Objective To investigate the pathogenic features and bacterial resistance of non-fermentative bacilli associated hospital-acquired pneumonia(HAP) for the sake of prevention and Evidence-based Medicine treatment of this condition.Methods A retrospective review was made in 92 diabetes patients admitted from December 2001 to April 2008 who acquired non-fermentative bacilli associated HAP during hospital.Results All 92 patients who contracted non-fermentative bacilli associated HAP had underlying diseases and contributing factors.All these patients was 1.2% of the patients admitted in respiratory diseases department;and 56.1% of the HAP patients who had diabetes in the corresponding time period.Pseudomonas aeruginosa was detected in 29 patients(31.5%),Acinetobacter baumanii in 27 patients(29.3%),Acinetobacter Lwoffii in 16 patients(17.4%),stenotrophomo-nas maltophilia in 9 patients(9.8%),Pseudomonas cepacia in 8 patients(8.7%),Pesudomonas fluorescen in 3 patients(3.3%).Drug sensitivity test showed that the condition was multi-drug resistant,especially to the third generation cephalosporins.Enzyme-inhibitors,the fourth-generation cephalosporins and Imipenem were tested sensitive.Conclusions Nearly all diabetes patients with non-fermentative bacilli associated HAP had multiple underlying disease,with high mortality.Early preventions and rigorously controlling the level of blood glucose are of primary importance,and both pathogenic examination and Evidence-based Medicine treatment of antibiotics is essential for better prognosis.

鲍曼不动杆菌(Acinetobacter baumanii)是一种非发酵类的革兰阴性杆菌,为条件致病菌.它广泛分布于土壤、水和湿热环境中,可引起伤口感染、泌尿系统感染、呼吸系统感染等,现已成为严重的院内感染病原菌之一.

AIM To evaluate the efficacy and safety of cefdinir capsule in treatment of patients with acute bacterial infections of respiratory tract and urinary tract. METHODS It was a randomized,double-blind,double-dummy,parallel controlled and multiple center trial design.Patients in test group were given one capsule of tested cefdinir capsule and one capsule of placebo of listed cefdinir capsule simulation,po,tid,for 7-14 d. Patients in control group were given one capsule of listed cefdinir capsule and one capsule of placebo of tested cefdinir capsule simulation,po,tid,for 7-14 d. RESULTS One hundred and thirty-eight patients with acute bacteriaI infections of respiratory tract and urinary tract were selected. Among them,137 patients can be carried out the evaluation analysis (69 patients in test group,68 patients in control group).The total effective rates of the test group and control group were 92.75% and 95.59% ,and the recovery rates were 75.36% and 77.94%,respectively.In the infections of respiratory tract ,the recovery rate and the effective rate were 69.44%and 91.67% in test group,respectively. In the infections of urinary tract,the recovery rate and the effective rate were 81.82% and 93.94% in control group,respectively. The bacteria-positive rates of two group were 91.30% and 80.88%,respectively.The bacterial clearance rates were 88.89% and 94.55%,respectively.The adverse events rates were 8.70% (6/69) and 13.04%(9/69),respectively. The main adverse drug reactions included nausea,abdominal discomfort,phlebitis,the elevation of ALT,BUN,and so on.The two groups were similar in the efficacy and safety (P0.05).CONCLUSION Tested cefdinir capsule is effective and safe in the treatment of patients with acute infections of respiratory tract and urinary tract.The effect is considerable as compared with the control drug listed cefdinir capsules.

Objective To explore the pathogenic features and bacterial resistance of non-fermentative gram-negative bacilli associated hospital-acquired pneumonia (HAP) for the sake of provide guidelines for the prevention and treatment of the condition. Methods A retrospective review was made of 102 elderly in-patients admitted from January 2003 to December 2006 who acquired non-fermentative gram-negative bacilli associated HAP during hospital stay. Results All 102 patients who contracted non-fermentative gram-negative bacilli associated HAP had underlying diseases and contributing factors. Aeromonas was detected in 38 patients (37.3%), Acinetobacter baumannii in 26 patients (25.5%), susceptible Acinetobacter in 19 (18.6%), Stenotrophomonas maltophilia Aeromonas in 17 patients (16.7%), and Alcaligenes xylosoxidans bacillus xy10 subspecies in 2 patients (2%). Drug sensitivity test showed that the condition was multi-drug resistant, especially to Tienam. Conclusions Most elderly patients with non-fermentative gram-negative bacilli associated HAP had multiple underlying disease, with a high mortality. Early prevention is of primary importance, and pathogenic examination is essential in directing clinical drug administration.

医院获得性肺炎NP是院内感染的常见并发症,随着医疗技术的发展,各种侵入性操作和器官移植的推广,尤其是抗菌素的广泛应用和病原菌的变迁,革兰氏阴性杆菌已占院内肺炎病原菌的50%～80%[1],且病情危重,死亡率高,治疗困难.现将我科2001～2003年院内获得性革兰氏阴性杆菌肺炎104例NP患者进行回顾性调查,报道如下:

Objective: To compare the efficacy and safety of intravenous and oral levofloxacin versus ceftriaxone and cefixime in treatment of lower respiratory tract infections(LRTI) and urinary tract infections(UTI). Methods:A prospective, randomized, multicenter, comparative study was carried out in LRTI and UTI patients. Patients received either levofloxacin 300 mg twice daily intravenously followed by the same dosage orally or ceftriaxone 2.0 g once daily intravenously followed by oral cefixime 200 mg three times daily for 10-14 days. Results:Two hundred and fourteen patients were enrolled this study, 192 patients were evaluable, 92 in levofloxacin group with 54 cases of LRTI and 38 UTI; 100 patients in ceftriaxone followed by cefixime group with 59 cases of LRTI and 41 UTI. Clinical cure rates and total effective rates were 77.2%(71/92) and 93.5%(86/92) in levofloxacin group, 82.0%(82/100) and 95.0%(95/100) in control group; the bacterial eradication rates being 93.0%(53/57) and 97.1%(66/68) respectively. The clinical adverse effect rates were 16.0%(17/106) and 4.6%(5/108), while abnormal laboratory tests being 12.3%(13/106) and 13.0%(14/108) in the two groups respectively. No significant difference of the above figures between the two groups were found, however, the adverse effect rates in levofloxacin group was higher than that of control group (P=0.012). Conclusions:Levofloxacin sequential therapy is as effective as parenteral ceftriaxone followed by oral cefixime in the treatment of lower respiratory tract infections and urinary tract infections, adverse effects are mild and transient in both groups but more frequent in levofloxacin group than in control group.

To study the clinical features,anfimicrobial resistance,prevention and treatment of pulmonary infection caused by extended spectrum β-lactamase(ESBL)producing Klebsiella pneumoniae and Escherichia coli in elderly pa- tients.Methods 98 elderly patients with pulmonary infection caused by ESBL producing Klebsiella pneumoniae and Es- cheichia coli treated in the Sixth People’s Hospital of Shanghai were enrolled in this study.The clinical features,chest X -ray findings,treatment and outcome of these patients were analyzed so as to understand the charateristics of the infec- tion.Antimicrobial drug susceptability tests for these organisms were carried out and presence of ESBL also tested.Results Fever,cough and expectoration were the main clinical symtoms of the 98 patients and decrease of consciousness found in a portion of them.The main chest X-ray findings of the pulmonary infection due to these two bacteriae were lobar consoli- dation with air containing segmental bronchi,(25% and 3.3%),lobular infiltration(61.8% and 83.3%)and formation of lung abscess or empyema(13.2 % and 3.3 %)Among the patients with Klebsiella infection,9 cases(13.2%)showed the characteristic X-ray finding of interlobar fissure depression.21(30.9%)and 8(26.7%)strains were found to be ESBL producing in each of the groups with the infection.The isolated bacteriae were resistant to many antibiotics,but sus- ceptible to imipenem and compound antibiotics containing β-lactamase inhibitors.Conclusions Elderly patients with pulmonary infection caused by ESBL producing bacteriae may present with loss of appetite,diarrhea,somnolence and de- creased consciousncess.Diagnosis of these infection depends mainly on the isolation of etiologic bacteriae as well as chini- cal and X-ray findings,Imipenem and compound antibiotics containing β-lactamase inhibitors may be used.Measures for preventing nosicimial infection of these bacteriae should be taken.

Objective To evaluate the safety and effectiveness of etimicin sulfate and amikacin sulfate on bacterial infection in lower respiratory tract infection.Methods Using the random,contrast and ope test method,in etimicin sulfate group (n=60) 100 mg in 100 ml NS was intravenously given,twice a day;in amikacin sulfate group  (n=60)  400 mg in 500 ml NS was intravenouly given,once a day,with a treatment course of 5～10 days for both groups.Results 30 cases in each group were evaluated for its effectiveness,the effective rates in etimicin sulfate group and in amikacin sulfate group were 90.0% and 86.7% respectively,the clearing bacteria rates were 88.5% and 88.0% respectively.The other 30 cases in each group were evaluated for its safety,the incidences of dys response of deafness were 3.3% and 3.3%,and the incidences of dys response of kidney were 3.3% and 3.3%.There was no significant difference between two group (P0.05).Conclusion Etimicin sulfate is safe and effective in treating bacterial infection in lower respiratory tract.

Objective To learn about the clinical characteristics and the drug resistance of Klebsiella pneumonie induced extensive spectrum β-lactam(ESBL). Methods Analysis of Klebsiella pneumonie lung infection,clinical symptomatology,chest X-ray,treatment and outcomes of 61 elderly patients were made in our department during 2001 to 2002.Drug sensitivity in vitro ESBL detected in 12 antibiotics including amikacin were observed in their activities to the bacterial resistance by in vitro test sensitivity drug with paper testing method for ESBL.Results 94.9% of those patients had underlying diseases and most of them presented fever, productive cough with sputum, X-ray of lobar consolidation (26.2%), lobular infiltration (59.9%) and lung abscess(14.8%) . In ten patients(16.4%) there were the specific X-ray sign,curling down of lobular fissure in Klebsiella pneumonie lung infection.Among the 61 patients, ESBL-positive Klebsiella pneumonie was 31.1%,being cross-resistant to many antibiotics, but were sensitive to imipenem and inhibitor of ESBL compounding antibiotics.Conclusion The elderly patients having Klebsiella pneumonie lung infection usually have underlying diseases with nonspecific clinical features.The diagnosis is mainly made by sputum culture in combination with clinical and radiological examination.In the treatment,one should rely on the drug sensitivity test and choose the the sensitive antibiotics. For ESBL's Klebsiella infection of lung, one should use imipenem or compound antibiotics of ESBL-inhibitor or other sensitive drugs shown by sensitivity test.

Objective:To evaluate the efficacy and safety of dom estic levofloxacin injection and tablet in treating moderate bacterial infectio n.Methods:106 patients with moderate bacterial infection were randomly divided into 2 groups:group A received domestic levofloxacin,iv,drip 200mg bid for (10～)14 days,and group B(sequential therapy group)received levofloxacin,iv, drip 200mg bid for 4 days then followed by levofloxacin tablets 200mg bid orally for 7～10 days.Results:The clinical efficacy rate was 86.79% in group A and 84.91% in group B,while bacterial clearance was 77.78% and 76.00% respectively,without si gnificant difference (P0.05).The adverse reaction incidences were mild and low in both groups.But the cost/efficacy ratio in group B was higher than group A,because of the shorter hospitalization and lower medical expenditure (P0. 01).Conclusion:The domestic levofloxacin was effective and safe in treating moderate bacterial infection.And sequential antibiotic therapy of levofloxacin was more economic in clinical use.

Objective To learn about the clinical characteristics and the drug resistance of Klebsiella Pneumoniae inducing extensive spectrum β lactam(ESBL). Methods 60 patients infected by Klebsiella Pneumoniae in lung were studied depending on clinical data, inculding age, basic diseases, drug usage before infection, the deficiency of immune system, clinical symptoms and signs, the treatment and the prognosis. 34 of 60 (56.7%) were under the test of drug sensitiveness in vitro for ESBL; 26 patients without the test. 16 antibiotics inculding amikacin and ceftazidime were observed their activity to the germ resistance in vitro. Results 95.9% of 60 patients, had basic diseases, mostly chronic obstructive pulmonary disease. These patients presented simptoms of fever, sputum produced cough, X-ray of lobular consolidation in air inflated sign (26.7%); infiltration in lung lobar (58.3%) and lung abscess. 11 (18.3%) patients presented classical X-ray sign of lobular fissure curving down of Klebsiella Pneumoniae lung infection. White blood cell was elevated in 68.3%. of 60 patients. And neutrophil was higher than 81%(61.7%), perhaps due to the rapid development of the infection. 34 of 60 patients tested for ESBL and 11 of them were positive. ESBL negative Klebsiella Pneumoniae and the germ without testing of ESBL were sensitive to amikacin and tobramycin, with sersitivity of 91.3%, 96.2% and 95.7%,96.2%, respectively. Also, the sensitivity to these Klebsiella Pneumoniae was higher than 80% to cefuroxime and cefoxitin, even higher than 90% to ceftazidine, ceftriaxone, and cefoperazone. But resistance of cefuroxime and ceftazidine to ESBL Klebsiella Pneumoniae were 72.7% and 63.6% ; the cross resistance of ESBL Klebsiella Pneumoniae to amikacin and tobramycin was 63.6% and 54.5%; and the resistance to ciprofloxacin and compound sulfamethoxazde as high as 54.5% and 90.9%. All the tested Klebsiella Pneumoniae were sensitive to imipenem or inhibitor of ESBL compounding antibiotics. Conclusion Being diagnose by the culture of Klebsiella Pneumonia and combination of clinical date and X-ray s,lung infection of Klebsiella Pneumoniaepresents unclassical symptoms and basic disease. It can be treated depending on drug sensitive testing and chosing the sensitive antibiotics, especially in combination. But imipenem and compound antibiotics of ESBL-inhibitor or drugs demonstrated by cultrue sensitive to these germs were introduced to treat the lung infection of ESBL Klebsiella Pneumoniae.

目的:进一步讨论"利复星针剂静脉滴注-片剂口服序贯治疗"对中-重度社区肺部细菌感染的疗效,安全性及卫生经济学的综合评价.方法:采用区组随机化,多中心平行对照实验设计.例:A组,利复星,咳?00mg/100ml,2次静脉滴注;B组,先用利复星注射液200ml,每日2次静脉滴注,连续4天改为利复星200mg,每日2次口服,总疗程药为10-14天.结果:两组总有效率分别为86.79%、84.91%,统计学上无显著差异,两组细菌清除率分别为77.78%、76.00%,统计学上亦无差异,两组的不良反应均相似,且很低,未见引起肝肾功能异常改变,在药物经济学上,B组各项指标均占优势,住院天数明显缩短,住院费用分别为565.53、395.30元,总医疗费分别为3812.38、2452.67元.成本-效果比,两组分别为4394、2889元,经统计学分析,均有显著差异.结论:利复星具有良好的药动力学和安全性,抗菌谱广,疗效显著,利复星针剂静脉滴注-片剂口服序贯治疗,治疗呼吸系统中-重度细菌性感染,是一种理想的,成本效果上佳的治疗方案.

为观察被动吸烟大鼠肺泡灌洗液炎性细胞及呼吸道病理形态学改变,将清洁级SD大鼠随机分成两组,吸烟组(n=13)置于隔离器内被动吸烟2 h/d,共20 d,对照组置隔离器内2 h/d,无被动吸烟.20 d后行支气管肺泡灌洗液(BALF)炎性细胞计数及分类,并作右总支气管气道表面电镜下的病理形态学观察及肺组织学检查.结果显示吸烟组大鼠BALF中炎性细胞计数为(46.1±28.3)×106/L,较对照组(17.7±9.9)×106/L明显增高(P《0.05).光镜检查示吸烟组小气道和肺组织炎性细胞浸润,扫描电镜观察见柱状上皮细胞纤毛倒伏凌乱,部分脱落;对照组未见明显异常.烟雾刺激导致大鼠呼吸道炎性细胞增多,炎症反应增强及纤毛功能减退,因而被动吸烟可能是引起呼吸道损伤的重要因素.

目的:比较氨力农与洋地黄治疗肺心病肺心功能失代偿期的安全有效性.方法:选择40例肺心病肺心功能失代偿期住院患者,随机分为氨力农组(n=20);洋地黄组(n=18/20).分别用氨力农200mg+NS250ml,以5～10mg·kg-1·min-1静滴,疗程7天;洋地黄首次以西地兰0.4～0.8mg静推,以后地高辛0.125mg口服,疗程7天.治疗前后观察患者的心功能级别、心动超声(PAP,EF)指标、肺功能(VC,RV/TCL,FEV1%)指标及不良反应情况.结果:氨力农组心功能改善总有效率为85%,洋地黄组为88.9%,同时,对肺动脉压、射血分数及肺功能指标治疗前后均有明显改善(P＜0.05).各指标两组对照无明显差异(P＞0.05).不良反应发生率氨力农组为0,洋地黄组为10%.结论:氨力农与洋地黄对治疗肺心病肺心功能失代偿期患者有明显的疗效,但是,氨力农治疗肺心病肺心功能失代偿期既有效又安全,而洋地黄对治疗肺心病心力衰竭应持慎重态度.

目的探讨呼吸衰竭重复机械通气患者肺部细菌感染的细菌分布及耐药变迁并提出经验性对策.方法住院慢性支气管炎急性发作期呼吸衰竭患者经机械通气等治疗好转脱机后再感染,治疗中需要重复机械通气;对本组患者取其深部痰标本培养及药物敏感测定,连续两次相同阳性结果为观察有效标本.结果阴沟杆菌、不动杆菌分别占26.09%和24.64%,其次为铜绿假单胞菌17.39%,金黄色葡萄球菌10.15%,白色念珠菌8.69%,表皮葡萄球菌7.24%;细菌对常用几大类抗生素耐药株多于敏感株,少数细菌对少数药物敏感性大于耐药性;5例死于多脏器功能衰竭.结论避免不必要的抗生素应用,全面预防、积极支持为抢救成功之关键.

AIM: To evaluate the efficacy and safety of lomefloxacin injection in the treatment of acute bacterial infections. METHODS: A total of 190 patients (160 patients in a randomized trial, 30 patients in an open trial) were divided into 2 groups. One hundred and ten patients (M 54,F 56; age 54 a± s 11 a) in treatment group received 200-400 mg,iv,qd for 7-10 d. Eighty patients (M 45,F 35; age 53 a±10 a) in control group received ciprofloxacin 200-400 mg,iv,bid, for 7-10 d. RESULTS: The effective rate and the bacterial clearance rate of the treatment group were 86% and 81% respectively, and that of the control group were 80% and 73% respectively. No significant difference was found between the 2 groups ( P 0.05). The adverse reaction of lomefloxacin was 4%. CONCLUSION: Lomefloxacin is the effective and safe antibacterial in the treatment of bacterial infections.

目的研究应用非侵入性呼吸机治疗老年人COPD急性加重期的临床价值.方法对24名老年COPD急性加重期患者应用非侵入性鼻(面)罩双水平气道正压通气(BiPAP)治疗,观察治疗前后呼吸频率、潮气量(Vt)、血PaO2、PaCO2、SaO2、pH以及心率、平均动脉压(MAP)、呼吸窘迫等指标的变化.结果患者在24h的鼻(面)罩BiPAP治疗中,呼吸频率从25±3次/分降低到16±3次/分(P＜0.01),潮气量(Vt)从0.32±0.05升增加到0 56±0.06升(P＜0.01),PaO2从54±5 mmHg提高到 96±11 mmHg(P＜0.01),PaCO2从68±8mmHg降低到47±6 mmHg(P＜0.01),pH从7.28±0.05升高到7.34±0.03(P＜0.01),呼吸窘迫明显改善(P＜0.01),心率从108±11下降到93±12(P＜0.05)、血压无明显改变(P＞0.05).结论对老年COPD急性加重期患者应用非侵入性口鼻面罩BiPAP治疗是安全有效的,值得在临床推广应用.

目的:分析我科104例医院获得性革兰阴性杆菌肺炎的诊断与治疗.方法:其中男性68例,女性36例,平均年龄(56±2.52)岁,60岁以上者85例(占81.7%).所有病例均有基础疾病,包括慢性阻塞性肺疾病(COPD)38例(占36.5%),慢性肺心病15例(占14.4%),充血性心力衰竭5例(占4.8%),呼吸衰竭11例(占11.6%),支气管哮喘14例(占13.5%),支气管扩张12例(占11.5%),肺癌6例(占5.8%),脑血管意外3例(占2.9%).痰细菌阳性者65例(占62.5%),其中40例为单一菌,25例为复数菌或二重感染,致病菌主要为铜绿假单胞菌、克雷伯菌属、沙雷杆菌属、大肠埃希菌、硝酸盐阴性不动杆菌、阴沟肠杆菌等.治疗一般病例,选用敏感、窄谱及廉价抗生素,对常用抗生素耐药严重的,采用β内酰胺类联合氨基糖苷类.结果:治疗有效率75.9%(79/104),自动出院7例,死亡17例,病死率16.3%.结论:发生医院感染原因与侵袭性医疗操作、机体免疫功能减退、反复使用多种抗生素及激素等因素有关.为防止发生医院感染,应努力做到:①应加强对抗生素使用的监控;②严格消毒隔离制度;③提高医务人员对医院获得性肺炎的认识;④改善患者生活环境;⑤及时检测病原菌;⑥提高患者自身免疫功能.

Objectives To investigate the effectiveness of PHV combined with low PEEP for severe asthma.Methods 12 severe asthma patients were treated with PHV combined with low PEEP ventilation. Ventilation modewas set as volume control or assistant/control with PHV (PaCO2＜10.6 kPa,pH＞7.15). 2 of them were treated withSIMV and PEEP. The tidal volume was set as 6 8 mi/kg. PEEP was set at 5～10 cm H2O. Breath frequency wasset at 14 - 16 per minute. FiO2,PIP,ABG,HR, and BP were all recorded. Results Before treatment, 12 patientswere all in the state of respiratory failure and mental confusion, including lethargy and coma with PaO2. 6.18 ± 0.64kPa, pH7.14 ± 0.07 kPa, and PaCO2 10.6 1.53 kPa. After 2 - 8 hours, 24 hours, 48 hours, and 72 hours of PHVcombined with PEEP treatment, pH and PaO2 were all raised remarkbly (P＜0.01). However, PaCO2 was loweredstep by step above the normal level in 72 hours. All 12 patients were alive without any complications. ConclusionWith sufficient oxygen support, PHV combined with PEEP may gradually decrease PaCO2 and raise pH to normal lev-el. It has been proved to be an effcctive mechanical ventilation therapy of severe asthma. (Shanghai Med J, 2000,23:491-492)

伊米配能治疗院内获得性重症肺炎１２例沈爱娣邱雪菲艾华郭忠医院内获得性肺炎（ＮＰ），是重病患者及老年患者死亡的主要原因之一，尤其是院内获得性重症肺炎。抗生素选择是否恰当，是影响本病预后的主要因素之一。现将我院采用伊米配能—西司他丁治疗院内获得性重症肺炎...