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  • 2022 Volume 19 Issue 7
    Published: 25 July 2022
      
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  • Research Progress in Protective Effect of Traditional Chinese Medicine Cortex Magnoliae Officinalis on Stomach and Its Pharmacological Mechanism
    ZHANG Ming-fa, SHEN Ya-qin
    2022, 19(7): 933-937. https://doi.org/10.13493/j.issn.1672-7878.2022.07-001
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    As a traditional Chinese medicine, cortex magnoliae officinalis has the effect of tonifying the stomach and intestines, such as promoting gastric emptying, contracting gastric smooth muscle, protecting gastric mucosa and preventing ulcer. The effect of promoting gastric emptying may be related to the inhibition of nitric oxide pathway and the regulation of secretion of motilin and gastrin, while the effect of contracting gastric smooth muscle may be achieved by increasing proliferation of Cajal interstitial cells and enhancing gastric electrical activity. This paper summarizes the protective effect of traditional Chinese medicine cortex magnoliae officinalis on stomach and its pharmacological mechanism, and analyzes related studies.
  • Research Progress in Neuraminidase Inhibitor Type Anti-influenza Drugs*1
    YUAN Ke-yang, LIAO Hong-mei, LI Dong-lin
    2022, 19(7): 938-942. https://doi.org/10.13493/j.issn.1672-7878.2022.07-002
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    Neuraminidase (NA) is one of important targets of anti-influenza drugs. The marketed neuraminidase inhibitors (NAIs) are all sialic acid derivatives with good activity, but have the disadvantages of many chiral centers in the structure and complicated synthesis. Virus mutations prompt people to develop new anti-influenza drugs. In recent years, many non-sialic acid NAIs have been discovered, either on the basis of pharmacophore or serendipitous discovery, or natural product development or virtual screening. In addition, the application of new technologies such as molecular blotting and network pharmacology has facilitated the research and development of new NAIs type anti-influenza drugs. This paper summarizes newly discovered non-sialic acid new NAIs and their development technologies, and analyzes related studies.
  • Analysis of Clinical Use of Vancomycin in Patients of Orthopedics Department in a Primary Traditional Chinese Medicine Hospital
    YANG Jing-jing, WANG Hai-feng
    2022, 19(7): 946-949. https://doi.org/10.13493/j.issn.1672-7878.2022.07-004
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    Objective: To analyze clinical use of vancomycin in patients of orthopedics department in a hospital, and to provide reference for the rational clinical use of vancomycin in the department. Methods: 41 patients who were admitted to the orthopedics department of Sihong Hospital of Traditional Chinese Medicine and treated with vancomycin from November 2018 to November 2020 were sellected as study subjects, and the gender and age distribution, pathogenic bacteria detection, vancomycin use and monitoring, and types of reasons for irrational drug use of the patients were analyzed. Results: Among 41 patients treated with vancomycin, there were more males than females (56.10% vs. 43.90%), more patients greater than 60-80 years old (21.95%) and fewer patients greater than 10-20 years old (12.20%), but the gender and age were generally distributed in balance. 35 of 41 patients had pathogenic bacteria culture, and 35 strains of pathogenic bacteria were detected in total. Among them, the main strains were Staphylococcus aureus (10 strains, accounting for 28.57%), Staphylococcus haemolyticus (7 strains, accounting for 20.00%) and Staphylococcus epidermidis (5 strains, accounting for 14.29%). Regarding the use and monitoring of vancomycin, the drug was mainly for treatment (36 cases, accounting for 87.80%), the daily dose was mainly less than 2 g (24 cases, accounting for 58.54%), and the duration of the drug mainly was shorter than 1 week (24 cases, accounting for 58.54%). The drug was mainly administrated in mode of intravenous drip (38 cases, accounting for 92.68%), most of the patients were combined with other antibacterial drugs (31 cases, accounting for 75.61%), most of them were cured or improved after treatment with adverse drug reactions (all 36 cases, accounting for 87.80%), and most had blood concentration monitored (33 cases, accounting for 80.49%) and renal function monitored (29 cases, accounting for 70.73%). 24 of 41 patients had unreasonable use of vancomycin, as predominant cases of excessive liquid concentration (10 cases, accounting for 41.67%) and short drug administration (5 cases, accounting for 20.83%). Conclusion: Patients treated with vancomycin in the hospital have a high pathogenic detection rate, and blood concentration monitoring and renal function monitoring are commonly carried out, with good prognosis after treatment and fewer adverse reactions. However, irrational drug use is more serious, and hospitals should strengthen the standardized management of vancomycin to improve the rational clinical use level of vancomycin.
  • Analysis of Clinical Features and Drug Resistance of Patients with Staphylococcus aureus and Coagulase-negative Staphylococcus Infection in a Hospital*1
    ZHAO Chao-hui, GUO Zhao-wang, LUO Yu-ting, LIU Xi
    2022, 19(7): 950-955. https://doi.org/10.13493/j.issn.1672-7878.2022.07-005
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    Objective: To analyze clinical features and bacterial resistance of patients with Staphylococcus aureus (SA) and Coagulase-negative Staphylococcus (CNS) infection in a hospital, and to provide reference for clinical treatment of such patients. Methods: Patients with SA infection (n=151) and CNS infection (n=130) admitted to the Fifth Affiliated Hospital, Sun Yat-sen University from October 2019 to September 2020 were collected as study subjects, and the underlying diseases, departmental distribution and source of specimens, as well as pathogenic characteristics of SA and CNS were analyzed. Results: The majority of patients with SA infection and CNS infection had certain underlying diseases, mainly as malignant tumor, diabetes mellitus and chronic renal failure. The patients with SA infection were mainly distributed in oncology department (28 cases, accounting for 18.54%), burns department (17 cases, accounting for 11.26%), ICU (16 cases, accounting for 10.60%), nephrology department (16 cases, accounting for 10.60%) and infection department (14 cases, accounting for 9.27%). The patients with CNS infection were mainly found in orthopedics department (24 cases, accounting for 18.46%), urology department (21 cases, accounting for 16.15%), nephrology department (13 cases, accounting for 10.00%) and oncology department (11 cases, accounting for 8.46%). SA was mainly detected in sputum (35 cases, accounting for 23.18%), blood (21 cases, accounting for 13.91%) and urine (11 cases, accounting for 7.28%), while CNS was mainly detected in urine (35 cases, accounting for 26.92%), blood (33 cases, accounting for 25.38%) and ascites (11 cases, accounting for 8.46%). Pathogenic findings showed that Staphylococcus epidermidis (67 cases, accounting for 51.54%) and Staphylococcus haemolyticus (24 cases, accounting for 18.46%) were mostly detected in CNS. The results of drug susceptibility test showed that the resistance rates of SA and CNS to vancomycin, tigecycline, linezolid, and quinupristin/dalfopristin were 0.00%, while the resistance rates to gentamicin, moxifloxacin, tetracycline, clindamycin and rifampicin were also low (less than 30.00%). The resistance rate of methicillin-resistant SA to penicillin-G, oxacillin, tetracycline, erythrocin, clindamycin and cefoxitin was significantly higher than that of methicillin-sensitive SA (P<0.05). Compared with oxacillin-resistant SA, oxacillin-resistant CNS had a higher resistance rate to moxifloxacin, ciprofloxacin, levofloxacin and compound sulfamethoxazole (P<0.05), and a lower resistance rate to tetracycline and erythromycin (P<0.05). Conclusion: Patients with SA infection and CNS infection in the hospital have similar underlying diseases, but are distributed in different departments with different sources of specimens. In addition, SA and CNS have much common in overall drug resistance characteristics, but there are more differences between methicillin-resistant SA and CNS. In clinical treatment of SA infection and CNS infection, the pathogenic species and their drug resistance characteristics should be clarified as far as possible to achieve better therapeutic effects.
  • Analysis of Detection and Drug Resistance of Pathogenic Bacteria in Blood Specimens of Inpatients in a Hospital
    HONG Xiao-lan, ZHOU Shao-bo, CAI Yuan-yuan
    2022, 19(7): 956-960. https://doi.org/10.13493/j.issn.1672-7878.2022.07-006
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    Objective: To investigate detection of pathogenic bacteria in blood specimens of inpatients in a hospital and their drug resistance characteristics, and to provide reference for treatment of clinical bloodstream infection patients. Methods: Pathogenic testing data were collected from 15 276 blood specimens from inpatients in 910 Hospital of Joint Logistic Support Force of the Chinese People's Liberation Army from January 2019 to December 2021, and the detection of pathogenic bacteria and the drug resistance of major pathogens in blood specimens were analyzed. Results: A total of 595 strains of pathogenic bacteria were detected in 15 276 blood specimens, including 303 strains of Gram-negative bacteria (accounting for 50.92%, mainly Escherichia coli and Klebsiella pneumoniae), 202 strains of Gram-positive bacteria (accounting for 33.95%, mainly coagulase-negative Staphylococcus, Streptococcus spp. and Staphylococcus aureus) and 25 strains of fungi (accounting for 4.2%). The top three source departments of 595 strains of pathogenic bacteria detected were general surgery department (116 strains, accounting for 19.50%), infection department (75 strains, accounting for 12.60%) and burns department (67 strains, accounting for 11.2%). The drug susceptibility test showed that the resistance rates of Escherichia coli and Klebsiella pneumoniae to meropenem, imipenem, amikacin and tobramycin were low (less than 15.00%), the resistance rate of Escherichia coli to compound sulfamethoxazole, levofloxacin and ciprofloxacin was high (greater than 50.00%), the resistance rates of coagulase-negative Staphylococcus, Streptococcus spp. and Staphylococcus aureus to vancomycin and linezolid were low (less than 5.00%), and the resistance rates to penicillin were high (greater than 50.00%). Conclusion: Hospital inpatients are low in positive rate of blood culture, and the detected pathogenic bacteria are mainly Gram-negative bacteria with generally strong drug resistance, so clinical treatment regimens should be made based on the pathogenic characteristics of pathogenic bacteria as far as possible to ensure the effectiveness of anti-infection treatment.
  • Analysis of Pathogenic Bacteria Distribution and Drug Resistance in Postoperative Complication of Abdominal Infections in 102 Patients in a Hospital
    SHAO Yi
    2022, 19(7): 960-963. https://doi.org/10.13493/j.issn.1672-7878.2022.07-007
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    Objective: To analyze pathogenic bacteria distribution and drug resistance in postoperative complication of abdominal infections in patients in general surgery department of a hospital, and to provide reference for prevention and treatment on postoperative abdominal infections of clinical patients. Methods: 102 patients with postoperative complication of abdominal infections, admitted to the general surgery department of Huangzhou District People's Hospital, Huanggang from August 2019 to August 2021, were selected as study subjects, and the distribution of pathogenic bacteria in abdominal puncture fluid specimens of the patients and the drug resistance of major pathogenic bacteria were analyzed. Results: A total of 128 strains of pathogenic bacteria were isolated from submitted specimens of 102 patients, including 79 strains of Gram-negative bacteria (accounting for 61.72%, mainly Escherichia coli, Acinetobacter baumannii and Klebsiella pneumoniae), 43 strains of Gram-positive bacteria (accounting for 33.59%, mainly Enterococcus faecalis) and 6 strains of fungi (accounting for 4.69%). The drug susceptibility test showed that the resistance rates of Escherichia coli and Klebsiella pneumoniae to piperacillin-tazobactam sodium, minocycline, tobramycin, amikacin, imipenem, tigecycline, cefoperazone-sulbactam sodium were low (less than 30.00%), while the resistance rate of Acinetobacter baumannii only to levofloxacin, minocycline, amikacin and tigecycline was low (less than 30.00%), and the resistance rate of Enterococcus faecalis only to vancomycin, linezolid, moxifloxacin and rifampin was low (less than 30.00%). Conclusion: The pathogenic bacteria in postoperative complication of abdominal infections in patients in general surgery department of the hospital are mainly Gram-negative bacteria, but Gram-positive bacteria are also detected more often, so antibacterial drugs should be clinically selected with reference to the results of microbial culture and drug susceptibility test as far as possible to ensure the therapeutic effect on patients.
  • Analysis of Pathogenic Bacteria Distribution and Drug Resistance in Postoperative Complication of Pulmonary Infections in Elderly Patients with Lung Cancer
    LIU Yuan-yuan, DING Cheng-zhi, WU Xiao-ming
    2022, 19(7): 963-967. https://doi.org/10.13493/j.issn.1672-7878.2022.07-008
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    Objective: To analyze pathogenic bacteria distribution and drug resistance in postoperative complication of pulmonary infections in elderly patients with lung cancer, and to provide basis for rational clinical use of antibacterial drugs. Methods: 230 elderly lung cancer patients with postoperative complication of pulmonary infections, admitted to Henan Provincial Chest Hospital, Zhengzhou University from September 2019 to September 2021, were selected as study subjects, and the distribution of pathogenic bacteria in patients' sputum specimens and the drug resistance characteristics of major pathogenic bacteria were analyzed. Results: A total of 245 strains of pathogenic bacteria were detected in sputum specimens of 230 patients with complicated pulmonary infections, including 156 strains of Gram-negative bacteria (accounting for 63.67%, mainly Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli), 56 strains of Gram-positive bacteria (accounting for 22.86%, mainly Staphylococcus aureus, Staphylococcus haemolyticus and Staphylococcus epidermidis) and 33 strains of fungi (accounting for 13.47%, mainly Candida albicans and Candida tropicalis). The drug susceptibility test showed that Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli had low resistance rates (less than 20%) to cefoperazone-sulbactam and imipenem-cilastatin, and high resistance rates (greater than 60%) to cefazolin, cefepime, ampicillin and ampicillin-sulbactam; Staphylococcus aureus, Staphylococcus hemolyticus and Staphylococcus epidermidis had low resistance rates (less than 15%) to tetracycline and vancomycin, and high resistance rates (greater than 50%) to penicillin, gentamicin, erythromycin, clindamycin, compound sulfamethoxazole and amikacin; Candida albicans and Candida tropicalis had low resistance rates (less than 10%) to voriconazole and ketoconazole, and high resistance rates (greater than 65%) to fluconazole, amphotericin B and 5-fluorouracil. Conclusion: Postoperative complication of pulmonary infections in elderly patients with lung cancer is mainly caused by Gram-negative bacteria, which are resistant to clinical common antibacterial drugs to varying degrees. Antibacterial drugs should be reasonably selected according to the results of pathogenic bacteria culture and drug susceptibility test to ensure the accuracy and effectiveness of anti-infection treatment.
  • Analysis of Pathogenic Characteristics and Risk Factors of 392 Patients with Cerebral Infarction Complicated by Hospital Infection in a Hospital
    HUO Ye-hong, ZHANG Shu-xia, WANG Shi-chao
    2022, 19(7): 1050-1054. https://doi.org/10.13493/j.issn.1672-7878.2022.07-035
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    Objective: To analyze pathogenic characteristics and risk factors of patients with cerebral infarction complicated by hospital infection in a hospital, and to provide reference for prevention and treatment of hospital infection of clinical patients with cerebral infarction. Methods: 392 patients with cerebral infarction admitted to Taikang County People's Hospital from May 2018 to January 2022 were selected as study subjects and divided into an infection group (n=128) and a non-infection group (n=264) according to complication of hospital infection, and the distribution and drug resistance characteristics of pathogenic bacteria in patients with cerebral infarction complicated by hospital infection as well as the risk factors for infection were analyzed. Results: A total of 214 strains of pathogenic bacteria were detected in specimens of 128 patients complicated by hospital infection, including 142 strains of Gram-negative bacteria (accounting for 66.36%, mainly Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae), 54 strains of Gram-positive bacteria (accounting for 25.23%, mainly Staphylococcus aureus and Staphylococcus epidermidis) and 18 strains of fungi (accounting for 8.41%). The drug susceptibility test showed that the resistance rates of Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae to meropenem and imipenem were low (less than 10.00%), and the resistance rates to other antibacterial drugs varied, the resistance rate of Staphylococcus aureus to cefepime, amikacin and vancomycin was low (less than 5.00%), and the resistance rate of Staphylococcus epidermidis only to vancomycin was low (less than 5.00%). The regression analysis showed that concurrent hospital infection in patients with cerebral infarction was related to age, smoking history, length of stay, invasive operation, disturbance of consciousness, combined diabetes mellitus, and combined chronic obstructive pulmonary disease etc. (P<0.05), with age greater than or equal to 60 years old, smoking history, length of stay longer than or equal to 30 d, invasive operation, disturbance of consciousness, combined diabetes mellitus, and combined chronic obstructive pulmonary disease as independent risk factors for concurrent hospital infection (P<0.05). Conclusion: The pathogenic bacteria in patients with cerebral infarction complicated by hospital infection are mainly Gram-negative bacteria, and the detected pathogenic bacteria are generally highly drug-resistant. In addition, concurrent hospital infection in patients is closely related to factors such as age, smoking history, length of stay, invasive operation, disturbance of consciousness, combined diabetes mellitus and combined chronic obstructive pulmonary disease, so special care should be taken to special patients in clinical care and monitoring to detect and treat infections as early as possible.
  • Analysis of Pathogenic Characteristics and Influencing Factors of Infection with MDR-KP in Lower Respiratory Tract of Elderly Patients in ICU
    WANG Cheng-juan, WU Guang-rui
    2022, 19(7): 1055-1058. https://doi.org/10.13493/j.issn.1672-7878.2022.07-036
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    Objective: To analyze pathogenic characteristics and influencing factors of infection with multidrug-resistant Klebsiella Pneumoniae (MDR-KP) in lower respiratory tract of elderly patients in ICU, and to provide reference for prevention and treatment on clinical MDR-KP infections. Methods: 98 elderly patients with Klebsiella Pneumoniae (KP) infection in lower respiratory tract, admitted to ICU of the hospital from March 2020 to October 2021, were selected as study subjects, and were divided into an MDR-KP infection group (n=54) and a non-MDR-KP infection group (n=44) according to whether KP was MDR-KP, and pathogenic characteristics and influencing factors of MDR-KP infection of the patients were counted and analyzed. Results: The drug susceptibility test showed that MDR-KP only had a low resistance rate (less than 10.00%) to minocycline, a relatively low resistance rate (25.00%-40.00%) to amikacin and imipenem, and a high resistance rate (greater than 90.00%) to aztreonam, ceftriaxone, ceftazidime and cefoperazone. The single factor results showed that MDR-KP infection of elderly patients in ICU was related to factors such as blood glucose, time of ICU admission, timing of ventilator use, and use of broad-spectrum antibacterial drugs (e.g., 3rd generation cephalosporins, and carbapenems)（P<0.05）, with time of ICU admission longer than or equal to 7 d, ventilator use, and time of ventilator use longer than or equal to 7 d as independent risk factors of MDR-KP infection in patients （P<0.05）. Conclusion: MDR-KP infection of elderly patients in ICU is closely related to time of ICU admission, ventilator use, and time of ventilator use, and MDR-KP has strong drug resistance, making it very difficult for treatment once infected, so high-risk patients should be more intensively managed clinically to avoid or reduce bacterial drug resistance.
  • Clinical Analysis of Polymyxin B-induced Neurotoxic Adverse Reactions Based on Literature Data*1
    GUAN Yu, TANG Liu-xing, PAN Jie
    2022, 19(7): 1059-1064. https://doi.org/10.13493/j.issn.1672-7878.2022.07-037
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    Objective: To analyze clinical characteristics and occurrence mechanism of polymyxin B-induced neurotoxic adverse reactions, and to provide reference for safe and rational use of polymyxin B. Methods: 17 cases of polymyxin B-induced neurotoxic adverse reactions occurred in real work and retrieved from authoritative databases at home and abroad were selected as study subjects, and clinical characteristics and occurrence mechanism of these adverse reactions were analyzed. Results: Neurotoxic adverse reactions in 17 cases occurred within 30 d of polymyxin B administration, of which 11 cases occurred in the day of administration. Neurotoxic adverse reactions have major clinical manifestations of abnormal peripheral sensation, respiratory distress, cardiac arrest, coma, dizziness, epileptic seizure and rhabdomyolysis, etc. For the adverse reactions, after symptomatic treatment (7 cases), drug withdrawal (4 cases) and adjustment of treatment regimen (6 cases), symptoms relieved or disappeared in 14 patients, and 3 cases ended in death. Conclusion: Polymyxin B-induced neurotoxic adverse reaction may cause relatively serious consequences, and its occurrence mechanism may be related to oxidative stress, mitochondrial dysfunction, inflammatory response, etc., while drug combination, dose, drug concentration and infusion speed during the drug use may induce the reaction, so polymyxin B should be normatively and rationally used clinically to avoid or reduce adverse reactions.
  • Anti-infective Treatment and Pharmaceutical Care of a Patient Undergoing Colonic Surgery with Septic Shock Involving Clinical Pharmacist
    WU Ling, ZHANG Li
    2022, 19(7): 1066-1070. https://doi.org/10.13493/j.issn.1672-7878.2022.07-039
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    Objective: To analyze anti-infective treatment and pharmaceutical care process of a patient undergoing colonic surgery with septic shock, and to provide reference for scientific treatment on such patients. Methods: The clinical pharmacist participated in the anti-infective treatment of a patient undergoing colonic surgery with septic shock in the form of consultation, assisted the physician in adjusting and formulating the anti-infective treatment regimen according to the patient's actual condition, and carried out pharmaceutical care. Results: The patient developed progressive thrombocytopenia after initial anti-infective therapy with vancomycin, imipenem-cilastatin sodium and voriconazole, whereby the platelet level gradually returned to normal after discontinuing vancomycin. Thereafter, a bloodstream infection with Elizabethkingia meningoseptica also occurred, which was treated with levofloxacin according to the drug susceptibility but with poor effect, then the treatment regimen was adjusted to piperacillin-tazobactam sodium (4.5 g, q8h) after consultation and analysis of the clinical pharmacist, and the blood culture results turned negative after several days. Conclusion: With professional expertise, the clinical pharmacist assists the physician in developing scientific and individualized anti-infection therapeutic methods to successfully treat acute and critically ill patients like septic shock, well reflecting the role and value of clinical pharmacist in the team.