[Clinical analysis of sepsis with extensively drug resistant Gram-negative bacteria in intensive care unit treated with polymyxin B-based combination therapy].

OBJECTIVE: To investigate the clinical efficacy and safety of polymyxin B in the treatment of sepsis caused by extensively-drug resistant (XDR) Gram-negative bacteria. METHODS: A retrospective analysis of 39 septic patients with XDR Gram-negative bacterial infection treated with polymyxin B in the department of critical care medicine of Xiangya Hospital of Central South University from June 2018 to September 2019 were enrolled. The clinical characteristics, bacterial culture, the sensitivity antibacterial drugs, types and courses of antibiotics, biochemical indexes, and acute physiology and chronic health evaluation II (APACHE II) before and after polymyxin B treatment were collected, to assess microbial clearance and efficacy, drug related adverse effects, and 28-day mortality in septic patients with XDR. RESULTS: Of the 39 septic patients with XDR, 32 (82.1%) were male, with the mean age of (53.6±12.6) years old. The main infection site was pulmonary infection (51.2%), and the treatment courses of polymyxin B were ≥ 5 days. A total of 66 pathogenic bacteria were detected from 39 patients. Among them, with the high estrate of detecting Acinetobacter baumannii of 51.5% (34/66). After treatment with polymyxin B, the results showed that the clearance rate of microorganisms was 65.2% (43/66), the overall effective rate was 59.0% (23/39), and the 28-day all-cause mortality was 41.0% (16/39). There were no significant differences in clinical efficacy and microbial clearance among patients with different treatment groups of polymyxin B [< 10 days, 10-15 days, and > 15 days groups: effective rates were 56.5% (13/23), 54.5% (6/11), 80.0% (4/5), χ 2 = 0.999, P = 0.728; the microbial clearance rates were 43.5% (10/23), 54.5% (6/11), and 80.0% (4/5), χ 2 = 2.141, P = 0.393]. The effective and microbial clearance rates of the polymyxin B daily doses of 150 mg and 200 mg groups were significantly higher than those of the daily dose of 100 mg [effectiveness: 85.7% (6/7), 87.5% (7/8) vs. 41.7% (10/24); microbial clearance rate: 71.4% (5/7), 87.5% (7/8) vs. 33.3% (8/24), all P < 0.05], however, there were no significant differences in the length of intensive care unit (ICU) stay and mechanical ventilation time among different daily dose groups. The APACHE II score after polymyxin B administration was significantly lower than before administration (all patients: 16.20±9.24 vs. 24.40±4.73, effective patients: 11.30±4.08 vs. 23.00±4.56, both P < 0.05). Four patients with renal injury had an increase in serum creatinine during the administration of polymyxin B, and recovered after discontinuation of the drug without other adverse reactions. CONCLUSIONS: Polymyxin B can be used as an effective treatment option for patients with severe infection of XDR Gram-negative bacteria.

[Efficacy observation of electroacupuncture intervention on severe acute pancreatitis at early stage complicated with intestinal paralysis].

OBJECTIVE: To explore the clinical efficacy of electroacupuncture intervention on severe acute pancreatitis (SAP) at early stage complicated with intestinal paralysis. METHODS: Sixty-eight cases of SAP were randomly divided into observation group (48 cases) and control group (20 cases). In observation group, according to the course of sickness, the early-stage subgroup (30 cases, hospitalized in 3 d) and late-stage subgroup (18 cases, hospitalized in 3-7 d) were subdivided. In control group, the conventional treatment was applied. In observation group, based on the same treatment as control group, electroacupuncture was supplemented at Zhongwan (CV 12), Zusanli (ST 36), Neiguan (PC 6), Hegu (LI 4), etc. Acute physiology and chronic health evaluation (APACHE) II scores, the recovery time of intestinal paralysis and laboratory indices, complications, operation transfer rate, death rate and the admission time were compared among groups after treatment. RESULTS: The total effective rate was 83.3% (25/30) in early-stage subgroup, which was superior to 72.2% (13/18) in late-stage subgroup and 65.0% (13/20) in control group (P < 0.05, P < 0.01). In early-stage subgroup, the remission time of abdominal pain, the remission time of abdominal distention, the recovery time of borborygums, the recovery time of gas discharge, and the recovery time of defecation were all shorter significantly than those in late-stage subgroup and control group (P < 0.05, P < 0.01). In early-stage subgroup, APACHE II scores, the recovery time of WBC and blood/uric amylase, complications, operation transfer rate, death rate and admission time were all lower remarkably than those in late-stage subgroup and control group (P < 0.05, P < 0.01); but, there were no statistical significant differences in comparison between late-stage subgroup and control group (all P > 0.05). CONCLUSION: The clinical efficacy of electroacupuncture intervention on SAP complicated with intestinal paralysis is superior remarkably to that of conventional treatment, and the efficacy of electroacupuncture intervention at early stage is better than that at late stage.