OBJECTIVE To study the synergism of imipenem(IMP) combined with azithromyicn(AZM) in the treatment of infection associated with Pseudomonas aeruginosa biofilm.METHODS The inhibitory activity of AZM to glycocalyx(GLX) production was detected with the L-tryptophan method.Viable counts in biofilms treated with AZM combined with IMP were detected with the methyl thiazolyl diphenyltetrazolium(MTT) method in vitro.The tissue cage method was used to establish the animal model of local P.aeruginosa biofilm infection and the synergism of IMP combined with AZM was also studied in vivo.RESULTS AZM could inhibit the production of GLX.When IMP was combined with 1/4MIC or 1/16MIC of AZM viable counts in biofilms were less than they were when IMP was given alone in vitro.When AZM and IMP were administered at the same time viable counts in tissue cage fluids were also less than they were when IMP was administered alone in vivo.CONCLUSIONS AZM could enhance the antibacterial activity of IMP in the treatment of infection associated with biofilm.

OBJECTIVE To establish a rat model of pulmonary infection by inoculating Pseudomonas aeruginosa to Sprague-Dawley(SD) rats and evaluate it.METHODS Two hundred SD rats were divided into 2 groups: the P.aeruginosa group and the control group,P.aeruginosa was embedded in minute seaweed alginate beads by an ejection set with an acuminate hole.Then the beads were inoculated into the rats′ lung through tracheal intubation.RESULTS The bacteriological values: P.aeruginosa was detected from rats of infected groups.Bacterial number was higher than 105CFU/g 3 and 7 days after infection and higher than 103CFU/g 14 and 28 days after infection.The pathological changes showed: 3 and 7 days after infection,lung abscess,edema,and consolidation could be seen from lungs of infected groups.At optical microscopy,alginateP.aeruginosa caused a pronounced inflammatory reaction with polymorphonuclear cells surrounding a bead.Fourteen and 28 days after infection,fibrinous adhesions and granulomas became the major pathological changes.CONCLUSIONS The animal model of pulmonary infection can be established by inoculating P.aeruginosa embedded in minute seaweed alginate beads made by an ejection set with an acuminate hole to SD rats.

Objective To establish a rat model of chronic pulmonary infection by inoculating Pseudomonas aeruginosa to Sprague-Dawley (SD) rats, and to evaluate the animal model with bacteriological and pathological stndies. Methods 240 healthy, clean SD rats were randomly divided into 2 groups: the infected group and the control group. Pseudomonas aeruginosa were embedded in minute seaweed alginate beads using an ejection set with an acuminate hole. Then the beads were inoculated into the rats′ lung through tracheal intubation. The bacteria number in the lung and pathological scores were determined 3, 7, 14 and 35 days after inoculation. The control group was treated with the same method using the sterile normal saline instead of the bacteria suspension. Results Bacteriological values: no bacterium was detected in the control group. Pseudomonas aeruginosa was detected from the rats of infected group in which the bacterial number was up over 105cfu/g at 3 and 7 days after infection, and up over 103cfu/g at 14 and 35 days after infection. Pathological changes: at 3 and 7 days after infection, lung edema, consolidation and hemorrhage could be seen in rat lungs of the infected group. Under the optical microscope, alginate-Pseudomonas aeruginosa caused a pronounced inflammatory reaction with polymorphonuclear cells surrounding beads, and microcolonies formed at the periphery of beads were also seen. Atelectasis and fibrosis and granalation were the major pathological changes at 14 and 35 days after infection. While in the control group, there were little changes after the inoculation except mild congestion and inflammatory reaction in the lungs 3 days after inoculation. Conclusion The rat model of chronic pulmonary infection can be reproduced by inoculating Pseudomonas aeruginosa embedded in minute seaweed alginate beads.

Objective To reveal the differences in clinical characteristics between health care associated pneumonia (HCAP) and community acquired pneumonia (CAP) in elderly patients.Methods A total of 282 elderly patients were evaluated,including 69 patients with HCAP (25.5％) and 213 with CAP (75.5％).A retrospective observational study was conducted.The baseline characteristics,comorbidities,pathogen distribution,antibiotics,and clinical outcomes between HCAP and CAP patients were compared.Results The incidence of chronic obstructive pulmonary diseases and cerebrovascular diseases were higher in HCAP group (49 cases,71.0％; 36 cases,52.2％) than in CAP group (93 cases,43.7％; 57 cases,26.8％) (x2 =15.598,15.229,all P＜0.001).The infection of Pseudomonas aeruginosa (29 cases,51.8％),Staphylococcus aureus (19cases,34.0％) and Acinetobacter baumannii (18 cases,32.1％) in HCAP group were more than in CAP group [(26 cases,27.7％),(12 cases,2.8％),(8 cases,8.5％),(x2 =8.796,9.586,13.678,all P＜0.05)],respectively.While the infection of Streptococcus pneumoniae (38 cases,40.4％) in CAP group was much more than in HCAP group (4 cases,7.1％)(x2 =19.283,P＜0.001).Initial inappropriate antibiotics treatment failure was more frequent in HCAP group (24 cases,34.8％) than in CAP group (37 cases,17.3％)(x2=9.321,P＜0.05).The mortality was higher in HCAP group (19 cases,27.5％) than in CAP group (29 cases,13.6％)(x2 =7.151,P＜0.05).Conclusions HCAP should be distinguished from CAP in elderly,which is helpful to choose appropriate empirical anti-infective regimen and improve the effect of HCAP treatment.

Objective To explore the value of Oxford acute severity of illness score in evaluating the severity and prognosis of critical illness patients.Methods All adult patients admitted to the Department of Critical Care Medicine from August 2012 to July 2014 were retrospectively analyzed.The severity in survivors and non-survivors was evaluated by using Oxford acute severity of illness score and APACHE Ⅲ score,and then statistic analysis were performed.Results Of 470 patients,321 (68.297％) were male,the range of age and ((x) ±s) age were 18 to 97 years and (59 ± 18) years respectively,and 123 patients (26.170％) were in non-survivors group and 347 patients in survivors group.The area under the ROC of Oxford acute severity of illness score was 0.760 (95％ CI:0.712-0.808,P ＜ 0.001),and Youden index was biggest when Oxford acute severity of illness score was 30.5.The area under the ROC of APACHE Ⅲ score was 0.844 (95％ CI:0.806-0.882,P ＜ 0.01),and Youden index was biggest when APACHE Ⅲ score was 70.5.Mortality was high (above 70％) as Oxford acute severity of illness score increased (＞ 40),and Spearman r was 0.976 (P ＜ 0.01).Conclusions Oxford Acute Severity of Illness Score was useful to evaluating the severity and prognosis of critical illness patients and it was easy in clinical practice.

ObjectiveTo explore the risk factors of the occurrence of acute kidney injury (AKI) in critically ill patients, and to investigate the effect of hydroxyethyl starch (HES) on renal function in these patients.Methods A prospective investigation was conducted. Critically ill patients admitted to Department of Critical Care Medicine of People's Hospital of Huangshan, Wannan Medical College from March 2012 to October 2013 were enrolled. For all the patients under observation, the following data were collected: demography, comorbidities, clinical presentation, severity of illness, and the use of blood product and drugs. All patients were divided into AKI group and non-AKI group by means of Acute Kidney Injury Network (AKIN) criteria, then the risk factors of AKI were investigated by means of univariate and multivariate logistic regression analysis. The effect of HES 130/0.4 administration on renal function in critically ill patients was evaluated.Results 314 patients were enrolled for study out of 1 152 patients admitted. Among these patients enrolled, 89 of them were found to suffer from AKI. AKI was classified as stage 1 in 59 patients, stage 2 in 19 patients, and stage 3 in 11 patients. It was shown by the univariate analysis that 12 variables were the risk factors of AKI, including age, hypertension, diabetes mellitus, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, coagulation SOFA score, neurological SOFA score, cardiovascular SOFA score, blood pH on intensive care unit (ICU) admission, blood glucose on ICU admission, accumulating dose of HES, and presence of shock (P< 0.05 orP< 0.01). However, HES administration and daily maximum dose of HES were not the risk factors of AKI in critically ill patients (bothP> 0.05). Using the multivariate logistic regression analysis, it was shown that total SOFA score [odds ratio (OR) = 1.20, 95% confidence interval (95%CI) = 1.09-1.32,P< 0.001], hypertension (OR = 2.44, 95%CI = 1.22-4.89,P= 0.012), blood glucose level on ICU admission (OR= 1.85, 95%CI = 1.32-2.59,P< 0.001), and presence of shock (OR = 3.81, 95%CI = 1.93-7.53,P< 0.001) were independent predictors of AKI in critically ill patients, however, the cumulative dose of HES was not independent risk factor for AKI (OR = 0.77, 95%CI = 0.68-0.87,P< 0.001).Conclusions Total SOFA score, hypertension, blood glucose level on ICU admission, and presence of shock were independent risk factors for AKI in critically ill patients. HES administration may not be a causative factor of an increased risk of AKI in the ICU.

Objective To explore the application value of pulse induced contour cardiac output (PiCCO) monitoring in diagnosis and treatment of patients with neurogenic pulmonary edema (NPE).Methods With review of literature, the data of 4 patients of severe neurological disease complicated by NPE admitted into Department of Critical Care Medicine of Huangshan People's Hospital Affiliated to Wannan Medical College from 2011 to 2013 were retrospectively analyzed and discussed in their PiCCO hemodynamic characteristics and processes of treatment.Results The PiCCO of 4 patients with NPE showed that the extravascular lung water index (EVLWI) was increased significantly (EVLWI was 12 - 42 mL/kg on admission and 10 - 22 mL/kg after hospitalization for 24 hours), all revealing a high permeability pulmonary edema type. The capacity balance of the first 24 hours in the 4 cases was all of positive balance (+1 130, +1 200, +1 750, +1 120 mL respectively). In the treatment, the supplementary colloid was strengthened, the vasoactive drugs such as, dopamine, dobutamine, milrinone, etc were applied to improve the circulatory oxygenation, then the EVLWI was declined; finally the disease situation in 3 cases was improved and one died.Conclusions The clinical diagnosis and treatment of NPE is complex, and many contradictions appear in the therapeutic course. PiCCO monitoring is valuable in early diagnosis, identification of pulmonary edema type, guidance in fluid supplement and vascular active drug application, and assessment of disease severity and prognosis.

Objective To explore the value of waring score of potential critical disease in predicting changes in condition of patients with multiple injuries. Methods From January 1, 2013 to July 31, 2013, all patients with multiple injuries were included prospectively. Patients were observed as soon as ICU admission. The waring score of potential critical disease and MEWS of all patients and the rates of changes in condition of patients were calculated then statistic analysis was performed. Results Of 50 patients enrolled, 44 were survived and 6 were died and 295 changes were found. The maximum , minimum median (P25, P75) of waring score of potential critical disease were 22, 0, 5 (3, 7). The maximum, minimum median (P25, P75) of MEWS were 12, 0, 4 (2, 6). The area under the ROC of waring score of potential critical disease was 0.880 (95% CI, 0.813-0.947, P < 0.001). Youden index was the biggest when waring score of potential critical disease was 6.5. The area under the ROC of MEWS was 0.767 (95% CI, 0.661-0.873, P < 0.001). Youden index was the biggest when MEWS was 5.5. Conclusion The waring score of potential critical disease was effective to predict changes in conditions of patients with multiple injuries and better than MEWS.

Objective:To investigate the level and changing trend of microparticles (MPs) in super-elderly infected patients, and explore its early warning effect on infection.Methods:The infected patients ≥ 85 years old admitted to the Second Medical Center of Chinese PLA General Hospital from December 2018 to March 2019 were selected as the observation group, and the healthy volunteers ≥ 85 years old in the same period were selected as the control group. Venous blood samples were collected at the 2nd hour, the 2nd day and the 7th day after fever, and the inflammatory markers such as white blood cell count (WBC), neutrophil percentage (NEUT), C-reactive protein (CRP) and procalcitonin (PCT) were measured. The levels of MPs were determined by flow cytometry. AnnexinⅤlabeled CD11b positive MPs (AnnexinⅤ +/CD11b + MPs) represented leukocyte microparticles (LMPs), and AnnexinⅤlabeled CD66b positive MPs (AnnexinⅤ +/CD66b + MPs) represented neutrophil microparticle (NMPs). The differences of each index at different time points between the two groups were compared, and the predictive value of each index to the infection of elderly patients was analyzed by receiver operating characteristic (ROC) curve. Results:A total of 38 subjects were enrolled, including 28 cases in the observation group and 10 cases in the control group. The levels of LMPs and NMPs in the observation group increased to the peak at the 2nd hour after fever, and were significantly higher than those in the control group [LMPs (cells/μL): 55.0 (28.8, 197.2) vs. 19.0 (13.5, 28.3), NMPs (cells/μL): 226.5 (123.3, 516.5) vs. 26.5 (22.0, 48.8), both P < 0.01]. With the control of the disease, LMPs and NMPs decreased gradually. The NMPs on the 2nd day was significantly lower than that at the 2nd hour of fever [cells/μL: 106.0 (40.0, 309.0) vs. 226.5 (123.3, 516.5), P < 0.05], and the LMPs and NMPs on the 7th day were significantly lower than those on the 2nd day [LMPs (cells/μL): 17.0 (12.5, 43.8) vs. 42.0 (13.0, 117.0), NMPs (cells/μL): 30.0 (15.8, 62.0) vs. 106.0 (40.0, 309.0), both P < 0.05]. There was no significant difference in the levels of LMPs and NMPs between the two groups on the 7th day. Among the inflammatory markers, the NEUT in the observation group was significantly higher than that in the control group at the 2nd hour of fever (0.70±0.09 vs. 0.59±0.04, P < 0.01), but there was no significant difference in WBC, CRP and PCT between the two groups. On the 2nd day, the inflammatory markers in the observation group reached the peak and were significantly higher than those in the control group [WBC (×10 9/L): 9.33±2.44 vs. 6.37±1.28, NEUT: 0.78±0.08 vs. 0.57±0.04, CRP (mg/L): 5.67±2.99 vs. 0.33±0.18, PCT (μg/L): 0.80±0.67 vs. 0.07±0.03, all P < 0.01]. On the 7th day, the inflammatory markers in the observation group decreased significantly, and there was no significant difference between the observation group and the control group. ROC curve analysis showed that the area under ROC curve (AUC) and 95% confidence interval (95% CI) of LMPs and NMPs on the day of fever were higher than those of WBC, NEUT, CRP and PCT [0.888 (0.763-1.000), 0.973 (0.931-1.000) vs. 0.679 (0.346-0.811), 0.829 (0.700-0.958), 0.607 (0.404-0.811), 0.554 (0.358-0.749)]. Conclusion:LMPs and NMPs are significantly increased in the early stage of fever, which can predict the incidence of infection in the super-elderly patients.