Objective To understand antimicrobial resistance and therapeutic efficacy of imipenem/cilastatin and meropenem for treatment of multidrug-resistant Pseudomonas aeruginosa (MDRPA)from patients with mechanical ventilation.Methods From January 2010 to December 2015,78 patients with mechanical ventilation and isolated MDRPA from sputum cultures were selected and divided into imipenem/cilastatin (n=44)and meropenem(n=34) treatment groups,basic condition,time of emergence of drug resistance,and therapeutic efficacy of antimicrobial agents between two groups were compared.Results The basic data of two groups were comparable,before treat-ment by imipenem/cilastatin and meropenem,resistance rates of Pseudomonas aeruginosa (P .aeruginosa )to quinolones,ceftazidime,piperacillin,and amikacin were not significantly different (all P >0.05).After patients received antimicrobial agents for 6 days,difference in antimicrobial resistance between imipenem /cilastatin and meropenem treatment groups were not significantly different (22.73% vs 8.82%,P >0.05).On the 8th,10th,and 12th day of treatment,resistance rates of imipenem treatment group were 40.91%,77.27%,and 97.73%, respectively,which were all higher than meropenem treatment group (17.65%,32.35%,44.12%,respectively,all P <0.05).After the treatment with different antimicrobial agents,the average time for the emergence of resistance in imipenem/cilastatin and meropenem treatment group were 9.0 days and 13.5 days respectively.Therapeutic efficacy between two groups was not significantly different (64.71% vs 74.19%,P =0.41).Conclusion Compared with meropenem,imipenem/cilastatin shows higher risk for the emergence of drug resistance during therapy of P . aeruginosa infection in patients with mechanical ventilation,there is no significant difference in therapeutic efficacy between two groups of patients after 7 days of treatment.

Objective To evaluate the safety of pirfenidone in treatment of idiopathic pulmonary fibrosis( IPF). Methods PubMed,the Cochrane library,EMbase,CNKI,and WanFang database were searched using the keywords pirfenidone,idiopathic pulmonary fibrosis,and IPF from January 1999 to January 2015. Randomized controlled trials( RCTs)of pirfenidone in treatment of IPF were selected. The patients in the trial group were given pirfenidone alone while the patients in the control group were given oral placebo. The primary end point event of the outcome was the incidence of pirfenidone′s adverse events. The Meta-analysis was performed using RevMan 5. 2. Results A total of 4 articles including 5 RCTs were enrolled. There were 945 patients in the trial group and 766 patients in the control group. The incidents of many kinds of adverse events in the trial group were markedly higher than those in the control group, including gastrointestinal discomfort[12. 6%(101/804)vs. 5. 2%(40/766),RR = 2. 31,95% CI:63-3. 29,P< 0. 01],nausea[34. 6%(241/695)vs. 15. 0%(99/659),RR = 2. 373,95% CI:1. 92-2. 92,P< 0. 01]and vomiting[13. 3%(83/623)vs. 6. 3%(39/624),RR= 2. 13,95% CI:1. 48-3. 06,P< 0. 01],diarrhea[25. 8%(161/623)vs. 20. 4%(127/624),RR= 1. 27,95% CI:1. 03-1. 56,P=0. 02],anorexia[15. 2%(122/804)vs. 4. 7%(36/766),RR= 3. 10,95% CI:2. 16-4. 46,P<0. 01],abnormal liver function[6. 0%(49/804)vs. 1. 7%(13/766),RR= 2. 48,95% CI:1. 46-4. 23,P<0. 01],rash[30. 4%(189/623)vs. 10. 3%(64/624),RR= 2. 95,95% CI:2. 27-3. 83,P<0. 01],photosensitivity reaction[24. 7%(129/526)vs. 6. 1%(30/489),RR= 5. 54,95%CI:1. 78-17. 30,P<0. 01],insomnia[10. 4%(65/623)vs. 6. 6%(41/624),RR=1. 59,95% CI:1. 09-2. 31,P= 0. 02],dizziness[16. 4%(120/732)vs. 9. 8%(72/731),RR=1. 67,95% CI:1. 27-2. 19,P<0. 01],fatigue[25. 6%(178/695)vs. 16. 3%(108/659),RR = 1. 60,95% CI:1. 29-1. 98,P< 0. 01],and weight loss[10. 1%(63/623)vs. 5. 4%(34/624),RR= 1. 85,95% CI:1. 24-2. 77,P = 0. 03]. However,there was no statistically significant difference in treatment-related serious events[26. 5%(165/623)vs. 26. 4%(165/624),RR = 1. 00,95% CI:0. 83-1. 20,P = 0. 94]. Compared with the control group,there was a statistical significance in the rate of drug withdrawal in the trial group[14. 6%( 117/804 ) vs. 9. 0%( 69/766 ),RR = 1. 62,95% CI:1. 22-2. 15,P <0. 01 ). Conclusion The common adverse events of pirfenidone are gastrointestinal,skin,and neurological system damage and fatigue and loss of weight. The adverse events are mild and mostly recoverable without obvious sequelae. The pirfenidone is safe and well-tolerated.

Objective To evaluate the safety of pirfenidone in treatment of idiopathic pulmonary fibrosis( IPF). Methods PubMed,the Cochrane library,EMbase,CNKI,and WanFang database were searched using the keywords pirfenidone,idiopathic pulmonary fibrosis,and IPF from January 1999 to January 2015. Randomized controlled trials( RCTs)of pirfenidone in treatment of IPF were selected. The patients in the trial group were given pirfenidone alone while the patients in the control group were given oral placebo. The primary end point event of the outcome was the incidence of pirfenidone′s adverse events. The Meta-analysis was performed using RevMan 5. 2. Results A total of 4 articles including 5 RCTs were enrolled. There were 945 patients in the trial group and 766 patients in the control group. The incidents of many kinds of adverse events in the trial group were markedly higher than those in the control group, including gastrointestinal discomfort[12. 6%(101/804)vs. 5. 2%(40/766),RR = 2. 31,95% CI:63-3. 29,P< 0. 01],nausea[34. 6%(241/695)vs. 15. 0%(99/659),RR = 2. 373,95% CI:1. 92-2. 92,P< 0. 01]and vomiting[13. 3%(83/623)vs. 6. 3%(39/624),RR= 2. 13,95% CI:1. 48-3. 06,P< 0. 01],diarrhea[25. 8%(161/623)vs. 20. 4%(127/624),RR= 1. 27,95% CI:1. 03-1. 56,P=0. 02],anorexia[15. 2%(122/804)vs. 4. 7%(36/766),RR= 3. 10,95% CI:2. 16-4. 46,P<0. 01],abnormal liver function[6. 0%(49/804)vs. 1. 7%(13/766),RR= 2. 48,95% CI:1. 46-4. 23,P<0. 01],rash[30. 4%(189/623)vs. 10. 3%(64/624),RR= 2. 95,95% CI:2. 27-3. 83,P<0. 01],photosensitivity reaction[24. 7%(129/526)vs. 6. 1%(30/489),RR= 5. 54,95%CI:1. 78-17. 30,P<0. 01],insomnia[10. 4%(65/623)vs. 6. 6%(41/624),RR=1. 59,95% CI:1. 09-2. 31,P= 0. 02],dizziness[16. 4%(120/732)vs. 9. 8%(72/731),RR=1. 67,95% CI:1. 27-2. 19,P<0. 01],fatigue[25. 6%(178/695)vs. 16. 3%(108/659),RR = 1. 60,95% CI:1. 29-1. 98,P< 0. 01],and weight loss[10. 1%(63/623)vs. 5. 4%(34/624),RR= 1. 85,95% CI:1. 24-2. 77,P = 0. 03]. However,there was no statistically significant difference in treatment-related serious events[26. 5%(165/623)vs. 26. 4%(165/624),RR = 1. 00,95% CI:0. 83-1. 20,P = 0. 94]. Compared with the control group,there was a statistical significance in the rate of drug withdrawal in the trial group[14. 6%( 117/804 ) vs. 9. 0%( 69/766 ),RR = 1. 62,95% CI:1. 22-2. 15,P <0. 01 ). Conclusion The common adverse events of pirfenidone are gastrointestinal,skin,and neurological system damage and fatigue and loss of weight. The adverse events are mild and mostly recoverable without obvious sequelae. The pirfenidone is safe and well-tolerated.