Objective To evaluate and analyze the degree of correlation between the bispectral index (BIS) and COMFORT behavior scale (COMFORT B scale) and to explore the usability of BIS in assessing the level of sedation for young infants from 6 months to 2 years old after surgical repairs of congenital heart disease.Methods A prospective observational study was designed to involve 50 young infants to assess their postoperative sedation depth.Two investigators evaluated the level of sedation simultaneously and independently by using BIS and COMFORT B scale at each fixed observational points.A total of 375 data sets were gathered by observations.Correlations between BIS value and COMFORT B scale were determined by using Spearman rank correlation test and prediction probability to evaluate the accuracy of the performance of BIS on various sedation depths.Results BIS values in correspondence with different level of sedation,which was divided into oversedation,adequate sedation,undersedation according to COMFORT B scale,were 57.0 ±11.0,69.9 ± 7.6 and 84.4 ± 9.0.There was a moderate correlation between BIS values aad COMFORT B scale ( rs =0.63,P ＜0.000 1 ).The Spearman correlation between BIS and COMFORT B was rs =0.66 and rs =0.59 for the age groups 6 months ～ 1 year old and 1 ～ 2 years old,respectively ( P ＜0.000 1 ).Prediction probability value which indicated BIS can correctly predict various levels of sedation was 0.85 ( P ＜0.000 1 ).Contusion BIS is an accurate and valid objective parameter to assess the level of sedation for young infants from 6 months to 2 years old.

INTRODUCTIONAntibiotic resistance in gram-negative bacilli is an area of increasing importance. This prospective study was performed to survey antibiotic resistance in Escherichia coli (E. coli), Klebsiella spp., Pseudomonas aeruginosa and Acinetobacter spp. over a 1-year period.

MATERIALS AND METHODSNon-duplicate isolates of E. coli, Klebsiella spp., P. aeruginosa and Acinetobacter spp. were collected from participating Singapore hospitals during defined collection periods in 2006 and 2007. Confirmatory identification and antibiotic susceptibility testing were performed at Changi General Hospital. Minimum inhibitory concentrations (MIC) to a defined panel of antibiotics were determined using microbroth dilution methods. The presence of extended-spectrum beta lactamases and AmpC beta-lactamases in Enterobacteriaceae was determined by phenotypic methods, and susceptibility results were defined using current breakpoints from the Clinical Laboratory Standards Institute (CLSI).

RESULTSSeven hundred and forty-six gram-negative bacilli were received for testing. Resistance to extended-spectrum cephalosporins was present in a third of Enterobacteriaceae isolates, and extended-spectrum beta-lactamases (ESBL) carriage was present in 19.6% and 30.1% of E. coli and Klebsiella pneumoniae, respectively. AmpC enzymes were also detected in 8.5% and 5.6% of E. coli and K. pneumoniae isolates respectively. All Enterobacteriaceae were susceptible to imipenem and meropenem. The most active antibiotics against P. aeruginosa were amikacin, meropenem and piperacillin-tazobactam. A third of P. aeruginosa showed reduced susceptibility to polymyxin B. Carbapenem resistance was significantly higher in Acinetobacter baumannii (70.5%) than in other Acinetobacter species (25.0%). The most active antibiotic against A. baumannii was polymyxin B.

CONCLUSIONAntibiotic resistance is prevalent in gram-negative bacilli isolated from Singapore hospitals. The MIC testing surveillance programme complemented susceptibility data from wider laboratory-based surveillance, and has revealed emerging mechanisms of antibiotic resistance.

Acinetobacter Infections ; drug therapy ; Acinetobacter baumannii ; drug effects ; isolation & purification ; Anti-Bacterial Agents ; pharmacology ; therapeutic use ; Bacterial Proteins ; Drug Resistance, Bacterial ; Escherichia coli ; drug effects ; enzymology ; Hospitals ; Humans ; Klebsiella Infections ; drug therapy ; Klebsiella pneumoniae ; drug effects ; enzymology ; Microbial Sensitivity Tests ; Prospective Studies ; Pseudomonas aeruginosa ; drug effects ; isolation & purification ; Singapore ; beta-Lactamases