OBJECTIVE To investigate the etiology of ventilator-associated pneumonia(VAP) in our respiratory intensive care unit(RICU) and to explore the antimicrobial resistance of predominant pathogens in last ten years. METHODS From 1992 to 2003,totally 149 cases with VAP were collected for analyzing in our RICU.Standard disk diffusion susceptibility tests were performed on the predominant pathogens. RESULTS During this period,the incidence of VAP in RICU was 35.57%,33 cases were infected by two or more pathogens(67.35% VAP cases).The main pathogens of VAP were Gram negative organisms(65.51%) whose predominant pathogens were Pseudomonas aeruginosa and Acinetobacter.On the other hand,the main Gram positive organisms were Staphylococcus epidermidis.During the recent 10 years,the incidence of Acinetobacter rose up from 8.99% to 15.49% and the rate of Candida decreased from 13.33% to 7.04%. CONCLUSIONS The main pathogens of VAP in our RICU are P.aeruginosa and Acinetobacter,and the changes in pathogens distribution and infection spectrum have been taken place during the past 10 years.

Objective To evaluate VITEK2 Advanced Expert System (AES) for detection and analysis of clinically important beta-lactam phenotypes.Methods 124 known resistant phenotype strains including Staphylococcus spp, E.coli, Klebsiella spp. and Ent. cloacae were tested by VITEK2 AES. Results The resistant phenotypes for methicillin susceptible, and resistant Staphylococcus spp, producing ESBL E. coli, Klebsiella spp. and Ent. cloacae isolates, and inducible AmpC and hyperproduced AmpC Ent. cloacae isolates can be accurately identified by VITEK2 AES. The most Ent. cloacae strains for both producing ESBLs and hyperproduced AmpC were partially identified.Conclusion VITEK2 AES can be accurately identified most clinically important beta-lactam phenotypes and suggested additional therapeutic correction based on phenotype. Certain problems for Ent. cloacae in the study should be remediable with further work on AES.

Objective To analyze the worldwide advances on bacterial quantitative proteomics over the past fifteen years with bibliometric approach.Methods Literature retrieval was conducted throughout the databases of Pubmed,Embase and Science citation index (SCI),using bacterium and quantitative proteomics as the key words.The deadline is July 2013.We sorted and analyzed these articles with Endnote X6 from the aspects of published year,the first author,name of journal,published institution,cited frequency and publication type.Results 932 English articles were included in our research after deleting the duplicates.The first article on bacterial quantitative proteomics was reported in 1999.The maximal publications were 163 related articles in 2012.Up till July 2013,authors from more than 23 countries and regions have published articles in this field.China ranks the fourth.The main publication type is original articles.The most frequently cited article is entitled with Absolute quantification of proteins by LCMSE:a virtue of parallel MS acquisition by Silva JC,Gorenstein MV,Li GZ,et al in Mol Cell Proteomics 2006.The most productive author is Smith RD from Biological Sciences Division,Pac.Northwest National Laboratory.The top journal publishing bacterial quantitative proteomics is Proteomics.Conclusion More and more researchers pay attention to quantitative proteomics which will be widely used in bacteriology.

Based on metagenomic next-generation sequencing (mNGS), sequencing of plasma microbial cell-free DNA (mcfDNA) has recently been shown to provide a non-invasive pathogenic diagnostic technique for infectious diseases. In sepsis and bloodstream infections, mcfDNA sequencing has advantages in sensitivity, timeliness, and pathogen coverage compared with traditional pathogenic diagnostic techniques such as blood culture, according to available research results. However, the sensitivity of mcfDNA is much lower than that of mNGS with high-quality lower respiratory tract (LRT) specimens such as bronchoalveolar lavage fluid in pulmonary infections, and high-quality clinical research is still unavailable. Therefore, mcfDNA sequencing should not be used as a first-line etiological method for pulmonary infection and should only be used in patients with severe infection in whom pathogens cannot be identified by classical etiological methods and high-quality LRT specimens are not available for microbial mNGS. In order to improve the sensitivity of mcfDNA and to identify the most suitable patients as well as the best time of its application in pulmonary infections, the optimization of these testing techniques is urgently needed.

Acinetobacter baumannii ; drug effects ; Anti-Bacterial Agents ; pharmacology ; Carbapenems ; pharmacology ; Drug Resistance, Bacterial ; Microbial Sensitivity Tests ; Minocycline ; analogs & derivatives ; pharmacology

BACKGROUNDElderly multiple organ dysfunction syndrome (MODS) patients receiving invasive mechanical ventilation have poor prognosis in intensive care units (ICUs). We studied the usefulness of four commonly used severity scores and extrapulmonary factors that affected weaning to predict outcome of such patients.

METHODSClinical data of 197 patients on admission to ICUs (from January 2009 to June 2012) were used retrospectively. The Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Sample Acute Physiological Score (SAPS) II and MODS scores were calculated. All the patients were grouped into survivors and nonsurvivors according to the prognosis. Patients, who weaned from ventilator (n = 154), were subdivided into a successful weaning group and a failed weaning group. The receiver operating characteristic (ROC) curves and Logistic regression was used for prognostic and weaning assessment.

RESULTSBased on the outcomes, the areas under the ROC of APACHE II, APACHE III, SAPS II, and MODS were 0.837, 0.833, 0.824, and 0.837, respectively. The Logistic regression analysis revealed that the odds ratio (OR) of underlying lung diseases, serum albumin and creatinine, and the number of organ failures was 2.374, 0.920, 1.003, and 1.547. APACHE II scores on admission performed excellent (ROC: 0.921) on the weaning assessments.

CONCLUSIONSAPACHE II and MODS systems were marginally better for evaluating the prognosis of elderly MODS patients who received invasive mechanical ventilation. Underlying lung diseases, serum albumin, serum creatinine and the number of organ failures were independent prognostic factors. Using the APACHE II scores on admission before weaning may increase the likelihood of successful weaning. (ClinicalTrial.gov identifier NCT01802983).

Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Multiple Organ Failure ; pathology ; therapy ; Prognosis ; Respiration, Artificial ; methods ; Retrospective Studies