Empirical Antibiotic Treatment Of Community-acquired Pneumonia, Prevention Of Ventilator-associated Pneumonia In ICUs And Genomic Analysis Of Legionella—Clinical And Experimental Study

Objective Comparison of clinical efficacy and economy of empirical antibiotic regimen between covering and uncovering atypical pathogen in hospitalized patients in China.Method Population-based, multi-center, retrospective cohort study adjusting for demographics, comorbidities, and clinical characteristics.During the period from June1,2010through May31,2011, all patients presented to participated4municipal hospitals and6district hospitals were enrolled. Consistent with inclusion and exclusion criteria, data of eligible patients were collected including demographic, underling diseases, physical examination, laboratory examination, antibiotic treatment regime and prognosis. Using Logistic regression analysis to compare the main outcome and the minor outcomes between treatment group and comparator group.Results The inclusion of anti-atypical pathogen active antibiotics in initial empiric CAP treatment was associated with significantly lower mortality0.9%(95%CI,0.1-1.7%)than therapy with either a β-lactam alone (4.9%(95%CI,2.6-8.2%)), adjusted odds ratio [AOR],0.18(95%CI,0.06-0.50).Major economic index:LOS of AP covered group was10.1(95%CI,9.79-10.50), significantly less than that of comparator group10.1(95%CI,9.79-10.50). Total hospitalization expenditure in AP covered group was7306.0(95%CI,6905.9-7706.2), while which of comparator group was much higher9411.8(95%CI,8613.9-10209.6), p<0.01. Antibiotic associated expenditure was2653.1(95%CI,2477.6-2828.7) in AP covered group which was still lower than that in comparator group3133.0(95%CI,2860.8-3405.2), p<0.01. Daily defined dose in AP covered group was19.2(95%CI,18.3-20.2), is not statistically differ from that in comparator group18.3(95%CI,17.0-19.6), p=0.28. Conclusions The inclusion of anti-atypical pathogen active antibiotics in initial empiric CAP treatment was associated with improved survival, reduced IOS total hosnitalization evnenditure and antibiotic associated expenditure OBJECTIVE The aim of this study was to evaluate the effectiveness of a multidimensional infection control bundle on the reduction of incidence of ventilator-associated pneumonia (VAP) in176intensive care units (ICUs) in Shanghai.METHODS The trial was designed as a before-after study from January2007to June2012, which was divided into baseline, transition and intervention periods. VAP prevention bundle included hand hygiene, recumbent position, oral care with antiseptic, as well as education and audit the medical personnel. Number of patients, length of ICU stay, mechanical ventilator days and number of VAP cases in ICU were collected by infection control personnel. VAP rates compared in yearly periods, which used to evaluate the effectiveness of VAP control bundle. RESULTS Totally463,208patients data,2,535,917ICU bed days and695,185mechanical ventilator days(VDs) were collected in this study. Baseline VAP rate was23.4per1000ventilator days. After implementation of VAP prevention bundle, VAP rate was significantly decreased to14.3per1000ventilator days (RR0.61(95%CI,0.59-0.64), RD9.1(95%CI,8.3-9.9)).CONCLUSION Implementation of VAP prevention bundle in ICU was associated with dramatically decreasing of VAP rate in patients. OBJECIVE Analysis the difference between an environmental isolate and clinical isolates of Legionella pneumophila and explore the impacts to human pathogenesis.METHODS The genome sequence of L. pneumophila strain LPE509(LPE509) has been acquired by de novo sequencing by Illumina. The complete genomic data has been achieved after assembling the contigs. Bioinformatic methods were applied to predict putative genes and proteins. Genome comparison between LPE509and the other known L. pneumophila genomes (strains130b,570-CO-H, Alcoy, Corby, Lens, Paris, Philadelphia1) was performed with OrthoMCL and Vaxign that incorporates Ortho MCL.RESULTS The genome sequence of LPE509has been deposited at GenBank under accession number CP003885and CP003886. Gene organization of LPE509is highly syntenic with those of the seven sequenced L. pneumophila strains. Gene clusters encoding all the structural components of the type I secretion system (T1SS), the T2SS, and the Dot/Icm T4BSS were found in syntenic positions. Of the277experimentally verified protein substrates the Dot/Icm transporter (7,13),274are present in the LPE509genome. In addition to the7.3kbp plasmid unique to strain LPE509which codes for genes putatively involved in resistance to multiple drugs. We found that comparing to the other7sequenced strains (130b,570-CO-H, Alcoy, Corby, Lens, Paris, Philadelphia1), strain LPE509codes for580,235,512,522,669,443,562unique proteins. CONCLUSION Highlighting the high levels of genomic plasticity among different L. pneumophila isolates, T1SS, T2SS, and the Dot/Icm T4BSS found to be relatively conservative.