The Study Of TCM Syndromes Distribution And Correlation Of Multidrug-resistant Organism Infection

ObjectiveTo obtain the features of TCM syndrome distribution of multidrug-resistant organism infection through a retrospective analysis on the clinical data of the patients infected with multidrug-resistant organism, and to further discuss and analyze the relevant factors of TCM syndrome distribution.MethodsThis study is a retrospective analysis, which collected the data of the patients hospitalized in comprehensive wards of emergency treatment and EICU of Guangdong TCM Hospital from May,2013 to May,2016, the patient who is in accordance with any result of the specimen bacteria medicine sensitivity cultures of sputum, midstream urine and blood indicating that the patient has been infected with the multidrug-resistant organism is immediately qualified to join the group, there were 200 cases in total. A data base has been built, in which the patients’age, gender, underlying disease, general situation, type of bacteria infected, position of infection, degree of drug resistance of the bacteria, antibiotic use, APACHEⅡ evaluation, TCM syndrome and other contents were collected, the SPSS19.0 data package was used to conduct a statistical analysis.ResultsThis study has collected the data of 200 cases of patient hospitalized in comprehensive wards of emergency treatment and EICU of Guangdong TCM Hospital from May,2013 to May,2016, among which, male accounted for 43.5% and female accounted for 56.5%, there were 87 cases of male and 117 cases of female. They averagely aged 79.85±10.78, the patients aged from 71 to 90 years-old were overwhelming, accounting for 73%; in the next place were the ones aged from 51 to 70 years-old, accounting for 19%; the ones aged from 30 to 50 years-old and over 90 years-old respectively accounted for 3%and 5%.The leading five diseases with a high incidence in the past medical history were respectively hypertension(73.5%), diabetes(72%), cerebral infarction(65.5%), chronic heart failure(27.5%) and bronchiectasis(24%). There were 133 cases of long-term bed ridden patients, accounting for 66.5%; there were 184 cases of patient diseased with hypoproteinemia, accounting for 92%; there were 96 cases of patient having a history of using broad-spectrum antibiotic, accounting for 48%; there were 3 cases of patient having a long-term use of glucocorticoid, accounting for 1.5%; within 30 days before this hospitalization, there were 9 cases of patient who had been treated with immunosuppressive therapy, accounting for 4.5%. The invasive medical measures include assisted mechanical ventilation, tracheal incision, central venous indwelling catheter, indwelling catheter, fiber bronchoscopic examination, among which, indwelling catheter had the highest incidence, which was 93.5%, followed by assisted mechanical ventilation with an incidence of 92.5%. The mean value of APACHEⅡ evaluation was 21.18±5.67 with 9 points as the minimal evaluation and 37 points as the maximal evaluationThe pulmonary infection was the most common among the infected positions by multidrug-resistant organism, there were 125 cases of patient who had a positive result of sputum culture among 200 cases, accounting for 62.5%; in the next place was the urinary tract infection, accounting for 30.5%; the blood circulation infection occurred the least, accounting for 7%. The Gram-negative bacteria were more than Gram-positive bacteria, there were 177 cases of negative bacteria, accounting for 88.5%, and there were 23 cases of positive bacteria, accounting for 11.5%; the baumanii was the most common in all the bacteria, accounting for 26% of the overall cases, in the next place was the pseudomonas aeruginosa, accounting for 21.5% of the overall cases; the proteus mirabilis and Escherichia coli respectively accounted for 15.5% and 14% of the overall cases; the baumanii (36.8%) and pseudomonas aeruginosa (25.6%)were mainly responsible for pulmonary infection, the proteusbacillus vulgaris(34.43%) and Escherichia coli (19.67%)were mainly responsible for urinary tract infection, the blood cultures was based on staphylococcus(50%).Among the results of drug sensitivity test, there were 35 cases of pan drug resistant strains, accounting for 17.5%. The baumanii (82.86%)predominated in the pan drug resistant strains, the pseudomonas aeruginosa took the second place(14.28%). The β-lactam antibiotics was the most used antibiotics, accounting for 84.67%, among such antibiotics, the third generation cephalosporin and carbapenems were used most frequently; the joint use rate of antibiotics was 14.72%, based on joint use of 2 kinds of antibiotics. Among the 200 cases of patient, there were 37 cases who didn’ t use antibiotics.The syndrome manifestations were grouped based on the principle of laterality on deficiency or excess, in accordance with proportion and syn-position, which were successively deficiency-prevailed syndrome with intermingled deficiency and excess(30.5%), pure deficiency syndrome(25.5%), excess-prevailed syndrome with intermingled deficiency and excess(25%), pure excess syndrome(19%). As for the nine specific syndrome factors, they were sorted in a high-to-low order, which successively were:qi deficiency syndrome(72%)> phlegm-turbidity syndrome(28.5%)> blood stasis syndrome (27.5%)>yin deficiency syndrome (18.5%)>excess heat syndrome (15.5%) >dampness retention syndrome(14%)>yang deficiency syndrome(11%)>blood deficiency syndrome(10%)> water stagnation syndrome(10%). Among the deficiency syndrome category, qi deficiency syndrome predominated, while among the excess syndrome category, the phlegm-turbidity syndrome and blood stasis syndrome prevailed, the concurrence of two kinds of syndrome prevailed in the combinations of syndrome factor, accounting for 76%; the combination of qi deficiency and blood stasis and qi deficiency and phlegm-turbidity prevailed over the rest among the concurrence of two kinds of syndrome, respectively accounting for 16.45% and 15.79%; among the concurrence of three kinds of syndrome, the combination of qi deficiency, yin deficiency and phlegm-turbidity (25.81%) and the combination of qi deficiency, yin deficiency and blood stasis (19.35%)prevailedThe analysis on correlation of syndrome factors with age and gender:among the patients of qi deficiency syndrome group, the difference between "30-50y" group and "71-90y" group and the one between “51-70y” group and "71-90y" group the difference was statistically significant, the relevant Spearman analysis shows that qi deficiency syndrome was positively correlated with age, indicating that, with the increase of age, the likelihood of patients in the research group to develop qi deficiency syndrome increased. Among the patients in the excess heat syndrome group, the difference between "30-50y" group and "71-90y" group was between a statistically significant difference, contrary to the qi deficiency syndrome group, excess heat syndrome was negatively correlated with age, namely, the likelihood of the patients having a young age to develop an excess heat syndrome increased. The difference between male patients and female patients in the blood deficiency syndrome group was statistically significant, P<0.01, it showed that the proportion of male patients with the blood deficiency syndrome(15.93%) is higher than female patients who was in the blood deficiency syndrome group(2.30%).According to the fact that the multiple resistant bacteria have different degree of drug resistance, they were grouped into pan resistant bacteria group and non-pan resistant bacteria group, the correlation of syndrome factors with degree of drug resistance was analyzed, it was indicated by the result that, as for the patients with phlegm-turbidity syndrome, the difference between pan resistant bacteria group and non-pan resistant bacteria group was statistically significant(P< 0.05). The proportion of patients in pan resistant bacteria group occured in phlegm-turbidity syndrome (45.71%)was higher than the other group (24.85%).During the process of evaluating the correlation of TCM syndromes with the APACHEⅡevaluation, firstly, all of the patients’APACHEII evaluation had been tested for normality, the result shows that, APACHEII evaluation value accorded with normal distribution (P=0.319, P> 0.05); secondly, a homogeneity test for variance was conducted on each group, of which the result shows that they were accorded with homogeneity test for variance(P=0.696, P >0.05);then a single-factor ANOVA analysis was conducted, indicating that, the difference in APACHE Ⅱevaluation between different groups was statistically significant, (F=9.307, P=0.000,P<0.01), thus, a multiple comparison of mean value had been conducted on each group with the method of Scheffe, further understanding the inter-group difference, the final result indicated that, the difference in APACHEⅡ evaluation between pure excess syndrome groups and pure deficiency syndrome groups was extremely statistically significant(P< 0.01), the difference between pure excess syndrome and deficiency-prevailed syndrome with intermingled deficiency and excess was extremely statistically significant(P< 0.01), the difference between excess-prevailed syndrome with intermingled deficiency and excess and deficiency-prevailed syndrome with intermingled deficiency and excess was also statistically significant (P<0.05).ConclusionThe age of the patients infected with multidrug-resistant organism was relatively old, most of them had a condition of long-term bed ridden and hypoproteinemia, The leading five diseases with a high incidence in the past medical history were respectively hypertension(73.5%), diabetes(72%), cerebral infarction(65.5%), chronic heart failure(27.5%) and bronchi-ectasis(24%).The pulmonary infection (62.5%) was the most common among the infected positions by multidrug-resistant organism; in the next place was the urinary tract infection, accounting for 30.5%; the blood circulation infection occurred the least (7%); The leading five types of bacteria were respectively baumanii(26%), pseudomonas aeruginosa(21.5%), proteusbacillus vulgaris (16.5%), Escherichia coli (14%)and klebsiella pneumoniae(5.5%); among the sputum culture, baumanii and pseudomonas aeruginosa prevailed, among the midstream urine culture, proteusbacillus vulgaris and Escherichia coli prevailed, the staphylococcus prevailed in the blood culture. The pan-drug resistant bacteria accounted for 17.5% in multidrug-resistant organism, among which, the baumanii was the predominant resistant bacteria.The patients infected with multidrug-resistant organism had the highest incidence of syndrome of intermingled deficiency and excess, which was partial to deficiency syndrome in terms of deficiency and excess, as for the syndrome factors, the qi deficiency and yin deficiency syndrome prevailed in the category of deficiency syndrome, while the phlegm-turbidity syndrome and blood stasis syndrome prevailed in the category of excess syndrome, as for the combination of syndrome factors, the qi deficiency and phlegm-turbidity and qi deficiency blood stasis had a higher incidence. In terms of the correlation of syndrome factors with age, with the increase of age, the likelihood of patients in the research group to develop qi deficiency syndrome increased, while the likelihood to develop excess heat syndrome decreased, In terms of the correlation of syndrome factors with gender, the likelihood of female patients to develop blood deficiency syndrome was higher than that of male patients. The difference between pan resistant bacteria and non-pan resistant bacteria lies in that the likelihood of patients with pang resistant bacteria to develop phlegm-turbidity syndrome was greater. APACHEII evaluation value was related with the categorization of syndrome, which was manifested as that the patient could have a more severe condition in the case of weakened body resistance, so it should be paid high attention to focus on strengthening the body resistance at an early stage, strengthening the body defense against evil.