OBJECTIVE To investigate the distribution and drug resistance of pathogenic bacteria in blood culture,and provide a basis for clinical treatment.METHODS The blood samples were poured into the blood culture bottles of Beijing Botai Technique Development Center,and cultured with BacT/Alert 3D automated blood culture system.Isolated bacteria were identified by the VITEK system.Drug sensitivity was tested by the BIOMIC.RESULTS From Jan 2003 to Dec 2007,607 strains of pathogenic bacteria were isolated from 4116 clinic blood specimens,the positive rate was 14.8%,Gram-negative bacteria were the most common pathogens then Gram-positive bacteria and fungi.The sensitivity of Gram-negative bacteria to imipenem/cilastatin(TPM) was the best,the next was FEP;the sensitivity of Gram-positive bacteria to teicoplanin(TCN) was the best,Second was VAN.CONCLUSIONS Drug resistance of isolated pathogenic bacteria in blood cultures is very serious.Monitoring the change of pathogens and trends of drug resistance is very important in guiding the clinical use of drug.

9).Renal pathology revealed 3 patients with class Ⅳ, 1 patient with class Ⅱ. Image results showed diffuse pulmonary infiltration lesions. Bronchial lavage fluid was hemorrhage. Three patients recovered after treatment with corticosteroid and intravenous cyclophosphamide therapy. Conclusions Diffuse alveolar hemorrhage is rare serious complications of lupus nephritis. Aggressive immunosuppressive therapy should be started early for a favorable outcome.

Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from blood culture of children in a pediatric intensive care unit (PICU),provide reference for empirical treatment of bloodstream infection in critically ill children.Methods Pathogenic bacteria isolated from blood culture of children in a PICU in 2011-2015 were identified and performed antimicrobial susceptibility testing.Results A total of 180 strains of pathogens were isolated from 3 215 blood specimens,the positive rate was 5.60 ％,153 (85.00 ％) of which were grampositive bacteria and 27 (15.00 ％) were gram-negative bacteria.The top five isolated pathogens were Staphylococcus epidermidis (26.67 ％),Staphylococcus hominis (25.00 ％),Staphylococcus haemolyticus (11.66 ％),Escherichia coli (5.55 ％),and Staphylococcus aureus (3.89 ％).The resistance rates of Staphylococcus spp.to linezolid,vancomycin,and quinupristin/dalfopristin were all 0;the detection rates of methicillin-resistant coagulase-negative staphylococci (MRCNS) and methicillin-resistant Staphylococcus aureus(MRSA) were 70.18％ and 42.68％ respectively;Escherichia coli had high resistance rates to ampicillin,cefazolin,ceftriaxone,gentamycin,and compound sulfamethoxazole (50.00 ％-80.00 ％).Conclusion CNS and Escherichia coli are the main pathogens in blood culture of children in PICU,differences in antimicrobial resistance exist among different types of CNS.

Objective To determine the optimum dose of normal saline (NS) for preloading epidural space required to prevent the injury to blood vessel by epidural catheter placement for caesarean section.Methods Two hundred ASA Ⅰ or Ⅱ parturients with a single baby at full term in vertex presentation,aged 24-35 yr,weighing 63-78 kg,scheduled for caesarean section under continuous epidural anesthesia,were randomly divided into4 groups (n-50 each):control group (group Ⅰ),NS2 ml group (group Ⅱ),NS5 ml group (group Ⅲ)and NS 10 ml group (group Ⅳ).The epidural puncture was performed at L2-3 interspace with a Tuohy needle attached to a 5 ml syringe.Loss of resistance was used to identify the epidural space.In group C no fluid was injected into the epidural space before insertion of the catheter,while in groups Ⅱ,Ⅲ and Ⅳ NS 2,5 and 10 ml were injected into the epidural space before the catheter insertion respectively.After a test dose of 3 ml 1.5％ lidocaine,0.75％ ropivacaine 10-20 ml was administered through the epidural catheter.MAP and HR were recorded before epidural puncture (T0),at 10 and 20 min after the end of epidural administration (T1.2),and at the end of surgery (T3).The number of patients in whom blood or blood tinted fluid was withdrawn from the epidural catheter was recorded.The amount of ropivacaine consumed was recorded.The upper level of anesthesia was measured by pin-prick and the degree of motor block was assessed using modified Bromagc scale at T2.Results The hemodynamic parameters were in the normal range in the four groups.MAP was significantly lower at T2,the upper level of anesthesia was significantly higher,and the degree of motor block was significantly smaller in group Ⅳ than in groups Ⅰ,Ⅱ and Ⅲ (P ＜ 0.05).There was no significant difference in MAP among groups Ⅰ,Ⅱ and Ⅲ (P ＞ 0.05).There was no significant difference in HR and the amount of ropivacaine consumed among the four groups (P ＞ 0.05).The number of patients in whom blood or blood tinted fluid was withdrawn fiom epidural catheter was significantly smaller in groups Ⅲ and Ⅳ compared with groups Ⅰ and Ⅱ (P ＜ 0.05).Conclusion Preloading the epidural space with NS 5 ml can prevent the occurrence of injury to blood vessel induced by insertion of epidural catheter with no influence on the efficacy of anesthesia and NS 5 ml is the optimum dose.

ObjectiveTo evaluate the effect of preloading epidural space with 0.9％ sodium chloride on the incidence of the injury to blood vessel by epidural catheter insertion for cesarean section.Methods One hundred uterogestation patients with single birth,ASA class Ⅰ - Ⅱ,underwent caesarean section and requested continuous epidural analgesia were divided into group P and group C with each 50 cases by random digits table.After identification of the epidural space,group C was inserted epidural catheter directly,and 5 ml of 0.9％ sodium chloride was injected into epidural space through the epidural needle in group P,while the syringe plunger was held closed for 20 s to make sure the solution spreaded sufficiently,following insertion the epidural catheter.Between the two groups,mean arterial pressure and heart rate were recorded prior to anesthesia,2 min after turn to the supine horizontal position after succeeded puncture,the time when the fetus were born and when the surgery were over.The cases with bloody fluid in the epidural puncture needle during puncture,or in the epidural catheter during catheter placement,fresh blood in the epidural catheter,and bloody fluid in caudal end of epidural catheter during extubation were recorded.ResultsThe changes of mean arterial pressure and heart rate were all in the normal range,there was no obvious difference between the two groups.The incidence of rates with bloody fluid in the epidural puncture needle during puncture and the bloody fluid in caudal end of epidural catheter during extubation in group P were significantly lower than those in group C [ 10％ (5/50) vs.26％ (13/50),22％ (11/50) vs.48％ (24/50),P ＜ 0.05 or ＜ 0.01 ].ConclusionPreloading epidural space with 5 ml 0.9％ sodium chloride can reduce the incidence of the injury to blood vessel induced by insertion of epidural catheter.

Objective To investigate the distribution of pathogens in intensive care units (ICU ) and their drug resistance . Methods 668 strains of pathogens isolated from specimens from ICU were collected .VITEK 2 Compact automated microbial iden-tification and susceptibility analyzer was utilized to conduct the antimicrobial susceptibility tests .Kirby-Bauer disk diffusion suscep-tibility test(K-B) was employed to conduct the antimicrobial susceptibility test for Gram-negative bacteria cefoperazone/sulbactam . Results 668 strains of pathogens were derived from sputum [434 (65 .0% )] ,blood[83(12 .0% )] ,urine[88(13 .0% )] ,drainage [14(2 .0% )] ,secretions[14(2 .0% )] and other[35(5 .2% )] .Acinetobacter baumannii was the major detected pathogen in Gram-negative bacteria and the resistance rates were over 50% toward other drug excepting levofloxacin ,sulfamethoxazole and amikacin . Staphylococcus Staphylococcus was the major detected pathogen in Gram-positive bacteria and it showed good sensitivity toward ni-trofurantoin ,quinupristin/dalfopristin ,tigecycline and vancomycin .Candida albicans demonstrated the highest detection rate in fun-gi .Conclusion ICU pathogens have drug resistance in serious condition ,and pathogens and drug resistance monitoring should be strengthened .

OBJECTIVE:To explore the new model and feasibility of the combination of ward round conducted by business president and pharmaceutical administration.METHODS:The organization form,procedures,content and experience of ward round conducted by business president were introduced based on the practice of our hospital.RESULTS & CONCLUSIONS:The pharmaceutical ward rounds conducted by business president are carried out once a month in our hospital to intervene irrational medication by means of medication survey,administration intervention and education with guidance and supervision of rational use of drug as core.Multi-disciplinary cooperation is effective measure for improving rational use of drug.It can strengthen public perception on rational use of drug in all areas by enhancing experience at key point which is worth of spreading.

Objective To investigate the clinical distribution situation and drug resistance change of Klebsiella pneumoniae in the Navy General Hospital during 2011‐2015 in order to provide reference for rational use of antibacterial agents in clinic .Methods The clinically isolated Klebsiella pneumoniae in this hospital during 2011‐2015 were selected and performed the analysis on the de‐tection rate ,department distribution ,specimens source ,resistance of antibacterial drugs and change trend of resistance to carbapen‐em antibacterial drugs .Results The number the detected Klebsiella pneumoniae strains and isolation rate during 2011 -2015 showed an increasing trend year by year ,the specimens sources were mainly from 10 departments of intensive care units(ICU) ,hy‐perbaric oxygen department ,respiratory department ,radiation oncology department ,kidney disease department ,etc .;the submitted specimens were dominated by sputum and urine ,accounting for 59 .7% and 21 .4% of submitted specimens ;the drug resistance of Klebsiella pneumoniae during 2011‐2015 showed the increasing trend year by year .Klebsiella pneumoniae had higher resistance rates to piperacillin ,ampicillin ,ampicillin/sulbactam and cefuroxime and had lower resistance rate to amikacin ,imipenem ,meropen‐em and tobramycin ;the resistance rates to imipenem and meropenem were increased year by year ,and pan‐drug resistant Klebsiella pneumoniae showed a rapidly rising trend .Conclusion The drug resistance of Klebsiella pneumonia is serious ,especially carbapene‐ms‐resistant Klebsiella pneumoniae is significantly increased in the recent years ,therefore its drug resistance monitoring should be strengthened for guiding rational drug use in clinic .

Objective To investigate the prostecdtive efficacy of one-stage bone grafting in man-aging chronic osteomyelitis after debridement.Methods From March 1999 to May 2003, 79 patients with chronic osteomyelitis including 28 patients with nonunion underwent one-stage autogenous bone graft-ing, allografts or mixed bone grafting after debridement in Nanjing General Hospital of Nanjing Military Command.All patients were followed up for a mean period of 77 months (60-111 months).Results Six patients (8%) , including two with autogenous bone grafting, three with allografts and one with mixed bone grafting, were confirmed with recurrence of infection, with no statistical difference among three methods of bone grafting.Of 28 patients with nonunion, 23 patients with autogenous bone grafting and two with allografting obtained union, the other three patients with mixed bone grafting obtained union in two patients but resulted in recurrence of infection with nonunion in one, with cure rate of 96% (27/28).Conclusions One-stage bone grafting after debridement for infection and bone union can reach cure rate of over 90%.The recurrence of infection mostly occurs within the first year after operation, with stable long-term curative effect.

Objective To observe the therapeutic effect of low dose tolvaptan combined with furosemide in ederly patients with CHF and diuretic resistance (DR).Methods Eighty-five elderly patients with CHF and DR were divided into observation group (n=43) and control group (n=42).The patients in observation group were treated with cardiotonics and hypotensors plus oral tolvaptan (15 mg/d) combined with intravenous furosemide (40 mg/d).The therapeutic effect of low dose tolvaptan combined with furosemide was assessed.Results The average urinary volume was larger,and the LVEDV was significantly lower in two groups after treatment than before treatment (P＜0.05).The urinary volume was significantly larger while the LVEDV was significantly lower in observation group than in control group (2.89±0.87 L/d vs 2.43±0.49 L/d,P=0.01;103.6±21.5 ml vs 116.7±24.3 ml,P=0.01).The total effective rate was significantly higher in observation group than in control group (86.0％ vs 71.4％,P=0.01).Conclusion Low dose tolvaptan combined with furosemide can effectively improve the DR and therapeutic effect in elderly CHF patients,and is thus worth popularization in clinical practice.