneumoiae may take an important role in the development and progress of the abdominal aortic aneurysm.
Objective To analyze the clinical and etiological characteristics and bacterial susceptibility in patients with ventilator-associated pneumonia (VAP) in Guangzhou area.Methods A retrospective study was conducted on VAP patients in four hospital of Guangzhou from Jan 2004 to Oct 2005.Totally 157 patients were enrolled in this study，whose flora was identified and tested by Kirby Bauer disk diffusion susceptibility test.The univariate analysis method was used to analyze the prognostic parameters.Results The average onset time of VAP was 7.7 days after mechanical ventilation with a mortality rate of 38.2%.The proportion of Gram-negative bacilli，Gram-positive cocci and eumycete was 68.0%，23.4% and 8.7% respectively in 184 isolated strains.The most common pathogens were Pseudomonas aeruginosa (18.5%)，Stenotrophomonas maltophilia (14.1％)，Burkholderia cepacia (10.9%)，Staphylococcus aureus (10.3%) and Acinetobacter baumannii (8.7%).Pseudomonas aeruginosa，Stenotrophomonas maltophilia，and Acinetobacter baumannii were resistant to most common antibacterials such as cephalosporin and imipenem.18 strains oxacillin resistant Staphylococcus aureus，7 strains oxacillin resistant Staphylococcus simulans and one vancomycin resistant Staphylococcus aureus were isolated.Expect for vancomycin，teicoplanin and fusidic acid，the resistance of Gram-positive cocci were above 50% to other 9 antibacterials.Conclusions The antibiotic resistance situation of VAP in Guangzhou is very serious with high mortality.It is important to reinforce the prevention and guidance on the proper treatment of VAP.
细菌耐药是一个全球性的难题，而滥用抗生素是导致细菌耐药的重要原因。合理使用抗生素的核心包括以下三点：①选择合适的抗生素（有效、经济、毒副作用小和使用方便）；②采取合适的给药方法（给药剂量、间期和途径）；③采取合适的疗程。其中抗生素的疗程究竟多长最合适是目前研究最薄弱的环节，同时也是当前和今后抗感染领域研究的热点[1]。
Objective To detect the levels and study the significance of serum soluble intercellular adhension molecule-1(sVCAM-1),soluble vascular cell adhension molecule-1 (sVCAM-1) in patients with community-acquired pneumonia(CAP).Methods sICAM-1 and sVCAM-1 were detected by enzymelinked immunosorbent assy（ELISA）in 25 patients with CAP before and after treatment as well as in 10 healthy controls.Results Before treatment, the levels of serum sICAM-1 and sVCAM-1 in the patients with CAP[（2.658 4±0.259 7）ng/mL,(2.680 9±0.255 4）ng/mL)] were significantly higher than those in controls[(2.472 8±0.077 6)ng/mL,（2.426 3±0.307 2)ng/mL](Plt;0.01,Plt;0.05). After treatment, the levels of serum sICAM-1, sVCAM-1 significantly decreased [(2.518 3±0.205 2)ng/mL,(2.523 0±0.279 4)ng/mL](Plt;0.01,Plt;0.01) and were not different from those in controls（Pgt;0.05）.The levels of sICAM-1 were positively associated with neutrophil counts（r=0.602，Plt;0.001）rather than the levels of sVCAM-1（r＝0.036，Pgt;0.05）.Conclusion The changes of sICAM-1 and sVCAM-1 before and after treatment are predictive to the prognosis in patients with CAP.
Objective To evaluate the efficacy and safety of Levofloxacin combined with Cefoperazone/Sulbactam on the patients with ventilator-associated pneumonia ( VAP) . Methods The clinical effect of Levofloxacin combined with Cefoperazone/ Sulbactam on ventilator-associated pneumonia in 58 paitiens with VAP were retrospectively analyzed. Results 26 patients ( 44. 8% ) were cured, 18 patients( 31. 1% ) were marked improved, and 14 patients ( 24. 1% ) were ineffective. The total clinical efficacy rate was 75. 9% . 55 strains of bacteria were isolated, and Gram-negative bacilli were dominant pathogens( 78. 2% ) . The bacterial clearance rate was 78. 2% . The prevalence of adverse reaction was 5. 1% . Conclusion Levofloxacin combined with Cefoperazone/ Sulbactam is effective and safe for patients with VAP.
Objective To study the risk factors and prognosis of hospital acquired pneumonia( HAP)caused by carbapenem-resistant Acinetobacter baumannii( CRAB) . Methods By a case-control study, the data of 44 cases of HAP caused by CRAB fromJan 2005 to Dec 2007 in Nanfang Hospital were analyzed. 66 cases of HAP caused by Carbapenem-susceptible A. baumannii ( CSAB) were selected randomly at the same time as control. Univariate analysis( T test and chi-square test) and multivariate logistic regression were used for statistics analysis. Results Univariate analysis revealed that five factors associated with the infection caused by CRAB were APACHE Ⅱ score ≥ 16, chronic pulmonary disease ( COPD/ bronchiectasis ) , imipenem/meropenem and fluoroquinolone used 15 days before isolation of CRAB, and early combination therapy of antibiotics. Multivariate logistic regression analysis identified two independent factors as APACHEⅡ score ≥16( OR=6. 41, 95% CI 2. 20-18. 67) and imipenem/meropenemused 15 days before isolation of CRAB( OR =6. 33,95% CI 1. 83-21. 87) . Of 44 cases of CRAB infections, 14 patients died and 30 patients survived. Univariate analysis revealed that two factors associated with poor prognosis were organ failure and clinical pulmonary infection score( CPIS) rise after three-day treatment. According to multivariate logistic regression analysis, only CPIS rise after three-day treatment ( OR =7. 01, 95% CI 1. 23-40. 03) was an independent predictive factor. Conclusions APACHEⅡ score ≥ 16 and imipenem/meropenem used 15 days before isolation of CRAB were independent risk factors for CRAB infection. CPIS rise after three-day treatment was a predictive factor for the prognosis of CRAB infection.
To evaluate the clinical efficacy and safety of piperacillin/ tazobactam in the treatment of hospital acquired pneumonia( HAP) . Methods A multicenter, open-labeled, non-comparative clinical trial was conducted. Patients with HAP were administered intravenously with piperacillin /tazobactam( 4. 5 g) every 8 h for 7-14 days. Results A total of 250 patients were enrolled in this study and 246 subjects were clinical valuable. At the end point, the clinical efficacy rate was 81. 7% ( 201 /246) and the bacterial eradication rate was 74. 1% ( 83 /112) . The rate of drug related adverse events was 2. 8% ( 7 /250) , in which 4 cases had clinical significance ( rash, dyspnea, injection site pain and diarrhea, respectively) and 3 cases had abnormal laboratory findings ( hepatic dysfuction , eosinophilia and so on ) . All events were mild and transient . Conclusions Piperacillin/ tazobactamis effective and safe in the treatment of HAP, therefore, it is recommended as one of the first-line antibiotics to treat the patients with HAP.
Objective To analyze the risk factors for ventilator-associated pneumonia( VAP) in adult patients undergoing cardiac surgery with cardiopulmonary bypass ( CPB) . Methods A total of 127 consecutive adult patients who received postoperative ventilation for more than 48 hours between January 2002 and June 2008 in the cardiac surgical intensive care unit( CSICU) were included in this study. The patients were assigned into a VAPgroup( n =64) and a control group( n = 63) . Pre-, intra-, and postoperative factors were collected and analyzed between two groups, and the multivariate analysis( logistic regression)were used to identify the risk factors of VAP. Results The overall incidence of VAP was 5.1%. The mortality of VAP was 28. 1% . Compared to the control group, the patients in the VAP group had longer duration of cardiopulmonary bypass time, ventilation time, more blood products usage and the duration of stay in CSICU( P lt; 0. 001) , higher morbidity of low cardiac output syndrome and tracheotomy( P lt; 0. 01) and higher rate of aortic surgery and mortality( P lt; 0. 05) . The preoperative left ventricular ejection fraction ( LVEF) and postoperative oxygenation index( PaO2 /FiO2 ) were lower in the VAP group than those of the control group( P lt; 0. 001) . Five variables were found to be significantly related to the development of VAP by multivariate analysis: CPB time gt; 120 min( OR = 6. 352, P = 0. 000) ; PaO2 /FiO2 lt; 300 mm Hg( OR =3. 642, P = 0. 017) , transfusion of blood products ≥1500 mL( OR = 5. 083, P = 0. 039) , ventilation time≥5 days( OR = 9. 074, P = 0. 047) and tracheotomy( OR = 19. 899, P = 0. 021) . A total of 102 pathogens were obtained by sputum culture in 64 VAP patients. There were 62( 60. 8% ) cases of gram negative bacilli, 19 cases( 18. 6% ) of gram positive cocci and 21( 20. 6% ) cases of eumycetes. Conclusion This study shows that the cardiopulmonary bypass time, ventilation time, hypoxemia, blood products transfusion and tracheotomy are risk factors most likely associated with VAP development.