A comparison of linezolid with glycopeptides in severe MRSA pneumonia

Evaluation of: Luna CM, Bruno DA, García-Morato J et al. Effect of linezolid compared with glycopeptides in methicillin-resistant Staphylococcus aureus severe pneumonia in piglets. Chest 135(6), 1564–1571 (2009).

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a major pathogen in nosocomial infections and accounts for a large proportion of nosocomial pneumonia. However, there are limited antibiotics available for the treatment of this serious and potentially lethal infection. Until recently, the only effective antibiotic was vancomycin, but the oxazolidinones, such as linezolid, have been shown to be a valuable addition to the arsenal of antimicrobial agents that can be used for MRSA pneumonia. Clinical trials have been conducted to compare vancomycin and linezolid head-to-head in pneumonia and, in post hoc subgroup analyses, showed that linezolid use was associated with improved survival. The ensuing debate over these results was dominated by two opinions; there were those who speculated on the mechanism by which linezolid achieved this benefit, namely attributing it to pharmacodynamics and pharmacokinetics, and others who criticized the methodology of the studies and questioned the validity of the results altogether. This study by Luna and colleagues was designed with several goals in mind. The first was to attempt to generate an animal model of MRSA pneumonia in piglets by duplicating techniques used in animal models of Gram-negative pneumonia. Then they studied the effect of three antibiotics (vancomycin, linezolid and teicoplanin) on outcomes in the same model, while simultaneously measuring antibiotic levels in the serum, bronchoalveolar lavage fluid and lung tissue, in an attempt to attribute differences in survival to pharmacological properties of the drugs used. Their results showed a survival benefit only for linezolid, despite the fact that all three antibiotics had levels above MIC in all the compartments sampled, leading them to speculate that linezolid may have improved outcomes by mechanisms not directly related to its antimicrobial actions.     

Shortening the course of antibiotic treatment in the intensive care unit

Effective antimicrobial stewardship is an increasingly important concern for healthcare providers globally. Antibiotics are frequently prescribed for patients who develop sepsis in the intensive care unit and traditionally courses are prolonged, with uncertain benefit and probable harm. There is little evidence to support many guidelines recommending between 10 and 14 days, and a number of studies suggest substantially shorter courses of less than 7 days may suffice. Safely reducing course length is likely to depend on a number of preconditions, including thorough eradication of any septic foci; optimization of serum antibiotic concentrations, particularly when there is physiological derangement; and use of novel biomarkers such as procalcitonin. The critical care environment is well suited to this aim as patients are closely monitored. With these measures in place, it is reasonable to believe short antibiotic courses can safely be used for the majority of intensive care infections.     

Hospice Volunteer Programs: A Proposed Agenda

With the expansion of hospice services, volunteers are being increasingly used to provide emotional, spiritual, and tangible support to the terminally ill and their significant others. Unfortunately, little has been published about the experiences of hospice volunteers. In this paper, we (1) propose a timely agenda for the development and refinement of hospice volunteer programs; (2) outline basic program criteria about which there is emerging consensus; (3) delineate pertinent issues in the screening, training, and job performance of hospice volunteers; and (4) indicate how the implementation of formal program regulations and operations and program evaluation may benefit service recipients and institutional providers.     

血清VA、PCT、Hb水平与急性期肺炎患儿病情严重程度的相关性分析

目的 分析血清维生素A(VA)、降钙素原(PCT)、血红蛋白(Hb)水平与急性期肺炎患儿病情严重程度的相关性.方法 回顾性收集2018年7月至2019年6月在我院就诊的急性期肺炎患儿临床资料83例,根据患儿的病情严重程度分为轻度组(n=33)、中度组(n=29)、重度组(n=21),收集同期于我院体检的正常儿童资料24...     

老年人肺癌并发院内获得性肺炎的临床研究

目的为探讨老年人肺癌院内获得性肺炎的临床特点、病原菌及耐药情况,为临床提供依据。方法分析72例老年人肺癌并发院内获得性肺炎的临床资料。结果老年人肺癌平均住院日期延长,化疗时不合理使用抗菌药物,发生院内获得性肺炎的机会最大。主要病原菌为G~-杆菌占80.70％,其中以铜绿假单胞菌、肺炎克雷伯氏菌为主,其次为表皮葡萄球菌占10.53％。病原菌对氨苄青霉素、哌拉西林、头孢菌素耐药性增加,对亚胺培南、万古霉素、阿米卡星敏感。病死率达30.56％。结论老年人肺癌免疫功能低下,住院日期延长,不合理使用抗生素是造成院内感染的主要因素。病原菌的耐药率呈增加趋势,病死率较高。     

重症监护室呼吸机相关性肺炎独立危险因素分析及护理对策

目的：探讨重症监护室患者呼吸机相关性肺炎（ VAP ）的独立危险因素,寻找相应的护理干预措施。方法：回顾性分析重症监护室120例机械通气患者的临床资料,根据发生VAP 与否分组,先行单因素分析筛选出有统计学意义的变量,再行Logistic回归逐步分析确定VAP 的独立危险因素,制定相应的护理措施。结果：发生VAP 与未发生VAP的患者单因素分析显示在插管方式、抑酸剂、机械通气时间、入住重症监护室时间、镇静评分、昏迷评分、使用激素和应用呼吸机前48h使用抗菌药物等比较,差异有统计学意义（ P＜0．05）。多因素分析只有抑酸剂、机械通气时间、昏迷评分及应用呼吸机前48h使用抗菌药物是重症监护室VAP发生的独立危险因素（ OR值分别为4．674、2．681、7．542和3．690）。结论：通过对重症监护室VAP 独立危险因素的分析,有利于制定科学的护理干预措施,为降低VAP的发生率奠定基础。     

低分子肝素治疗D-二聚体升高支原体肺炎的有效性分析

目的分析低分子肝素治疗D-二聚体升高支原体肺炎的有效性。方法选取我院2018年1～12月收治的64例D-二聚体升高支原体肺炎患儿作为研究对象,按照数字盲选法将其均分为两组(n=32),对照组采用常规治疗,观察组在常规治疗基础上给予低分子肝素,对比两组治疗效果。结果治疗后,观察组的血小板(PLT)、D-二聚体水平明显低于对照组(P0.05);观察组的发热时间、住院时间均短于对照组(P0.05);观察组治疗总有效率明显高于对照组(P0.05)。结论将低分子肝素应用于D-二聚体升高支原体肺炎患儿的治疗中,可有效改善患儿体内的凝血系统功能,缩短病情恢复时间,提高治疗效果,促进其病情恢复。     

儿童肺炎支原体肺炎临床特点及重症危险因素分析

目的:了解住院儿童肺炎支原体肺炎(MPP)的流行病学及临床特点,并分析儿童重症MPP的相关因素。方法: 收集2017年1月-2017年12月于天津医科大学第二医院儿科住院治疗的MPP患儿180例,进行回顾性分析。按病情严重程度分为重症组（SMPP组）73例、普通组（MPP组）107例进行比较,分析流行病学、临床特点以及SMPP相关因素。结果:（1）儿童MPP多以秋（84例,46.7%）、冬（56例,31.1%）季节为主。（2）SMPP组与MPP组比较,前者患病年龄大,发热时间长,影像学多表现为大片状实变影,住院时间偏长。（3）SMPP组与MPP组比较降钙素原（PCT）无差异,而外周血白细胞计数（WBC）、C-反应蛋白（CRP）、血清IgA、血清IgG、血清IgM、乳酸脱氢酶（LDH）和铁蛋白（SF）指标明显高于MPP组,差异有显著性。（4）二分类Logistic回归分析发现热程（OR=1.30,P=0.031）、CRP（OR=1.06,P=0.005）、LDH（OR=1.012,P= 0.001）及胸片大片状实变影（OR=11.57,P=0.000）共4个自变量为SMPP的独立相关因素。结论:儿童MPP多发生在秋冬季。SMPP多发生在学龄期,胸部影像学检查多表现为大片状实变影,WBC、CRP、LDH及SF等炎症指标升高明显,其中热程、CRP、LDH及影像学显示大片状实变影与病情严重程度有关。     

血清PCT与hs-CRP对新生儿细菌感染性肺炎的诊断价值

目的 比较血清降钙素原(PCT)和超敏C反应蛋白(hs-CRP)对新生儿细菌感染性肺炎的诊断价值.方法 选择2015年1月至2016年6月期间我院收治的新生儿肺炎90例为研究对象,根据病原体的不同分为细菌性肺炎组(n=46)与非细菌性肺炎组(n=44),比较两组患儿血清PCT和hs-CRP阳性率,以及细菌性肺炎患儿治疗后血清PCT和hs-CRP阳性率的变化.结果 细菌性肺炎组患儿的hs-CRP、PCT阳性率分别为71.74%、91.30%,明显高于非细菌性肺炎组患儿的18.18%和4.55%,差异均有统计学意义(P<0.05);细菌性肺炎患儿治疗1周后,PCT阳性率为32.61%,高于hs-CRP的13.04%,差异均有统计学意义(P<0.05);治疗2周后PCT和hs-CRP阳性率分别为4.35%和2.17%,差异无统计学意义(P>0.05).结论 血清PCT对于新生儿细菌性肺炎具有更好的诊断及鉴别诊断价值,且PCT有助于评估治疗效果并指导抗菌药物的应用.     

免疫功能变化在支原体肺炎感染患儿中的检测价值

目的 :探析支原体肺炎患儿感染后的免疫功能变化的临床价值.方法 :分析2014年10月~2016年10月在我院接受治疗的72例支原体肺炎感染患儿(观察组)的临床资料.另外选取同期在我院接受健康体检的72例健康儿童作为此次研究的对照组.比较两组儿童的一般资料、补体及免疫球蛋白水平、红细胞免疫水平及外周血T淋巴细胞亚群.结果 :两组患儿的一般资料无显著差异性.观察组患儿的血清IgA、IgM、IgG及补体C3、C4的表达水平均显著较对照组低,且急性期变化幅度较恢复期大.观察组患儿的免疫复合物花环率、C3b受体花环率及免疫黏附促进因子均显著较对照组低,而免疫黏附抑制因子则显著较对照组高,且急性期变化幅度较恢复期大.观察组患儿的CD3+、CD4+及CD4+/CD8+均显著较对照组低,而CD8+则明显较对照组高,且急性期变化幅度较恢复期大.结论 :支原体肺炎感染患儿的免疫功能相对处于低下状态,且对其免疫状态的调节可以有效改善患儿的疾病状态,值得推广.