Factores de riesgo de las infecciones nosocomiales en pacientes que reciben oxigenación por membrana extracorpórea / Risk factors for nosocomial infections in patients receiving extracorporeal membrane oxygenation supportive therapy

Antecedentes y objetivo: El objetivo de este estudio fue analizar los factores de riesgo de la infección nosocomial (IN) en pacientes que reciben soporte de extracorporeal membrane oxygenation (ECMO, «oxigenación por membrana extracorpórea»). Pacientes y métodos: Se recolectaron los datos clínicos de las IN de los pacientes que recibieron tratamiento de soporte ECMO, analizándose retrospectivamente. Resultados: Entre los 75 pacientes con ECMO, se encontró que 20 habían desarrollado IN (tasa de infección del 26,7%), aislándose un total de 58 patógenos, incluyendo 43 cepas de bacterias gramnegativas (74,1%) y 15 cepas de bacterias grampositivas (25,9%). Las cepas resistentes a múltiples fármacos se hallaban altamente concentradas, componiéndose principalmente de Acinetobacter baumannii, Pseudomonas aeruginosa y estafilococos coagulasa negativos. La incidencia de IN se relacionó con la duración del tratamiento de soporte ECMO y la estancia hospitalaria total, siendo las diferencias estadísticamente significativas (p<0,05). Un período prolongado de soporte ECMO ampliaba la estancia hospitalaria, aunque no incrementaba la tasa de mortalidad. Sin embargo, la elevación del nivel de ácido láctico incrementaba la tasa de mortalidad en esta población de estudio. Conclusiones: Las IN secundarias asociadas a ECMO guardaron una correlación considerable con la duración de la estancia hospitalaria y la duración del soporte ECMO. Por tanto, para reducir la incidencia de las IN asociadas a ECMO, deberán aplicarse estrategias en aras de reducir la duración del tratamiento de soporte ECMO y evitar la hospitalización prolongada, cuando ello sea posible (AU)

Background and objective: The aim of this study was to analyze risk factors for nosocomial infection (NI) in patients receiving extracorporeal membrane oxygenation (ECMO) support. Patients and methods: Clinical NI data were collected from patients who received ECMO support therapy, and analyzed retrospectively. Results: Among 75 ECMO patients, 20 were found to have developed NI (infection rate 26.7%); a total of 58 pathogens were isolated, including 43 strains of gram-negative bacteria (74.1%) and 15 strains of gram-positive bacteria (25.9%). Multi-drug resistant strains were highly concentrated and were mainly shown to be Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Incidence of NI was related to the duration of ECMO support therapy and the total length of hospital stay, and the differences were statistically significant (P<.05). A prolonged period of ECMO support extended the hospital stay, but it did not increase the mortality rate. However, an elevated level of lactic acid increased the mortality rate in this study population. Conclusions: ECMO-associated secondary NIs correlated significantly with the length of hospital stay and with the duration of ECMO support. Therefore, to reduce the incidence of ECMO-associated NIs, preventive strategies that aim to shorten the duration of ECMO support therapy and avoid lengthy hospitalization should be applied, wherever possible (AU)

Effect of garlic supplement in the management of type 2 diabetes mellitus (T2DM): a meta-analysis of randomized controlled trials.

The present study was designed to systematically evaluate the clinical efficacy and safety of garlic supplement in the management of type 2 diabetes mellitus (T2DM). PubMed, EMBASE, the Cochrane Library, and China National Knowledge Internet (CNKI) were searched for relevant randomized controlled trials (RCTs) by using the terms garlic and T2DM up to April 2017. The quality of included RCTs was assessed by the Cochrane tool of risk of bias, and data of outcomes were pooled by REVMAN 5.3. Clinical factors were handled by meta-regression and subgroup analysis, and risk of publication bias was explored by inverted funnel plots. Nine RCTs involving 768 T2DM patients were included in the meta-analysis, and the dose of daily garlic (allicin) supplement ranged from 0.05g to 1.5g. A significant reduction in the level of fasting blood glucose in 1-2 weeks [SMD = -1.61, 95%CI (-2.89, -0.32)], 3-4 weeks [SMD = -2.87, 95%CI (-4.74, -1.00)], 12 weeks [SMD = -9.57, 95%CI (-12.39, -6.75)], and 24 weeks [SMD = -21.02, 95%CI (-32.47, -9.57)] was achieved in favour of the garlic group rather than the control group. Significantly decreased fructosamine and glycated hemoglobin (both in 12 and 24 weeks) were also found in garlic group. Meanwhile, significantly improved blood liquids of total cholesterol [SMD = -1.93, 95%CI (-2.98, -0.87), 3-4 weeks], high density lipoprotein [SMD = -0.41, 95%CI (-0.83, -0.00), 3-4 weeks] and low density lipoprotein [SMD = -3.47, 95%CI (-5.76, -1.18), 12 weeks] were confirmed after garlic administration. There was no significant difference in complications. Current data confirms that garlic supplement plays positive and sustained roles in blood glucose, total cholesterol, and high/low density lipoprotein regulation in the management of T2DM. Abbreviations: T2DM = type 2 diabetes mellitus; RCT = randomized controlled trial; SMD = standard mean difference; CI = confidence interval; FBG = fasting blood glucose; HbA1c = glycated hemoglobin; HDL = high density lipoprotein; LDL = low density lipoprotein.

Risk factors for nosocomial infections in patients receiving extracorporeal membrane oxygenation supportive therapy. / Factores de riesgo de las infecciones nosocomiales en pacientes que reciben oxigenación por membrana extracorpórea.

BACKGROUND AND OBJECTIVE: The aim of this study was to analyze risk factors for nosocomial infection (NI) in patients receiving extracorporeal membrane oxygenation (ECMO) support. PATIENTS AND METHODS: Clinical NI data were collected from patients who received ECMO support therapy, and analyzed retrospectively. RESULTS: Among 75 ECMO patients, 20 were found to have developed NI (infection rate 26.7%); a total of 58 pathogens were isolated, including 43 strains of gram-negative bacteria (74.1%) and 15 strains of gram-positive bacteria (25.9%). Multi-drug resistant strains were highly concentrated and were mainly shown to be Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Incidence of NI was related to the duration of ECMO support therapy and the total length of hospital stay, and the differences were statistically significant (P<.05). A prolonged period of ECMO support extended the hospital stay, but it did not increase the mortality rate. However, an elevated level of lactic acid increased the mortality rate in this study population. CONCLUSIONS: ECMO-associated secondary NIs correlated significantly with the length of hospital stay and with the duration of ECMO support. Therefore, to reduce the incidence of ECMO-associated NIs, preventive strategies that aim to shorten the duration of ECMO support therapy and avoid lengthy hospitalization should be applied, wherever possible.

Utility of multiple-locus variant-repeat analysis method for the outbreak of the Pseudomonas aeruginosa isolates.

BACKGROUND: Pseudomonas aeruginosa (P. aeruginosa) predominated in hospitals. METHODS: In order to determine the source of the outbreak and take effective measures to prevent the spread, we tested their relationships between the strains. 97 P. aeruginosa samples were analyzed by multiple-locus variable-number tandem repeat (VNTR) analysis (MLVA) method. In order to identify a minimal subset that could provide high discrimination, we evaluated the ability of various VNTR sets. RESULTS: The result showed all of the 11 loci displayed high discrimination, and the lowest loci was ms223 (h = 0.59). The 97 strains were all discriminated (HGDI = 1.0000). The top 7-locus set produced a HGDI value of 1.0000, which was the same as the 11-locus set. The 4-locus set had a HGDI value of 0.9972 with a clustering rate of 11.3%. The strains were divided into four groups based on the phylogenetic clustering and genotypic characteristics. There were obvious differences among the four groups regarding the drug-resistance patterns of Imipenem, Ciprofloxacin, Ceftazidime, Levofloxacin, Meropenem, Piperacillin, Cefepime, Aztreonam (p < 0.05). CONCLUSIONS: In conclusion, the transmission of the strains was not found in this study. The 7-locus set yielded a high discrimination, while for an easier and more robust MLVA scheme, the number of markers can be reduced to 4 loci of ms212, ms211, ms213, and ms142. These four strains from four inpatients in the same ward displayed the same drug resistance spectrum. The MLVA genotype results showed the four strains had the same gene structures. The four patients were from the same treatment group. They showed the IMP-1 allele and belonged to the aac (6')-I type, and there was a deletion of the OprD2 gene in four strains, supporting the MLVA results in suggesting that they are similar.

Analytical performances and heart failure research of the BNP and NT-proBNP assays on the Cobas E601 and ADVIA Centaur.

BACKGROUND: The analytical performances of the NT-proBNP and BNP assays on the Cobas E601 and ADVIA Centaur were thoroughly evaluated. In addition, the values of BNP and NT-proBNP, which are heart failure markers, were compared in the diagnosis of HF patients with or without acute cerebral infarction since they could also be elevated in ischemic stroke. METHODS: Clinical and Laboratory Standards Institute (CLSI) documents were employed in the analytical evaluation of NT-proBNP and BNP assays on the Cobas E601 and ADVIA Centaur. Then 100 heart failure patients and 103 cerebral infarction complicated with heart failure patients, who had been diagnosed by clinical doctors blinded to NT-proBNP and BNP concentrations, were chosen to compare their values in the diagnosis of heart failure with or without acute cerebral infarction. RESULTS: The NT-proBNP and BNP methods are precise and accurate (total CV < 2.9%, deviation < 3.6%), have wide dynamic measuring ranges (8 pg/mL to 35 126 pg/mL and 2.0 pg/mL to 5094 pg/mL, respectively) with maximum dilutability of 1:2, and are free of common interferences. The most suitable sample types for NT-proBNP and BNP are serum and EDTA plasma, respectively, and both methods correlate well in simple-HF patients. Unlike BNP, the level of NT-proBNP is much higher in HF patients with acute cerebral infarction (p < 0.001). The Cobas E601 and ADVIA Centaur systems have good analytical performances. CONCLUSIONS: In HF patients with acute cerebral infarction, the NT-proBNP and BNP levels did not correlate and thus had implications for clinical diagnosis.