Healthcare-associated pneumonia(HCAP)is a new concept defined by the 2005 American Thoracic Society/Infectious Diseases Society of America(ATS/IDSA)guidelines for the management of adults with hospital-acquired,ventilator-associated,and healthcare-associated pneumonia.In order to provide helpful advice for clinicians,this review recommends how to choose the site of treatment,general management strategies and initial empirical antibiotic therapy in patients with HCAP,and introduces some new antibiotics may be useful in treatment of HCAP.

Objective To evaluate the anti-bacteria effects of polymyxin B combined with meropenem against 30 strains pan-drug resistant pseudomonas aeruginosa that separated in clinic. Methods The minimal inhibitory concentration (MICs) of 30 strains pan-drug resistant pseudomonas aeruginosa after treated with polymyxin B and meropenem as single-use or combination use were determined by both microdilution method and checkerboard method. The FIC index was calculated, then the type of combination effect was determined according to FIC index, which was used to determine whether there was synergistic or antagonistic effects. Results The MICs of pan-drug resistant pseudomonas aeruginosa were reduced significantly after polymyxin B combined with meropenem when compared with single-use. The percentages of the FIC index that less than 0.5 and the index between 0.5 and 1 were 60%and 30%respectively. Conclusion The results indicate that the combinations of polymyxin B with meropenem have good synergistic and additive effects against pan-drug resistant pseudomonas aeruginosa, there is no antagonism.

OBJECTIVE To evaluate the efficacy,the eradication rates of pathogens and safety of levofloxacin in patients with community-acquired pneumonia(CAP) in comparison with therapy using a combination of cefuroxime plus azithromycin.METHODS Fifty five patients with CAP were randomly divided into two groups: levofloxacin alone and cefuroxime plus azithromycin,and the efficacy,the eradication rates of pathogens and the rates of side effects were observed.RESULTS From 30 patients in the levofloxacin group,25 patients(83.3%) were clinically cured and 3 patients(10.0%) were improved.And from 25 patients in the cefuroxime plus azithromycin group, 20 patients(80.0%) were clinically cured and 3 patients(12.0%) were improved. The eradication rates of pathogens were 85.7% and 88.9%,respectively.And the rates of side effects were 3.3% and 4.0%,respectively.CONCLUSIONS There are no significant differences in the efficacy,the eradication rates of pathogens and safety between 2 groups in treating community-acquired pneumonia.

Objective To investigate the alternations in gene/amino acid sequence of penicillin-binding protein (PBP)2x from clinical isolates of Streptococcus pneumoniae, and to find the reasons for the rapid surge of penicillin and cefotaxime nonsusceptibility among pneumococcal isolates from Shenyang. Methods Thirty-four strains of Streptococcus pneumoniae were collected from January 2006 to February 2007. The antibiotics susceptibility of these strains was detected. PCR amplification and direct sequencing of pbp2x genes were performed. The sequence variations of PBP genes of the penicillin nonsusceptible Streptococcus pneumoniae(PNSP) in this region were studied by BLAST analysis. Results Two prominent substitutions were common to 12 PNSP isolates for which the MIC of penicillin resistance and cefotaxime were at least 0.5 mg/L, which included the replacement of Thr338→Ala in the first conservative motif STMK and Leu546→Val adjacent to third conservative motif KSG. The importance of the exchange of His394→Leu was identified in one PNSP isolate 15. The remarkable finding in this study was Met342→Ile following the first conservative motif STMK. pbp2x sequences of eight PRSP isolates shared Lys501-Glu505-Thr507 substitutions which might be served as a unique marker for PRSP in this region. Novel gene and amino acid sequence variants in 17 isolate were identified in this study, and these sequences have been deposited in the GenBank database and assigned accession No. EU044831, EU089706-EU089709, EU106881-EU106884 and EU124672. Conclusion It is likely that the emergence of penicillin and cefotaxime nonsusceptible Streptococcus pneumoniae in Shenyang might be associated with novel gene sequence variants.

Objective To analyze the clinical features of subacute thyroiditis (SAT ) manifested as fever of unknown origin (FUO) for early diagnosis .Methods The clinical and laboratory data were retrospectively reviewed for 20 SAT patients manifected as fever of unknown origin from October 2009 to February 2013 .Results A total of 20 patients were finally diagnosed as subacute thyroiditis ,about 3% of the 661 FUO patients .Only 5 SAT patients had complained of angina or pain in the anterior region of neck .Thyroid enlargement and tenderness were observed in 14 SAT cases .Elevated serum thyroid hormone and a very low serum level of thyroid stimulating hormone were seen in 17 patients with SAT .Ultrasound scan of thyroid showed inhomogenous hypoechongenic texture in 14 patients .99m Tc pertechnetate scan of thyroid showed extremely low radiopharmaceutical uptake in all the 20 cases .All patients had received antibiotic treatment prior to admission .Conclusions Subacute thyroiditis is an uncommon but important cause of FUO .Detailed history ,physical examination and laboratory evaluation can help minimize the chance of misdiagnosis and unnecessary antibiotic therapy .

AIM: To study the inhibitory effect of IGF binding protein-4(IGFBP-4),especially in corporation with heparin on the pathopoiesis of insulin-like growth factor-1(IGF-1) in alveolitis and fibrosis.METHODS: The diploid human embryonic lung(HEL) fibroblasts were incubated respectively with control,100 ?g/L IGF-1,100 ?g/L IGF-1+100 ?g/L IGFBP-4,100 ?g/L IGF-1+200 ?g/L IGFBP-4,100 ?g/L IGF-1+100 ?g/L IGFBP-4+100 ?g/L heparin,100 ?g/L IGF-1 + 100 ?g/L IGFBP-4+200 ?g/L heparin,100 ?g/L IGF-1+100 ?g/L heparin,100 ?g/L IGF-1+200 ?g/L heparin for 24 h.Then the content of glucose transporter-4(GLUT-4),hexokinase-2(HK-2),collagen-4 and elastin were detected,respectively.RESULTS: Compared with control group,HK-2,GLUT-4,elastin and collagen-4 expressed in IGF-1 group were increased obviously.The expression in the group of IGFBP-4 plus IGF-1 was more than that in IGF-1 group.However,all expression was depressed strikingly when heparin was added.CONCLUSION:(1) IGF-1 apparently stimulates HK-2,GLUT-4,elastin and collagen-IV secretions from lung fibroblasts.(2) The intact IGFBP-4 associated with heparin can inhibit the pathopoiesis of IGF-1.

AIM: To evaluate the role of alveolar macrophage(AM)lipid peroxidation in bleomycin(BLM)-induced TNF-? and PDGF release from AM in rats. METHODS: Male SD rats were intratracheally instilled with saline or BLM(5 mg/kg body weight), and AM were isolated and analyzed for malondialdehyde (MDA) and glutathione peroxidase(GSH-Px) following 1,3,7,14 or 28 day (s).Simultaneously, TNF-? and platelet-derived growth factor(PDGF) were also determined in AM-conditoned media by ELISA and bioassay respectively. RESULTS:(1) MDA in AM was markedly increased on day 1,peaked on day 3 and then decreased to near control level on day 7; on the other hand, GSH-Px activity in AM were decreased to non-detectable levels during day 1-7 after BLM instillation, returned to the control level by day 14. (2) TNF-? and PDGF were increased significantly from the third day on and then exhibited a consectutive changes.(3)AM lipid peroxidation preceded TNF-? and PDGF release. CONCLUSION: Prior oxidative changes leading to AM lipid peroxidation,depletion of antioxidative pool might be essential for the subsequent mediators release in BLM-induced pulmonary fibrosis.

OBJECTIVE To compare the changing trends of antibiotic resistance of Proteus mirabilis isolates.METHODS A total of 288 P.mirabilis isolates obtained from clinical patients in the First Affiliated Hospital of China Medical University between 2001-2006 were included in the study.K-B test was used to determine the susceptibility and the results were read based on National Committee for Clinical Laboratory Standards(NCCLS)of the USA.RESULTS The sensitivity of P.mirabilis isolates to imipenem,ceftazidime,cefotaxime,aztreonam,cefoperazone-tazobactam,cefepime,amikacin and piperacillin was from 74.5% to 95.2%,meanwhile there was a low sensitivity to ampicillin,cefazolin,ciprofloxacin,sulfamethoxazole co.and tetracycline,from 2.3% to 58.8%.CONCLUSIONS The result of antimicrobial susceptiveity test may instruct the applications of clinical antibiotics.

OBJECTIVE To compare the changing trends of antibiograms of Salmonella typhi and S.paratyphi A isolates.METHODS A total of 42 isolates of Salmonella obtained from blood cultures patients in the First Affiliated Hospital of Chinese Medical University between 2001-2004 were included in the study.K-B test was used for the antimicrobial susceptivity test and the results were read based on National Committee for Clinical Laboratory Standards(NCCLS) of USA.RESULTS Twenty two isolates were identified as S.typhi and 20 were identified as S.paratyphi A.Sensitivity of S.typhi isolates to cephalosporins and chloramphenicol was found to have increased from 2001 to 2004 while that of S.paratyphi A showed a decline,meanwhile there was obviously increasing in resistance to ciprofloxacin.CONCLUSIONS Perhaps the schedule of empirical treatment of typhoid fever needs to be adjusted.

Objective To identify the clinical features of patients with brucellosis in Liaoning Province in recent 5 years, and to improve the diagnostic level of the disease.Methods The clinical data including epidemiology, clinical features, laboratory data and diagnosis of 82 hospitalized patients who were diagnosed with brucellosis in the First Affiliated Hospital of China Medical University from 2011 to 2015 were collected and reviewed retrospectively.Results The majority of the 82 patients were middle-aged (45-59 years old) (47.6%) and male gender (63.4%).Fever (90.2%), muscle and joint pain (61.0%), hepatosplenomegaly (36.6%), lymphadenopathy (24.4%) and weight lose (32.9%) were the main complaints.The peripheral leucocyte counts were usually normal (70.7%).C-reactive protein (81.3%), procalcitonin (81.8%) and erythrocyte sedimentation rate (64.2%) increased in most cases.The results of the serum agglutination test in 67 patients were all positive (100.0%).The pathogen isolation was conducted in 60 patients and 49 patients were positive for Brucella species.Among them, 35(71.3%) isolates were identified as Brucella melitensis.A total of 90.2%(74/82) cases were firstly diagnosed with fever of unknown origin and were hospitalized.Misdiagnosis accounted for 52.4(43/82)%.Conclusions Contact history with cow and sheep should be inquired thoroughly in patients with clinical manifestations of fever, muscle and joint pain and hepatosplenomegaly.Pathogen isolation, agglutination test and other specific tests should be performed as soon as possible to diagnose the disease early.