Objective:To investigate the efficacy of intravenous combined with aerosol inhalation of polymyxin B for the treatment of pneumonia caused by multidrug-resistant Gram-negative (G -) bacteria. Methods:A observational study was conducted. The clinical data of 45 patients with pneumonia due to multidrug-resistant G - bacteria admitted to intensive care unit of Fujian Medical University Union Hospital from January to October in 2020 were analyzed. According to the different use methods of polymyxin B, 25 patients who received single intravenous drip (the first dose was 2.0 mg/kg, then 1.25 mg/kg, once every 12 hours) from January to April in 2020 were enrolled in the routine group, and 20 patients who received intravenous drip combined with aerosol inhalation (25 mg once every 12 hours, sputum in the airway was sucked and then sprayed aerosol) from May to October in 2020 were enrolled in the combination group. After the treatment course of polymyxin B, the total bacterial clearance rate, total clinical efficiency rate, recovery time of body temperature, time of bacterial clearance and the change of serum procalcitonin (PCT) level before and after treatment were compared between the two groups. Moreover, the incidence of adverse reactions during treatment in the two groups was observed. Results:The results of sputum culture in the routine group were Acinetobacter baumannii in 13 patients, Klebsiella pneumoniae in 5 patients, Pseudomonas aeruginosa in 6 patients, Enterobacter cloacae in 1 patient; the sputum culture results of the combination group showed that there were 5 patients of Acinetobacter baumannii, 9 Klebsiella pneumoniae and 6 Pseudomonas aeruginosa. There was no significant difference in the results of sputum culture between the two groups ( P > 0.05). The total bacterial clearance rate and the total clinical efficiency rate of the combination group were significantly higher than those in the routine group (total bacterial clearance rate: 70.0% vs. 40.0%, total clinical efficiency rate: 75.0% vs. 40.0%, both P < 0.05). The recovery time of body temperature and the time of bacterial clearance of the combination group were significantly shorter than those in the routine group [recovery time of body temperature (days): 6.0±3.9 vs. 10.2±7.3, time of bacterial clearance (days): 6.1±5.2 vs. 11.5±6.8, both P < 0.05]. No significant difference was found in serum PCT level before treatment between the two group. There was no significant difference in serum PCT level before and after treatment in the routine group [μg/L: 0.85 (0.44, 2.87) vs. 1.43 (0.76, 5.30), P > 0.05]. The serum PCT level after treatment in the combination group was significantly lower than that before treatment [μg/L: 0.27 (0.10, 0.70) vs. 0.91 (0.32, 3.53), P < 0.05], and it was significantly lower than that in the routine group [μg/L: 0.27 (0.10, 0.70) vs. 0.85 (0.44, 2.87), P < 0.01]. The incidence of renal toxicity of polymyxin B between the combination group and the routine group was not significantly different (5.0% vs. 4.0%, P > 0.05). Conclusions:The efficacy of intravenous combined with aerosol inhalation of polymyxin B for the treatment of pneumonia due to multidrug-resistant G - bacteria is better than that of intravenous drip of polymyxin B only. The aerosolized polymyxin B will not increase the risk of renal injury.

Objective:To investigate the effects of enteral nutrition feeding process in critically ill patients on nutritional status, inflammation indexes and cardiopulmonary function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure with mechanical ventilation.Methods:From December 2017 to January 2020, 60 patients who were diagnosed with AECOPD complicated with respiratory failure requiring mechanical ventilation were selected from the Department of Intensive Medicine of our hospital. The patients were divided into group A and group B according to the random number table method. Group A underwent conventional early enteral nutrition (EN) treatment, group B implemented early EN according to the enteral nutrition feeding process. The nutritional status, inflammation indicators, cardiopulmonary function, mechanical ventilation time and length of ICU stay before and after nutritional support between the two groups were comparedResults:After 2 weeks of nutritional support, the serum total protein (TP), albumin (ALB), prealbumin (PA) and hemoglobin (HB) in group B were increased by [(9.91±0.60)g/L, (7.6±0.58)g/L, (30.07±4.65)mg/L, and (15.43±1.18)g/L, which were significantly higher than those in group A (5.69±0.80)g/L, (4.20±0.47)g/L, (15.97±3.05)mg/L, and (6.70±0.49)g/L, respectively], and the difference between the two groups was statistically significant ( P<0.05). The high sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and plasma lactic acid (LA) in group B were decreased by 39.07±5.55, 1.24±0.22, and 1.11±0.13, which were significantly higher than those in group A (18.94±3.18, 0.58±0.17 and 0.70±0.09, respectively), and the difference between the two groups was statistically significant ( P<0.05). There was no significant difference in N-terminal-type brain urine peptide precursor (Nt-proBNP) and ejection fraction (LVEF) before and after nutritional support between groups A and B ( P>0.05). The blood oxygen partial pressure (PaO 2) and PaO 2/ inhaled oxygen fraction (FiO 2) of group B before tracheal intubation and 24 h after tracheal intubation were increased by (25.17±1.71) mmHg and (231.53±5.39)%, which were significantly higher than those of group A [(12.17±1.59) mmHg and (164.60±5.66)%, respectively]. The blood carbon dioxide partial pressure (PaCO 2) in group B was decreased by (25.26±1.66)mmHg, which was significantly higher than that in group A (20.11±1.08) mmHg, and the difference between the two groups was statistically significant ( P<0.05). The mechanical ventilation time and length of ICU stay in group B were significantly lower than those in group A (10.17±0.46) d vs (12.30±0.64) d, (15.70±0.23) d vs (17.93±0.52) d, all P<0.05). Conclusion:When compared with conventional early enteral feeding, early enteral nutrition based on the enteral nutrition feeding process in AECOPD with respiratory failure and mechanical ventilation patients can improve the nutritional status, reduce the level of inflammatory indicators and the inflammatory response, and shorten the mechanical ventilation time and length of ICU stay.

Objective:To investigate the clinical characteristics and influencing factors of mortality in patients with intra-abdominal candidiasis (IAC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 203 IAC patients who were admitted to 7 medical centers from June 2018 to June 2020 were collected, including 54 cases in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 31 cases in Fujian Medical University Union Hospital, 25 cases in Beijing Hospital, 25 cases in the First Affiliated Hospital of Xi'an Jiaotong University, 24 cases in China-Japan Friendship Hospital, 22 cases in General Hospital of Eastern Theater Command of Chinese PLA and 22 cases in Chongqing University Cancer Hospital. There were 130 males and 73 females, aged (64±15)years. Observation indicators: (1) candida infection and treatment of IAC patients; (2) analysis of influencing factors for mortality of IAC patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analyses were performed by Logistic regression model. Results:(1) Candida infection and treatment of IAC patients: 134 cases of candida albicans were cultured in the initial abdominal drainage fluid or intraoperative abdominal specimens of 203 patients, and 49 cases were treated with fluconazole. Of 69 cases infected with non candida albicans, 13 cases were treated with fluconazole. The resistance rate of candida albicans to fluconazole was 5.91%(12/203). Of 203 patients, there were 68 cases with infections shock, 53 cases with renal failure, 84 cases with respiratory failure and 63 cases with multiple organ failure, respectively. There were 148 of 203 patients admitted to intensive care unit for 9 days(range, 3-20 days), and the total hospital stay was 28 days(range, 17-50 days). Of 203 patients, 86 cases were cured and discharged, 50 cases were improved and transferred to local hospitals, 32 cases gave up treatment and discharged automatically, 19 cases died, 16 cases had no follow-up data. The mortality was 25.12%(51/203). (2) Analysis of influencing factors for mortality of IAC patients. Results of univariate analysis showed that acute physiology and chronic health evaluation score, sequential organ failure assessment score, the Cr, bilirubin, albumin, procalcitonin, and PLT on the first day of candida positive culture, of the lowest value in a week and the highest in a week, heart disease, diabetes, infections shock, renal failure, respiratory failure, multiple organ failure, anti-fungal therapy were the related factors for mortality of IAC patients ( t=-2.322, Z=-2.550, -2.262, -4.361, t=2.085, Z=-3.734, -5.226, -2.394, -5.542, t=3.462, Z=-4.957, -5.632, 3.670, -5.805, t=3.966, Z=-3.734, -5.727, χ2=4.071, 4.638, 27.353, 18.818, 13.199, 26.251, 13.388, P<0.05). Multivariate analysis showed that the bilirubin, procalcitonin on the first day of candida positive culture and infections shock were independent risk factors for mortality of IAC patients ( odds ratio=1.021, 1.022, 6.864, 95% confidence interval as 1.010-1.033, 1.001-1.044, 1.858-25.353, P<0.05). Conclusions:The common fungus of IAC was candida albicans, and fluconazole can be used as the initial empirical treatment. The prognosis of patients with abdominal candidiasis is poor. Bilirubin, procalcitonin on the first day of candida positive culture and infections shock are indepen-dent risk factors for mortality of IAC patients.