Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from lower respiratory tracts of early onset and late-onset ventilator-associated pneumonia (VAP)patients in intensive care unit. Methods A retrospective analysis was performed on data collected from1324 patients admitted to the ICU in the Third People' s Hospital in Wenzhou from July 2008 to December 2011 who received invasive mechanical ventilation.Patients were divided into early-onset pneumonia group (EOP,≤ 4 d mechanical ventilation ) and late-onset pneumonia group (LOP, ＞ 4 d mechanical ventilation).x2 or t test was performed to compare the pathogen distribution and antimicrobial resistance between two groups.Results In 1324 patients,552 (41.7％) suffered from VAP,including 74 ( 5.6％ )patients with EOP,382 (28.9％) patients with LOP,and 96 (7.3％) patients with both EOP and LOP.The top 6 pathogens in EOP group were Acinetobacter baumannii ( 72,22.6％ ),Pseudomonas aeruginosa (45,14.1％ ),Klebsiella pneumoniae (32,10.0％ ),Canidia albicans ( 31,9.7％ ),Burkholderia cepacia ( 31,9.7％ ) and Staphyloccocus aureus ( 28,8.8％ ) ; and in LOP group were Acinetobacter baumannii (235,21.2％ ),Canidia albicans (201,18.1％ ),Pseudomonas aeruginosa ( 111,10.0％ ),Candida glabrata ( 86,7.8％ ),Klebsiella pneumoniae ( 81,7.3％ ) and Staphyloccocus aureus ( 46,4.2％ ).Staphylococcus aureus infection in EOP group was more common than that in the LOP group (x2 =10.780,P =0.002),but the separation rate of Candida albicans in EOP group was significantly lower than that in the LOP group (x2 =12.907,P =0.000).Gram-negative bacteria isolated from EOP or LOP group were both highly resistant to most commonly used antibacterial agents,especially for Acinetobacter baumannii and Pseudomonas aeruginosa strains. Most Staphyloccocus aureus strains were methicillin-resistant strains (EOP:67.9％,19/28; LOP:63.0％,29/46).Canidia albicans and Candida glabrata were sensitive to most antifungal agents.Conclusion For both EOP and LOP groups,the majority of pathogens isolated from lower respiratory tract are Gram-negative bacteria,and drug resistance is serious.

Objective To study the value of plasma amino-terminal pro-B-type natriuretic peptide precursor (NT-proBNP) along with cystatin C (Cys-C) used together in early diagnosis of the type 1 cardiorenal syndrome (CRS) in patients with acute heart failure.Methods From January 2011 to January 2014,the data of 395 acute heart failure patients in Wenzhou People' s Hospital were retrospectively analyzed.Plasma concentrations of NT-proBNP and Cys-C of 395 patients with acute heart failure were measured by using PETIA and ECLIA methods at about 24 hours after admission.And the incidence of type 1 CRS syndrome was analyzed by statistics.ROC analyses were performed to evaluate the early diagnosing value of plasma NT-proBNP along with Cys-C in determining type 1 CRS and in discerning the optimal cut-off point for early diagnosing type 1 CRS patients.Results A total of 395 patients with acute heart failure aged from 29-96 years with (74.3 ± 13.0) years in mean,and 61.3％ male were enrolled in this study.Of them,82 patients were suffered from CRS syndrome.Logistic regression analysis showed diabetes,chronic heart failure,Cys-C and NT-proBNP were independent risk factors for predicting type 1 CRS,and serum Cys-C level was the most important predictor.ROC analysis showed the areas under the curve (AUC) of plasma NT-proBNP and Cys-C for early diagnosing CRS were 0.835 (95％ CI:0.785-0.886,P ＜ 0.01) and 0.885 (95％ CI:0.825-0.944,P ＜0.01),respectively.The value of plasma NT-proBNP alone in early diagnosing the type 1 CRS was limited with Youden index up to 0.483.When the NT-proBNP paired with Cys-C,the diagnostic reliability has been greatly improved,especially specificity with Youden index up to 0.717.Therefore,NT-proBNP doupled with Cys-C has great reference value in early diagnosing the type 1 CRS.Conclusion Plasma NT-proBNP level coupled with Cys-C level is a valuable biomarker for early diagnosing type 1 cardio-renal syndrome in patients with acute heart failure.If the levels of plasma NT-proBNP and Cys-C are detected simultaneously,the diagnostic reliability of CRS will be greatly improved,especially in the diagnostic specificity.

Objective To evaluate the value of Continuous renal replacement therapy ( CRRT) in the treatment of the type 1 cardio-renal syndrome.Methods From June 2008 to August 2014,the type 1 cardiorenal syndrome patients receiving continuous renal replace-ment therapy in Wenzhou People′s Hospital ICU were retrospectively analyzed .Before and after treatment , the mean arterial pressure , central venous pressure, shock index, rapid shallow breathing index, oxygenation index, urine, plasma amino-terminal pro-B-type natriuretic peptide precursor , creatinine and bicarbonate and other clinical data were observed in order to understand CRRT ′s value in type 1 cardiorenal syndrome patients.Results Total 37 patients [aged from 27-88(67.9 ±18.7)years,51.4%male] with type 1 cardiore-nal syndrome were enrolled in this study .Statistics showed that after CRRT treatment , the mean arterial pressure , central venous pres-sure, shock index , rapid shallow breathing index , oxygenation index , urine, plasma amino-terminal pro-B-type natriuretic peptide precursor, creatinine and bicarbonate were significantly improved , and there was a significant difference (P<0.05).Conclusion For type 1 cardiorenal syndrome , especially critical patients with serious diuretic resistance , CRRT has great therapeutic value , even the only treatment option .

Objective To evaluate the reference value of NGAL in sepsis patients with AKI to choose the timing of continuous renal replacement therapy (CRRT)treatment.Methods 62 sepsis patients with AKI were enrolled in this study.Within 24 hours after the diagnosis,the patients'urine samples were collected,the urinary NGAL levels were measured by ELISA.At the same time,the clinical parameters were collected,such as serum creatinine, blood urea nitrogen,blood leukocytes,etc.Depending on whether patients need to receive CRRT,the patients were divided into sepsis CRRT group and septic non CRRT group,the clinical data of the two groups were compared.ROC analysis was performed to evaluate the reference value of NGAL in sepsis patients with AKI to choose the timing of CRRT treatment.Results Total 62 sepsis patients with AKI were enrolled in this study.Ultimately,27 patients received CRRT treatment.Within 24 hours after the diagnosis,the clinical parameters of the two groups,such as serum creatinine,blood urea nitrogen and blood leukocytes showed no significant differences (all P >0.05);but the urinary NGAL level of sepsis CRRT group[(7.9 ±2.5)pg·mL -1 ·cr -1 ]was significantly higher than sepsis non CRRT group[(4.1 ±1.3)pg·mL -1 ·cr -1 ](t =12.912,P <0.01).ROC analysis showed that the area under the curve (AUC)for the value of NGAL in sepsis patients with AKI to choose the timing of CRRT treatment was 0.892(95%CI:0.775 ~0.898,P <0.01).Conclusion Urinary NGAL has a certain reference value in sepsis patients with AKI to choose the timing of CRRT treatment,could contribute to early intervention CRRT treatment.

Objective To evaluate the predictive value of serum cystatin C (sCys C),urinary neutrophil gelatinase associated lipocalin(uNGAL) and interleukin-18 (uIL-18)in early diagnosis of continuous renal replacement therapy (CRRT) in systemic inflammatory response syndrome (Sepsis) complicated with acute kidney injury (AKI) and difference post-replacement volume in CRRT.Methods Total of 71 patients admitted to the intensive care unit during from July 2012 to April 2016 were included in the current prospective study.The patients were assigned into the CRRT and non-CRRT groups based on whether the patients were accepted the CRRT.sCys C,uNGAL,uIL-18,serum creatine,blood urea nitrogen and leukocyte were measured on the day of admission.We collected blood and urinary samples at different time points (12h,24h)in order to measure sCys C,uNGAL,uIL-18 when the patients accepted difference post-replacement volume(2L/h and 4L/h) in CRRT.Multivariate logistic regression analysis was used to determine whether sCysC,uNGAL and uIL-18 levels were independent predictors of Sepsis complicated with AKI.A receiver operating characteristic (ROC) curve was constructed and the area under the ROC curve(AUC) was calculated to assess the predictive strength of sCys C,hNGAL and uIL-18.Results Compared to the Non-CRRT subjects,the age,the gender,Scr,BUN,WBC in the subjects of the CRRT group were of no significant diffience,but the levels of sCys C,uNGAL and uIL-18 were significantly higher(P ＜ 0.05).sCys C,uNGAL and uIL-18 achieved the AUC of 0.905(95％CI:0.831-0.979,P=0.000),0.926(95％CI:0.862-0.991,P=0.000),0.897(95％CI:0.827 -0.967,P =0.000),respectively,for predicting the development of Sepsis complicated with AKI.No significant differences were noted between 2L/h group with 4L/h group at the beginning of CRRT.The levels of sCys C,uNGAL and uIL-18 decreased significantly in 2L/h and 4L/h groups at different time points (12h,24h) during CRRT.The levels of sCys C,uNGAL and uIL-18 in 4L/h group had decreased more significantly than 2L/h group at the 24h time point.Conclusion The authors consider that sCys C,uNGAL and uIL-18 are both independent predictors of Sepsis complicated with AKI in CRRT.uNGAL has a better predictive value in early prediction of Sepsis complicated with AKI in CRRT.There was more significant treatment effect in the post-replacement volume of 4L/h after 24h treatment in CRRT.