OBJECTIVE To investigate the drug resistance and distribution of nosocomial infection(NI) pathogens.METHODS A total of 1 163 strains of NI pathogens during Jan 2002-Dec 2005 were completely surveyed and analyzed.RESULTS From them Gram-positive cocci were 376 strains(32.3%),the main pathogen was Staphylococcus aureus(12.7%),the average isolation rate of MRSA was 82.5%.Gram-negative bacilli were 474 strains(40.8%),the predominant pathogens were Escherichia coli(9.9%),Klebsiella pneumoniae(7.1%),Pseudomonas aeruginosa(5.4%),and Enterobacter cloacae(5.2%).The drug resistance of NI pathogens was markedly increased.Especially,the rates of drug resistance of P.aeruginosa to ceftazidime and imipenem were from 0 to 48.9% in 2005.CONCLUSIONS The Gram-negatives of NI pathogens are markedly increase year by year.The drug resistance rate of pathogens is higher,the clinically selected anti-bacterial drugs should be based on the bacterial culture and drug susceptibility test.

Objective To predict the length of peripherally inserted central venous catheters(PICC) with electronic chest radiograph scale measurement techniques, and observe its clinical effect. Methods A total of 185 breast cancer patients from October 2012 to December 2013 who were treated by PICC combined with MST guided by ultrasonic technology were as control group. A total of 192 breast cancer patients from January to November 2014 were as observation group. Control group adopted from the puncture point to right sternoclavicular joints impreaaion nip down again to the third floor of PICC in vitro measurement method. Observation group used to right sternoclavicular joints from the puncture point plus right sternoclavicular joints to subcarinal 1 vertebral body length, right sternoclavicular joints to subcarinal 1 vertebral body length measurement by electronic chest radiograph scale technology directly measured from the electronic chest radiographs. The accuracy rates and complications between the two measurement methods were compared. Results The accuracy rate in observation group was 97.92%(188/192), which was higher than that in control group (68.11%,126/185 ),and there was significant differencek,χ2=60.15, P<0.01. The complication rate in observation group was 6.77%(13/192), which was lower than that in control group (20.54%, 38/185) ,and there was significant difference,χ2=9.58, P<0.01. Conclusions The electronic chest radiograph scale measurement techniques could effectively improve the accuracy of PICC catheter placed, improve the quality of venipuncture, decrease the complications .

Objective To investigate the comparability of the activity detection of 6 common serum enzymes by different bio-chemical detecting systems at the same laboratory to provide the basis for realizing the traceability and comparability of serum en-zyme detection.Methods The detection system consisted of the Hitachi 008 biochemical analyzer,and original reagents,C-fas cali-brator and controller of Roche was taken as the reference system X(comparison method)and the detection system consisted of the ABBOTT ARCHITECT C16000 biochemical analyzer,reagents and calibrator of Zhongsheng,and controller of BIO-RAD was taken as the detecting systemY (laboratory method),which were used to detect the accuracy and precision of fresh serum enzymes inclu-ding ALT,AST,ALP,GGT,LDH and CK according to the NCCLS document EP9-A2.Then the enzyme activity results detected by the Y and X methods were compared and the relative error(SE%)was calculated.The comparability of the results detected by these two kinds of different detection systems was judged with 1/2 of allowable error in the external quality assessment stipulated by CLIA′88 as the standard.Results The accuracy and precision of the activity detection results of 6 enzymes by the Hitachi 008 and ARCHITECT C16000 biochemical analyzers all conformed to the requirements and the systematic error was clinically acceptable. Conclusion In measuring same test item by two or more detection systems,the method comparability and the bias assessment should be performed for ensuring the accuracy and comparability of the detection results.

Objective To investigate SCCmec types in clinical isolates of methicillin-resistant Staphylococcus epidermidis (MRSE) carrying psm-mec.Methods We collected 165 strains of Staphylococcus epidermidis identified by automated microbiological identification system and screened MRSE by PCR amplification of esp and mecA gene.Strains with psm-mec were identified by amplification of psm-mec,fudoh and p221 DNA fragment;mec,ccr and SCCmec typing was conducted by multiplex PCR assay.Results Among 138 strains of MRSE,29 strains were identified as MRSE with psm-mec,and the carrying rate was 17.58%.Results of mec and ccr typing by multiple PCR showed that MRSE with psm-mec carried Class A mec,but the ccr type had obvious diversity.Results of SCCmec typing showed that all strains with psm-mec belonged to type Ⅱ and/or Ⅲ SCCmec.Conclusion Clinical isolates of MRSE with psm-mec carry homologous type Ⅱ and/or Ⅲ SCCmec harboring Class A mec.

Objective To observe the clinical effects of early use of neuromuscular blocking agents (NMBA) in patients with severe sepsis and acute respiratory distress syndrome (ARDS).Methods A prospective study was conducted.96 patients with severe sepsis and ARDS admitted from July 2012 to September 2013 to intensive care unit (ICU) of Liuzhou People's Hospital in Guangxi Zhuang Autonomous Region were enrolled and divided into severe ARDS group (n=48) and moderate ARDS group (n=48) according to the Berlin definition of ARDS.Then patients in each group were randomly divided into treatment group (n =24) and control group (n=24).All patients with diagnosis in accordance with the 2008 international septic shock and severe sepsis treatment guidelines were provided with comprehensive treatment and mechanical ventilation on the basis of analgesia and sedation.The patients in treatment group were given a loading dose of vecuronium during mechanical ventilation,started with 0.l mg/kg up to 0.05 mg ·kg 1 ·h 1 for continuous intravenous infusion for 24-48 hours.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA),arterial oxygenation index (PaOfFiO2),central venous oxygen saturation (ScvO2),arterial blood lactate (Lac),C-reactive protein (CRP) levels of two groups were compared before treatment and 48 hours after treatment,and 21-day mortality rate was finally compared.Results In moderate or severe ARDS group,there were no statistically significant difference in APACHE Ⅱ score,SOFA score,PaO2/FiO2,ScvO2,Lac and CRP before treatment between two groups.APACHE Ⅱ score,SOFA score,PaO2/FiO2,ScvO2,and Lac 48 hours after treatment were significantly improved in severe ARDS group compared with control group [APACHE Ⅱ score:16.58 ± 2.41 vs.19.79 ± 3.52,t=3.679,P=0.010; SOFA score:12.04 ± 2.17 vs.14.75 ±3.26,t=3.385,P=0.010; PaO2/FiO2 (mmHg,1 mmHg=0.133 kPa):159.31 ±22.57 vs.131.81 ± 34.93,t=3.239,P=0.020; ScyO2:0.673 ± 0.068 vs.0.572 ± 0.142,t=3.137,P=0.030; Lac (mmol/L):3.10 ± 1.01 vs.4.39 ± 1.72,t=3.161,P=0.030],while the value of CRP (mg/L) showed no significant difference (180.91 ±37.14 vs.174.66 ± 38.46,t=0.572,P=0.570).21-day mortality in treatment group was significantly lower than that in control group [20.8％ (5/24) vs.50.0％ (12/24),x2=4.463,P=0.035].In moderate ARDS group,each of the above clinical parameters were improved in both groups expect for CRP at 48 hours after treatment,but the indexes showed no statistically significant difference between two groups (all P＞0.05).21-day mortality rate in the treatment group was slightly lower than that in the control group which showed no statistically significant difference [16.7％ (4/24) vs.25.0％(6/24),x2=0.505,P=0.477].Conclusion The early use of NMBA treatment of patients with severe sepsis and severe ARDS cannot only improve the severity but also reduce 21-day mortality.

Objective To evaluate the main performance of ABBOTT ARCHITECT C160000 biochemistry analyzer,and to judge whether the performance meets the laboratory requirement.Methods According to the clinical laboratory management meth-od and the requirement of accreditation of national laboratory,the precision,accuracy and linearity of the 17 test items(Urea,Cre, UA,Glu,etc.)were analyzed by the CLSI EP5-A2 document,CLSI EP9-A2 document and CLSI EP6-P document;the quotative ref-erence ranges of the 17 test items were verified.Results The coefficient of variation(CV)in within-batch precision of Urea,Cre, UA,Glu,etc.was ≤1/4 CLIA′88 standard and CV in the between-batch precision ≤1/3CLIA′88 standard;in the accuracy test,the relative bias of the 17 test items≤1/2CLIA′88 standard;the linearity of the 17 items was good(r2 >0.95);the cited reference range of various detection items was suitable.Conclusion The performance of the ABBOTT ARCHITECT C160000 automatic biochem-istry analyzer meets the laboratory demand.

Objective To assess the application of contrast-enhanced ultrasound (CEUS) in evaluation of the renal cortical and medullary perfusion changes before and after acute renal failure (ARF) in rabbits. Methods Rabbit ARF models were established with intramuscular 50% glycerin (12-15 ml/kg) injection into rabbits' thighs. One day before and after ARF models establishment, CEUS was performed on each rabbit. The renal perfusion time-intensity curve (TIC) was analyzed, including parameters like AT (arrival time), TTP (time to peak intensity), A (amplitude of peak intensity), AUC (area under the curve), β (slope rate of TIC) of renal cortex and medulla. Results The value of A and β before model establishment was (17.36±13.73) dB and (5.38±2.08) dB/s, respectively, both was significantly higher than those after glycerin injection ([6.59±4.25] dB and [1.58±1.41] dB/s, respectively) (P<0.05). The value of TTP and AUC before model establishment was (2.46±1.76) s and (329.31±171.70) dBs, both was significantly lower than those after injection ([5.93±4.80] s and [722.28±354.14] dBs, respectively) (P<0.05). No significant difference was found in AT of renal cortex and AT, A, TTP, AUC, β of renal medulla, nor in SCr or BUN. Conclusion CEUS can display the changes of perfusion image of the renal cortex of the ARF earlier than SCr and BUN.

Objective:To observe the effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO)combined with prone position ventilation (PPV) on oxygenation index (PaO 2/FiO 2), respiratory compliance (Crs) and vasoactive inotropic score (VIS) in severe acute respiratory distress syndrome (ARDS) patients. Methods:Eighteen patients with severe ARDS requiring VV-ECMO support in Liuzhou People's Hospital from June 2018 to April 2020 were selected for retrospective analysis, and 8 patients among of these cases received PPV after VV-ECMO. The differences in PaO 2/FiO 2, VIS and Crs before and 1, 2 or 3 days after treatment were compared between VV-ECMO group and VV-ECMO combined with PPV group, as well as the differences in these indices before PPV and 2 hours after PPV daily in VV-ECMO combined with PPV group. The incidence of adverse events in two groups were also observed. Results:Before treatment, there was no significant difference in PaO 2/FiO 2, Crs between two groups. Over time, PaO 2/FiO 2 and Crs increased and VIS decreased in both groups. Compared with before treatment, there were statistically significant differences in PaO 2/FiO 2 and VIS from 1 day after treatment [PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): VV-ECMO group was 197.75±39.80 vs. 75.57±7.44, VV-ECMO combined with PPV group was 255.20±31.92 vs. 68.24±11.64; VIS: VV-ECMO group was 5.51±3.72 vs. 10.20±7.10, VV-ECMO combined with PPV group was 6.73±3.32 vs. 14.50±2.48, all P < 0.05], up to 3 days after treatment [PaO 2/FiO 2 (mmHg): VV-ECMO group was 231.96±32.76 vs. 75.57±7.44, VV-ECMO combined with PPV group was 285.61±19.40 vs. 68.24±11.64; VIS: VV-ECMO group was 2.26±1.90 vs. 10.20±7.10, VV-ECMO combined with PPV group was 2.13±1.55 vs. 14.50±2.48, all P < 0.05], and the PaO 2/FiO 2 1 day and 3 days after treatment in VV-ECMO combined with PPV group were significantly higher than those in VV-ECMO group (mmHg: after 1 day of treatment was 255.20±31.92 vs. 197.75±39.80, after 3 days of treatment was 285.61±19.40 vs. 231.96±32.76, both P < 0.05). Before treatment, Crs of VV-ECMO combined with PPV group was significantly lower than that of VV-ECMO group (mL/cmH 2O: 17.91±0.82 vs. 20.54±1.26, P < 0.05). From 1 day after treatment, the Crs in VV-ECMO combined with PPV group was significantly higher than that before treatment (mL/cmH 2O: 21.20±1.50 vs. 17.91±0.82), the peak value was (24.93±2.18) mL/cmH 2O on 3 days after treatment, however, there was no significant difference between the two groups (all P > 0.05). In VV-ECMO combined with PPV group, compared with before PPV treatment, the PaO 2/FiO 2 and Crs of 2 hours after PPV treatment in 1, 2 and 3 days were significantly rose, and it reached the highest level in 3 days [PaO 2/FiO 2(mmHg): 285.61±19.40 vs. 189.91±28.34, Crs (mL/cmH 2O): 24.93±2.18 vs. 23.35±1.45, both P < 0.05]; the VIS was only increased in 2 hours after PPV treatment on the first day than before (6.73±3.32 vs. 6.38±3.22, P < 0.05). There were no related serious adverse events happened after PPV treatment. Conclusions:The combination of PPV during VV-ECMO could further increase PaO 2/FiO 2, improve hypoxemia and implement further protective lung ventilation to reduce the potential hazards during mechanical ventilation. In addition, no serious adverse events were observed in this study, suggesting PPV is safe during VV-ECMO.

Objective To study the therapeutic effect of rheum(Chinese herbal medicine) preparation made by using ultrasonic technique on pro-inflammatory cytokines and sepsis in rats.In order to offer novel measure for the treatment of critically ill patients.Methods Firstly, rheum sterile solution was prepared through ultrasonic technique.Secondly, fifty healthy male SD rats were randomly(random number) divided to CLP group and rheum group.Moderate degree of sepsis model was established by using cecal ligation and puncture(CLP).Rats in group rheum received the liquid rheumpreparation via intragastric administration, while rats in group CLP received saline instead.The 7-day survival rate was recorded and was compared between two groups.In addition, another fifty-four rats were randomly(random number) divided to sham group, CLP group and rheum group(n=18 in each group).CLP was performed to induce sepsis in CLP group and rheum group.Then rats in rheum group received rheum sterile solution via intragastric administration, while rats in CLP group received saline instead.At 12 hours, 24 hours and 48 hours after modeling, six rats in each group were randomly sacrificed.Serum TNF-α and HMGB1 levels were detected by ELISA method.Levels of RAGE, HMGB1 and NF-κB P65 in small intestine were detected by Western Blot.Results Level of anthraquinones extracted from rheum by ultrasonic technique was higher than that by conwentional decoction method.The 7-day survival rate of rats in rheum group(76%) was higher than that in CLP group(48%)(P<0.05).Compared with sham group, serum TNF-αand HMGB1 levels in CLP group and rheum group were significantly increased(P<0.05).TNF-α was significantly lower in rheum group than that in CLP group at each interval(P<0.05).At 12 hours after modeling, there was no significant difference in serum HMGB1 level between CLP group and rheum group(P>0.05).At 24 hours and 48 hours after modeling, serum HMGB1 levels were significantly lower in rheum group than those in CLP group(P<0.05).Compared with sham group, protein levels of HMGB1, RAGE and NF-κB in small intestine were elevated in CLP group and rheum group at 48 hours after modeling(P<0.01), while protein levels of above biomarker were higher in CLP group than those in rheum group(P<0.05).Conclusions Rheum sterile solution could down-regulate the level of pro-inflammatory cytokines, modulate the inflammatory response, and improve the survival rate in rats with sepsis.

Objective To discuss the application value of modified Hodge test(MHT) for screening carbapenemase-producing Enterobacteriaceae.Methods The 24 Enterobacteriaceae reduced susceptibility to carbapenems were detected by MHT.At the same time,polymerase chain reaction(PCR) was used to detect carbapenemase genes of KPC,NDM,IMP,SIM and VIM.PCR products were sequenced and the results were compared with the sequences of Gen Bank database.Comprehensive analysis the application value of MHT and PCR to detect carbapenemase.Results Among these 24 strains,13 stains appeared to produce carbapenemase by MHT,5 positive strains were found to carry carbapenemase genes by PCR.By comparing with the sequences of Gen Bank database 1 strain were confirmed to KPC-2 and 4 strains were confirmed to IMP-4.We found that 4 strains of Enterobacteriaceae,detected carbapenemase by MHT and PCR at the same time.9 strains of MHT were positive,but we couldn′t detect the carbapenemase genes.1 strain of MHT was negative,but carbapenemase gene was found in the strain.Conclusion The value of MHT to screen carbapenemase-producing Enterobacteriaceae is necessary to further study.