Objective To study the distribution characteristics and drug resistance of non-fermenting bacterial infection in intensive care unit (ICU) at a tertiary hospital during seven consecutive years,and to provide evidence for rational use of antibiotics in ICU.Methods A retrospective analysis was conducted.The related data about non-fermentative bacteria obtained from clinical specimens,collected from lower respiratory tract,blood,urine,bile and other secretions of ICU patients admitted to Binzhou Medical University Hospital from January 2009 to December 2015 were retrospectively analyzed.The distribution characteristics and drug resistance of non-fermentative bacteria,and isolation rate of multiple drug resistance (MDR) strains were analyzed.Results 2 672 strains of nonfermentative bacteria were isolated during seven consecutive years,accounting for 57.9％ gram negative (G-) bacilli (2 672/4 613),and 35.2％ of all bacteria (2 672/7 587).The top five were Acinetobacter baumannii (38.4％),Pseudomonas aeruginosa (34.6％),Onion burkholderia cepacia (9.9％),Stenotrophomonas maltophilia (6.2％),and Pseudomonas fluorescens (5.6％).Non-fermentative bacteria were mainly isolated from the lower respiratory tract (60.9％).Isolation of the non-fermentative bacteria accounted for over 50％ of G-bacilli during seven consecutive years,and the isolation rate of the top five types of bacteria showed no obvious change,while positive rate of Acinetobacter baumannii showed a tendency to increase (obviously from 26.5％ in 2009 to 50.2％ in 2015),and a lowering trend of positive rate of Onion burkholderia cepacia,Stenotrophomonas maltophilia,and Pseudomonas fluorescens was obvious (from 15.6％,10.6％,13.0％ in 2009 to 5.6％,7.4％,1.4％ in 2015 respectively) was observed.The isolation rate of Pseudomonas aeruginosa was stable (about 30％) during seven consecutive years.The drug susceptibility results showed that the resistant rates of Acinetobacter baumannii against imipenem,meropenem,aminoglycosides and third-generation cephalmsporins were all higher than 70％,while its resistant rate to cefoperazone-sulbactam was relatively lower (40.2％-68.1％)with relatively higher sensitivity rate (23.6％-46.0％).In contrast,the resistant rates of Pseudomonas aeruginosa against antibiotics were low,while the sensitivity rate to fourth-generation cephalmsporins cefepime (58.3％-87.7％)and third-generation cephalmsporins was high (ceftazidime:55.6％-79.3％,piperacillin-tazobactam:62.5％-86.2％,cefoperazone-sulbactam:46.0％-89.8％).From 2009 to 2015,the incidence of MDR strains of Acinetobacter baumannii showed an obvious increasing tendency (from 68.0％ to 84.1％);in contrast,the incidence of MDR strains of Pseudomonas aeruginosa did not show an obviously increase in incidence from 2009 to 2012,on the other hand,it showed a decreasing tendency from a peak 68.6％ in 2012 to 23.5％ in 2015.Conclusions The isolation rate of non-fermentative bacteria was high and the drug resistance situation was serious.Therefore,it is important to grasp the knowledge regarding distribution characteristics,drug resistance and variation of non-fermentative bacteria in ICU.It is not only beneficial for both rational use of antibiotics,improve efficacy but also helpful in reducing the emergence of drug resistance stains.

Objective: To study the effect of doxofylline on acute exacerbation of chronic obstructive pulmonary disease (COPD) and reduce the risk of early recurrence. Methods: From January 2016 to January 2018, 164 patients with acute exacerbation of COPD in Binzhou Central Hospital were randomly divided into two groups by random digital table: control group (n=82) and observation group (n=82). The control group was given tiotropium bromide and budesonide/formoterol.The observation group was treated with oral doxophylline bid for 8 weeks on the basis of inhaled drugs.The recovery time, acute exacerbation rate, FEV₁, CAT score and 6-minute walking test were compared between the two groups. Results: The time of convalescent stage in the observation group was shorter than that in the control group[(16.89±5.15)d vs.(19.12±6.29)d, t=2.48, P=0.014], and the acute exacerbation rate of the observation group was lower than that of the control group (26.83% vs.41.46%, χ²=4.58, P=0.032). There was no statistically significant difference in FEV₁[(45.59±9.82)% vs.(44.26±9.03)%, t=0.90, P=0.369], and the CAT score of the observation group was better than that of the control group [(19.32±6.16)points vs.(21.71±6.62)points, t=2.39, P=0.018]. The 6-minute walking distance of the observation group was longer than that of the control group[(146.32±10.20)m vs.(135.69±11.59)m, t=6.23, P=0.000], and the finger pulse oxygen of the observation group was higher than that of the control group[(94.12±5.09)% vs.(92.06±6.21)%, t=2.23, P=0.026]. The respiratory rate in the observation group was slower than that in the control group[(20.38±7.32)times/min vs.(22.86±6.53)times/min, t=2.29, P=0.023], and there was no statistically significant difference in heart rate[(98.24±12.35)bpm vs.(101.38±15.03)bpm, t=1.46, P=0.146]. No serious adverse drug reactions were found in both two groups. Conclusion As a beneficial supplement of inhaled drugs in convalescent COPD, doxofylline can shorten the recovery time, reduce the early acute exacerbation rate and improve the symptoms, which is worthy of clinical reference.

Objective To explore the variation and clinical value of the degradation of endothelial glycocalyx in the patients with septic shock. Methods A prospective case control study was conducted. Patients of 18 years or older diagnosed with septic shock and admitted to Department of Critical Care Medicine of Affiliated Hospital of Binzhou Medical University from June 2014 to May 2015 were enrolled. The levels of degradation products, including hyaluronic acid (HA) and heparin sulfate (HS), at 0, 6, 12, 24, 48 hours were determined, while 20 healthy people were enrolled and served as controls. The changes of HA and HS were analyzed in the patients with septic shock. The differences of HA and HS between survival group and death group after 28 days were also analyzed. The relationships between HA, HS and tumor necrosis factor-α (TNF-α), sequential organ failure assessment (SOFA) score, arterial blood lactate (Lac), platelet, albumin were analyzed by Pearson correlation analysis. The receiver-operating characteristic (ROC) curve was plotted to assess the prognostic value of HA and HS for patients with septic shock. Results Thirty-one patients diagnosed as septic shock were enrolled, among whom 17 patients died after 28 days, with a mortality of 54.8%. The levels of HA and HS in patients with septic shock were increased significantly as compared with those of health control group, peaked at 48 hours, and the levels of HA and HS at 48 hours were significantly higher than those at 0 hour [HA (μg/L): 119.47±32.44 vs. 94.84±23.63, HS (μg/L): 72.83±19.03 vs. 58.83±16.63, both P < 0.05]. The levels of HA and HS at 0 hour and 48 hours in death group were significantly higher than those of the survival group [HA (μg/L): 130.42±27.67 vs. 93.29±29.80, 105.14±19.18 vs. 70.82±13.24; HS (μg/L): 67.23±25.01 vs. 39.23±14.58, 79.74±19.84 vs. 56.17±14.53, all P < 0.05]. The levels of HA and HS in patients with septic shock were remarkably positively correlated with the levels of TNF-α, SOFA score, Lac, and platelet, but were remarkably negatively correlated with albumin levels (r value of HA was 0.595, 0.462, 0.545, 0.466, -0.534, respectively; r value of HS was 0.607, 0.468, 0.563, 0.547, -0.455, respectively; all P < 0.05). It was demonstrated by ROC curves that the areas under ROC curve (AUC) of HA and HS at 0 hour and 48 hours for predicting the prognosis of patients with septic shock were 0.881, 0.940 and 0.833, 0.821, respectively, the sensitivities of HA and HS were 87.5%, 100.0% and 83.3%, 81.3%, respectively, and the specificities of HA and HS were 82.6%, 78.3% and 91.3%, 78.3%, respectively. Conclusions The concentrations of degradation products generated by endothelial glycocalyx in the blood of the patients with septic shock are remarkably increased. The elevated levels of the degradation products are closely associated with the severity of septic shock, microcirculation disturbance, and the levels of inflammatory factors.