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Objective To compare the value of presepsin,procalcitonin (PCT) and C-reactive protein (CRP) in differentiating different types of pathogenic bacteria in septic patients.Methods A prospective study was conducted to collect 322 septic patients who met the diagnostic criteria of "sepsis 3.0"in the Emergency ICU of the First Affiliated Hospital of Dalian Medical University from July 2016 to January 2018.According to the results of blood culture,patients were divided into the positive blood culture group (n=114) and negative blood culture group (n=208).Patients in the positive blood culture group were further divided into four subgroups:Gram-positive coccus (G+),Gram-negative bacilli (G-),mixed bacteria,and fungi groups.Healthy volunteers were selected as the control group (n=45).The differences in presepsin,PCT and CRP levels were compared among the groups,and the curves of the subjects' working characteristic curve (ROC) were drawn.Results Presepsin,PCT,and CRP were significantly increased in the positive blood culture and negative blood culture groups compared with the control group (all P＜0.05);Presepsin and PCT were significantly higher in the positive blood culture group than those in the negative blood culture group (both P＜0.05).There was no significant difference in Presepsin among the four subgroups in the positive blood culture group (all P＞0.05),but PCT was significantly higher in the G-and mixed bacteria groups than that in the G+ and fungi groups (all P＜0.05).Presepsin predicted a positive blood culture with area under ROC curve of 0.680,which was higher than PCT (AUC=0.599).Conclusions Presepsin is more valuable than PCT in early predicting positive blood culture in septic patients,but only PCT has an ability to differentiate pathogenic bacteria in septic patients with positive blood culture.It suggested that a combination of Presepsin and PCT should be more meaningful in clinical practice.
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Objective To investigate the diagnostic value of combined detection of procalcitonin (PCT), C-reactive protein (CRP), white blood cell (WBC), and neutrophil percentage (NEU%) in bloodstream infection with gram-positive coccus(G+), gram-negative bacillus (G-)and fungus.Methods Detection results of positive blood culture of 389 patients in a hospital between January 2014 and December 2015 were analyzed retrospectively, according to the results of blood culture, patients were divided into G+ coccus, G-bacillus and fungal bloodstream infection groups, inflammatory indicators of different groups of patients were compared.Results Mann-Whitney U test revealed that PCT level of G-infection group was higher than that of G+ and fungal infection group (comparison between G-infection group and G+ infection group : Z=-2.68,P<0.01;comparison between G-infection group and fungal infection group: Z=-2.46,P<0.05).If PCT≥0.5 ng/mL, CRP≥5.0 mg/L, NEU%≥70% and WBC≥10×109/L were as the cut-off point, statistical analysis revealed the positive rate of PCT in G-infection group was higher than that in G+ and fungal infection group(comparison between G-infection group and G+ infection group:χ2=5.94,P<0.05;comparison between G-infection group and fungal infection group:χ2=7.721,P<0.01);the positive rate of CRP in G-infection group was higher than that in G+ infection group (χ2=5.03,P<0.05).Binary logistic regression was adopted to analyze the efficacy of four indicators for the differentiation of bloodstream infection caused by G+ coccus, G-bacillus, and fungus, only PCT had significant difference in the identification of bloodstream infection caused by G-bacillus, G+ coccus and fungus(P<0.01).Conclusion PCT has high accuracy in differentiating G-bacillus, G+ coccus, and fungus of blood culture, dynamic monitoring of PCT combined with detection results of CRP, WBC, and NEU%, patient's condition can be judged rapidly, and antimicrobial agents can be used rationally, so the mortality of patients with bloodstream infection can be reduced.
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Objective To evaluate the efficacy and safety of linezolid in the treatment of gram-positive coccus in-fection in the elderly.Methods Clinical data of patients (>60 years old)infected with gram-positive coccus and treated with linezolid for 10 days between January 2013 and December 2014 were collected,the therapeutic efficacy of linezolid were analyzed,laboratory indexes before and 14 days after linezolid treatment were compared,possible adverse effects were analyzed.Results A total of 70 old patients were enrolled,the majority of patients were infec-ted in lower respiratory tract (62.86%)and were infected with Staphylococcus aureus (42.86%,of which 19 were MRSA),more than 80% of the patients were >70 years old,had length of stay > 30 days,and admitted in ICU, more than 70% of the patients were with deep venous catheterization and indwelling urinary catheterization.Platelet count (PLT)after 14 days of linezolid treatment was significantly lower than before treatment([132.00±45.00]× 109/L vs [156.00±78.00]×109/L,P =0.009);the total therapeutic efficacy of linezolid was 81 .43%(57/70), while the rate of adverse effects was 17.14% (12/70).Conclusion Linezolid is effective for treatment of gram-posi-tive coccus infection in the elderly,and may be a good choice of empirical treatment.PLT should be intensively mo-nitored during the process of linezolid therapy.
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Objective To analyze the relationship between plasma concentration and efficacy , adverse drug reactions by monitoring vancomycin serum concentrations for appropriately treating the infections caused by methicillin‐resistant Staphylococcus aureus or other gram‐positive cocci .Methods Vancomycin concentration was monitored in the patients with indications for vancomycin therapy .Blood sample was taken after vancomycin was administered for at least 4 doses .The blood sample collected within 30 minutes before dosing was used to determine the trough blood concentration .The samples were taken within 30 minutes to 1 hour after infusion of vancomycin were used to estimate the peak concentration by fluorescence polarization immunoassay .The clinical data were collected at the same time to analyze clinical efficacy and safety .Results Vancomycin trough concentration ranged from 3 .22 mg/L to 50 .79 mg/L in 25 patients ,specifically ,＜ 5 mg/L in 3 cases ,5‐＜10 mg/L in 11 cases ,10‐15 mg/L in 3 cases ,and > 15 mg/L in 8 csaes .Peak concentration ranged from 13 .57 mg/L to 60 .47 mg/L ,specifically ,＜ 25 mg/L in 14 cases ,25‐40 mg/L in 7 cases ,and > 40 mg/L in 4 cases .The infection was cured in 80 .0% (20/25) of the patients .The gram‐positive cocci were eradicated in 87 .5% (21/24) of the patients .The dosage of vancomycin was adjusted in 13 patients according to the results of blood concentration monitoring .Majority of these patients (12/13 ,92 .3% ) were cured .Renal impairment was observed in 4 patients .Conclusions Vancomycin is safe and effective in treatment of methicillin‐resistant Staphylococcus aureus and other gram‐positive bacterial infections . Vacomycin concentration varies from person to person . Serum concentration monitoring is required to achieve best outcomes and the goal of individualized treatment of vancomycin.
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OBJECTIVE To investigate the distribution and resistance of clinical isolates to antimicrobial agents commonly used.Antimicrobial agents should be used rationally based on the results of susceptibility testing.METHODS The clinical isolates were identified with W/A-40 or VITEK-32.The results were analyzed by WHONET 5.3 software according to CLSI 2005.RESULTS A total of 2892 clinical isolates were collected in 2007.Gram-negative bacilli accounted for 68.2% and Gram-positive cocci accounted for 31.8%.The top eight pathogens were Pseudomonas aeruginosa,Escherichia coli,Klebsiella spp,Acinetobacter spp,coagulase-negative Staphylococcus,Enterobacter spp,Serratia spp and S.aureus.About 76.4% of S.aureus isolates were MRSA,81.6% of coagulase-negative Staphylococcus isolates were meticillin-resistant.Under 20.0% of Enterobacteriaceae strains were resistant to cefoperazone/sulbactam,imipenem and piperacillin/tazobactam.About 16.3% and 32.5% of P.aeruginosa isolates were resistant to cefoperazone/sulbactam and imipenem.CONCLUSIONS Gram-negative bacilli were dominant isolates in our hospital during 2007.P.aeruginosa is the most frequent pathogenwith severe antibiotic resistance.Enterobacteriaceae are susceptible to cefoperazone/sulbactam and imipenem.