In recent fifty years, Pseudomonas aeruginosa and Staphylococcus aureus were continuously the predominant in burn infections, the only change seen was a rapid increase in their drug-resistance. Under the pressure of antibiotics, Some opportunistic bacteria that were resistant to all available antibiotics emerged, such as Acinetobacter baumanii and Maltophilia stenotrophomonas. For critically burn patients, basing on early surgical intervention, early and short-term use of broad-spectrum antibiotic is advisable, and it may control the infection promptly, prevent further inflammatory reaction, as well as minimize the emergence of antibacterial resistance. To control infections due to pandrug-resistant bacteria, cyclic use of some old antibiotics may be helpful. In dealing with severe infection, a combination of anti-pathogen and anti-inflammatory reaction measures should be considered.
Anti-Bacterial Agents ; therapeutic use ; Burns ; drug therapy ; microbiology ; Cross Infection ; drug therapy ; prevention & control ; Humans ; Sepsis ; prevention & control

BACKGROUNDIt is important to achieve the definitive pathogen identification in hospital-acquired pneumonia (HAP), but the traditional culture results always delay the target antibiotic therapy. We assessed the method called quantitative loop-mediated isothermal amplification (qLAMP) as a new implement for steering of the antibiotic decision-making in HAP.

METHODSTotally, 76 respiratory tract aspiration samples were prospectively collected from 60 HAP patients. DNA was isolated from these samples. Specific DNA fragments for identifying 11 pneumonia-related bacteria were amplified by qLAMP assay. Culture results of these patients were compared with the qLAMP results. Clinical data and treatment strategies were analyzed to evaluate the effects of qLAMP results on clinical data. McNemar test and Fisher's exact test were used for statistical analysis.

RESULTSThe detection of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Stenotrophomonas maltophilia, Streptococcus pneumonia, and Acinetobacter baumannii by qLAMP was consistent with sputum culture (P > 0.05). The qLAMP results of 4 samples for Haemophilus influenzae, Legionella pneumophila, or Mycoplasma pneumonia (MP) were inconsistent with culture results; however, clinical data revealed that the qLAMP results were all reliable except 1 MP positive sample due to the lack of specific species identified in the final diagnosis. The improvement of clinical condition was more significant (P < 0.001) in patients with pathogen target-driven therapy based on qLAMP results than those with empirical therapy.

CONCLUSIONqLAMP is a more promising method for detection of pathogens in an early, rapid, sensitive, and specific manner than culture.

Anti-Bacterial Agents ; therapeutic use ; Cross Infection ; drug therapy ; microbiology ; Pilot Projects ; Pneumonia ; drug therapy ; microbiology ; Prospective Studies ; Pseudomonas aeruginosa ; drug effects ; pathogenicity

No abstract available.
Acinetobacter/*isolation & purification ; Acinetobacter Infections/*drug therapy/*microbiology ; Anti-Bacterial Agents/*therapeutic use ; Cross Infection/*microbiology/*therapy ; Female ; Humans ; Male ; Meningitis, Bacterial/*drug therapy/*microbiology ; Staphylococcal Infections/*drug therapy/*microbiology ; Staphylococcus/*isolation & purification

Cross Infection ; microbiology ; therapy ; Drug Resistance, Multiple, Fungal ; Fungi ; classification ; drug effects ; isolation & purification ; Humans ; Mycoses ; microbiology ; therapy ; Patient Care Management ; methods ; Singapore

Birth Weight ; Cross Infection ; complications ; drug therapy ; microbiology ; Humans ; Infant, Newborn ; Infant, Premature ; Microbial Sensitivity Tests ; Sepsis ; complications ; drug therapy ; microbiology

PURPOSETo investigate and analyze the clinical and etiological characteristics of community-acquired intraabdominal infections (CIAIs) and hospital-acquired or nosocomial intraabdominal infections (NIAIs) in a comprehensive hospital, to understand the characteristics, pathogen composition, and drug resistance of CIAIs as well as NIAIs, and to provide a reference for clinical treatment.

METHODSWe collected the clinical data of patients with intraabdominal infections admitted to our hospital from June 2013 to June 2014. In vitro drug sensitivity tests were conducted to separate pathogens, and the data were analyzed using the WHONET 5.4 software and SPSS 13.0 software.

RESULTSA total of 221 patients were enrolled in the study, including 144 with CIAIs (55 mild-moderate and 89 severe) and 77 with NIAIs. We isolated 322 pathogenic strains, including 234 strains of gram-negative bacteria, 82 strains of gram-positive bacteria, and 6 strains of fungi. Based on clinical features, NIAIs and severe CIAIs presented significantly higher values in age, length of hospital stay, mortality, and the incidence of severe intra-abdominal infection than mild-moderate CIAIs (p < 0.05). There was no significant difference in the prognosis between NIAIs and severe CIAIs. Primary diseases leading to CIAIs and NIAIs mostly were hepatobiliary diseases and gastrointestinal diseases respectively. Bacteria isolated from various types of IAIs mainly were Enterobacteriaceae; mild-moderate CIAIs mostly were mono-infection of gram-negative bacteria; NIAIs mostly were mixed infections of gram-negative and gram-positive bacteria; and severe CIAIs were from either type of infection. The rate of Extended Spectrum b-Lactamase-producing Escherichia coli and Klebsiella pneumoniae was much higher in NIAIs than in CIAIs (p < 0.05). The antimicrobial drug sensitivity of gram-negative bacteria isolated from NIAIs was significantly lower than that of CIAIs.

CONCLUSIONCIAIs and NIAIs have their own unique clinical features and epidemiological features of pathogens which should be considered during the initial empiric therapy for the rational use of antimicrobial drugs. Regional IAIs pathogenic bacteria have their own features in drug resistance, slightly different from some recommendations of 2010 Infectious Diseases Society of America guidelines.

Adult ; Aged ; Bacterial Infections ; drug therapy ; epidemiology ; Community-Acquired Infections ; drug therapy ; epidemiology ; microbiology ; Cross Infection ; drug therapy ; epidemiology ; microbiology ; Female ; Humans ; Intraabdominal Infections ; drug therapy ; epidemiology ; microbiology ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Prospective Studies

OBJECTIVETo observe the efficacy and safety of linezolid for the treatment of gram positive coccus infections in hematological disease patients.

METHODSOne hundred and two hematological disease patients with suspected or proven gram positive coccus bacteria infection were enrolled in this study. Linezolid was given at a dosage of 600 mg, iv, q12h. The mean treatment period was (10.82 ± 5.12) days (1 to 51 days) with 74.5% over 7 d and 51.0% over 10 d.

RESULTSAmong 102 patients, 57 were male, 45 female aged 11 to 81 years, with a mean of (45.26 ± 19.15) years. Ninety four cases were nosocomial infection (92.2%) and 8 community infection (7.8%); There were pneumonia in 80 (78.4%), septicemia in 11 (10.8%), and infection of other organsin 11 (10.8%); Forty five cases were proven gram positive coccus bacteria infection, and 57 were suspected infection; Fifty one bacteria strains were isolated from cultivated samples of proven patients, in which 22 were staphylococcus aureus with 19 methicillin resistant 13 hemolytic streptococcus, 9 staphylococcus epidermidis with 7 methicillin resistant 6 enterococcus faecom, and 1 enterococcus hirae. Seven cases were mixed with one kind gram negative bacillus infection, 4 mixed with two kinds of gram negative bacillus infection, and 12 mixed with fungal infection; Total clinical response rates by ITT (intention to treatment) analysis was 69.6%, in which 40 (39.2%) were curative and 31 (30.4%) obviously effective; PP (per-protocol) analysis was 70.9%, in which 39 (41.9%) were curative and 27 (29.0%) obviously effective. Bacteria clearance rate was 70.6%, and in this group the clinical effective rate was 88.9%; Adverse effect rate was 2.9%, being transient thrombocytopenia and increased transaminase.

CONCLUSIONLinezolid is a safe and effective antibiotic used in hematological disease patients complicated with infections of gram positive coccus.

Acetamides ; Anti-Bacterial Agents ; therapeutic use ; Cross Infection ; microbiology ; Gram-Positive Bacterial Infections ; drug therapy ; Gram-Positive Cocci ; Hematologic Diseases ; drug therapy ; Humans ; Linezolid ; Oxazolidinones ; Staphylococcus aureus

INTRODUCTIONWorldwide, Candida albicans is the most common Candida species implicated in bloodstream infections. However, the proportion of non-albicans bloodstream infections is increasing. Fluconazole resistance is known to be more common in non-albicans species, but is also reported in C. albicans. This retrospective study was performed to determine the species epidemiology of Candida bloodstream infections in Singapore hospitals, and to perform susceptibility testing to a range of antifungal drugs.

MATERIALS AND METHODSCandida spp. isolated from bloodstream infections from October 2004 to December 2006 were collected from 3 participating hospitals: a tertiary referral hospital (Singapore General Hospital), a secondary referral hospital (Changi General Hospital) and an obstetrics/paediatric hospital [KK Women's and Children's Hospital (KKWCH)]. Isolate collection was also retrospectively extended to January 2000 for KKWCH because of the limited number of cases from this hospital. Isolates were identified by a common protocol, and antifungal susceptibility testing was performed by microbroth dilution (Sensititre One, Trek Diagnostics, United Kingdom).

RESULTSThe most common isolates were C. albicans (37%), C. tropicalis (27%) and C. glabrata (16%). There were differences in species distribution between institutions, with C. parapsilosis and C. albicans predominant in KKWCH, and C. albicans and C. tropicalis predominant in the other 2 institutions. Fluconazole resistance was detected in 3.2% of all Candida spp., and 85.3% were classified as susceptible. All C. albicans and C. parapsilosis were susceptible to fluconazole and voriconazole, while susceptibility to fluconazole was much more variable for C. glabrata and C. krusei.

CONCLUSIONThis study shows that C. albicans remains the predominant Candida species isolated from bloodstream infections in the 3 participating hospitals. However, non-albicans species accounted for nearly two-thirds of all cases of candidaemia. Resistance to fluconazole was uncommon, and was generally confined to C. krusei and C. glabrata.

Antifungal Agents ; pharmacology ; Candida ; classification ; drug effects ; isolation & purification ; Candidiasis ; drug therapy ; epidemiology ; microbiology ; Cross Infection ; epidemiology ; microbiology ; Drug Resistance, Fungal ; drug effects ; Female ; Fungemia ; epidemiology ; microbiology ; Hospitals, University ; Humans ; Microbial Sensitivity Tests ; Retrospective Studies ; Singapore ; epidemiology

Most of the intra-abdominal infections are benign and critical diseases caused by trauma, surgery and gastrointestinal diseases, which require the attention of surgeons. The increase of drug resistance of pathogens is a common clinical problem. The intra-abdominal infection caused by multidrug-resistant bacteria is a huge challenge faced by clinicians, and is mainly found in hospital-acquired abdominal infections, of which gram-negative bacteria are the most common. This paper firstly summarizes the common types, early diagnosis and risk factors of multidrug-resistant bacteria according to the literature, and then describes the treatment strategy of intra-abdominal infection caused by multidrug-resistant bacteria from four aspects: anti-infective medication, infection source control, resuscitation and organ support, and nutritional support treatment. In addition, we should promote gastrointestinal function recovery through nutritional support treatment and prevent intestinal source infection, on the basis of understanding the risk factors of multidrug-resistant infection, rational use of anti-infective medication and infection source control measures. At the same time, proper organ function support can help to improve the success rate in the treatment of multidrug-resistant intra-abdominal infection.
Abdominal Cavity ; Anti-Bacterial Agents ; Bacteria ; drug effects ; Bacterial Infections ; microbiology ; prevention & control ; therapy ; Cross Infection ; Drug Resistance, Bacterial ; Drug Resistance, Multiple ; Humans ; Intraabdominal Infections

Adult ; Aged ; Aged, 80 and over ; Anti-Infective Agents ; pharmacology ; therapeutic use ; Cross Infection ; drug therapy ; microbiology ; Female ; Hospitalization ; Humans ; Inpatients ; Male ; Middle Aged ; Pneumoconiosis ; microbiology ; Pneumonia ; drug therapy ; microbiology ; Retrospective Studies