Objective To analyze morbility，risk factors，etiology，treatment and outcome of nosocomial pulmonary fungal infections in respiratory intensive care unit（RICU）.Methods Forty-seven respiratory RICU patients with nosocomial pulmonary fungal infections between July 2000 and June 2005 were retrospectively analyzed.Results All of the 47 cases were clinically diagnosed as probable nosocomial pulmonary fungal infections，with the morbidity of 10.8% significantly higher than general wards（1.8%，Plt;0.005）.COPD and bacterial pneumonia were the major underlying diseases of respiratory system with a percent of 38.30% and 36.17%，respectively.Forty-one patients (87.2%) had risk factors for fungal infections.Compared with general wards，the proportion of Aspergillosis was higher in RICU without significant difference (Pgt;0.1)；the proportions of Candida glabrata and Candida tropicalis were higher too，but that of Candida krusei was relatively low.The effective rate of antifungal treatment was 79.1% and fluconazol was the most common used antifungal agents.The mortality of fungal infection in RICU was higher than that of general wards but without significant difference（Pgt;0.1）.Conclusion The morbidity of nosocomial pulmonary fungal infection in respiratory RICU is higher than that in general wards.The proportions of infection caused by Aspergilli and some Candida resistant to fluconazol is relatively high.Early and effective treatment is needed in these patients considering the poor prognosis.
Objective To investigate the antibiotic resistance distribution and profiles of multidrug resistant bacteria in respiratory intensive care unit ( RICU) , and to analyze the related risk factors for multidrug resistant bacterial infections. Methods Pathogens from79 patients in RICU from April 2008 to May 2009 were analyzed retrospectively. Meanwhile the risk factors were analyzed by multi-factor logistic analysis among three groups of patients with non-multidrug, multidrug and pandrug-resistant bacterialinfection. Results The top three in 129 isolated pathogenic bacteria were Pseudomonas aeruginosa ( 24. 0% ) , Staphylococcus aureus( 22. 5% ) , and Acinetobacter baumannii( 15. 5% ) . The top three in 76 isolated multidrug-resistant bacteria were Staphylococcus aureus ( 38. 9% ) , Pseudomonas aeruginosa ( 25. 0% ) , and Acinetobacter baumannii( 19. 4% ) . And the two main strains in 29 isolated pandrug-resistant bacteria were Pseudomonas aeruginosa ( 48. 3% ) and Acinetobacter baumannii ( 44. 8% ) . Multi-factor logistic analysis revealed that the frequency of admition to RICU, the use of carbapenem antibiotics, the time of mechanical ventilation, the time of urethral catheterization, and complicated diabetes mellitus were independent risk factors for multidrug-resistant bacterial infection( all P lt; 0. 05) . Conclusions There is a high frequency of multidrug-resistant bacterial infection in RICU. Frequency of admition in RICU, use of carbapenem antibiotics, time of mechanical ventilation, time of urethral catheterization, and complicated diabetes mellitus were closely related withmultidrug-resistant bacterial infection.
Objective To evaluate the clinical features and complications of bedside tracheal intubation in intensive care unit ( ICU) , and explore the suitable strategy of intubation. Methods In this retrospective study,42 patients who underwent bedside tracheal intubation in ICU during September 2008 and March 2009 were divided into a schedule group ( n =24) and an emergency group ( n =18) . The time to successful intubation, number of intubation attempts, and complications were recorded. The schedule group was defined as those with indications for intubation and fully prepared, while the emergency group was defined as those undergoing emergency intubations without full preparation due to rapid progression of disease and accidental extubation. Results The success rate for all patients was only 57. 1% on the first attempt ofintubation. The main complications during and after induction were hypotension ( 45. 2% ) and hypoxemia ( 50. 0% ) . Compared with the emergency group, the schedule group had fewer attempts to successful intubation ( 1. 71 ±1. 12 vs. 2. 67 ±1. 75) , higher success rate on the second attempt ( 87. 5% vs.61. 1%) , and lower ypoxemia incidence ( 29. 1% vs. 77. 8%, P lt; 0. 05) . Conclusions The tracheal intubation in ICU is a difficult and high risk procedure with obvious complications. Early recognition ofpatients with indications and well preparation are critical to successful bedside intubation.
Objective To investigate the species distribution and antibiotic resistance among the bloodstream infections in intensive care unit ( ICU) . Methods A retrospective analysis was performed to review the microbiological and susceptibility test data of all bloodstream infections in ICU from January 2004 to September 2009. The patterns of antibiotic resistance among the top five bacteria were compared. Results 89 cases of bloodstream infection were detected with 112 strains, including 55 Gram-positive ( G+ ) bacteria( 49. 1% ) , 55 Gram-negative ( G- ) bacteria ( 49. 1% ) , and 2 fungi ( 1. 8% ) . The main pathogens causing bloodstream infection were Burkholderia spp. ( 33, 29. 5% ) , S. epidermidis( 31, 27. 7% ) , Klebsiella pneumoniae ( 7, 6. 3% ) , S. aureus ( 7, 6. 3% ) , S. hominis ( 6, 5. 4% ) , Acinetobacter baumannii ( 6,5. 4% ) , Pseudomonas aeruginosa( 5, 4. 5% ) and S. haemolyticus( 5, 4. 5%) , suggesting that Burkholderia spp. was predominant pathogenic G- bacteria, and coagulase-negative staphylococcus was predominant G+ bacteria. The antibiotic resistance tests demonstrated that isolated G- bacillus was highly sensitive to carbopenem, while vancomycin-resistant G+ cocci were not found. Conclusions Within the latest 5 years,the prevalence of G+ bacteria infection is almost equivalent to G- bacteria in blood stream infection.Coagulase-negative staphylococcus is the mainly G+ bacteria and Burkholderia spp. is predominant in G- bacteria. Carbopenemand glycopeptides still remain to be the first choice.
Objective To evaluate systematically the effectiveness and safety of procalcitonin ( PCT) -guided therapy in comparison with standard therapy in patients with suspected or confirmed severe bacterial infections in intensive care unit ( ICU) . Methods Five randomized controlled trials ( 927 patients) were included for statistical analysis by the cochrane collaboration′s RevMan5. 0 software. Results PCT-guided therapy was associated with a significant reduction in duration of antibiotic therapy [ MD =- 2. 01, 95% CI ( - 2. 37, - 1. 64) , P lt;0. 00001] , but the mortality [ OR =1. 11, 95% CI ( 0. 83, 1. 49) ,P =0. 47] and length of ICU stay[ MD = 0. 49, 95% CI( - 1. 44, 2. 42) , P = 0. 62] were not significantly different. Conclusions An algorithmbased on serial PCT measurements would allow a more judicious use of antibiotics than currently traditional treatment of patients with severe infections in ICU. It can reduce the use of antibiotics and appears to be safe.