Study On The Anti-drug-resistant Bacteria Of Shegan Component Preparation And Its Mechanism

Purpose:In this study,the Component preparation of pardanthus was studied,the infection of drug-resistant bacteria in inpatients in our hospital was analyzed retrospectively,the distribution of drug-resistant bacteria and the changing trend of drug resistance to various antibiotics were understood,and the in vitro bacteriostatic and serum pharmacological experiments of four main drug-resistant bacteria(CR-PA,CR-AB and MRSA)were carried out.Through meta analysis of the clinical efficacy of traditional Chinese medicine for clearing away heat and detoxification combined with antibiotics in the treatment of drug-resistant bacteria infection,the reliability of traditional Chinese medicine combined with traditional Chinese medicine for clearing away heat and detoxification in the treatment of drug-resistant bacteria infection was evaluated,which provided effective evidence-based medical evidence for clinical treatment and opened up a new idea for traditional Chinese medicine to reverse bacterial resistance and enhance the killing effect of antibiotics on drug-resistant bacteria.Shegan is a kind of traditional Chinese medicine for clearing away heat and detoxification with clear anti-inflammatory effect.The pathogenic characteristics of drug-resistant bacteria in respiratory tract infection are closely related to the etiology of "evil toxin entrapment" and the syndrome of "deficiency and excess inclusion".Therefore,it is proposed that it is feasible in theory to use traditional Chinese medicine for clearing away heat and detoxification combined with antibiotics to intervene drug-resistant bacteria.According to the bacteriostatic effect of rat drug-containing serum combined with piperacillin tazobactam sodium on drug-resistant bacteria,the effect and possible mechanism of reversal of bacterial drug resistance were judged,which provided scientific basis for in vivo experiments and mechanism research in the future.Material and method : From January 2017 to December 2019,1570drug-resistant bacteria were selected from all kinds of samples from intensive care unit(ICU)and non-intensive care unit(ICU).The main objectives of the collection were age,sex,antibiotic use,the type and quantity of drug-resistant bacteria detected each year,drug-sensitive results of drug-resistant bacteria,and sample source statistics.The clinical randomized controlled trial of traditional Chinese medicine for clearing away heat and detoxification combined with antibiotics in the treatment of drug-resistant bacterial infection was selected,and it was a human clinical study.The retrieval scope included 12 articles in Chinese and English,open or unpublished.Meta analysis was carried out on whether the combination of antibiotics and traditional Chinese medicine for clearing away heat and detoxifying had the advantage of using antibiotics alone.Four common drug-resistant bacteria(CR-PA,CR-AB and MRSA)were used to inhibit bacteria in vitro,and the drug-containing serum of rats was obtained by intragastrically administration,and the bacteriostatic experiments were carried out by using drug-containing serum,antibiotics and combined antibiotics respectively.Results:1.The main isolates of Gram-negative drug-resistant bacteria were Escherichia coli,Pseudomonas aeruginosa,Acinetobacter baumannii and Klebsiella pneumoniae,and Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae isolated from ICU ward.The Gram-positive drug-resistant bacteria isolated from our hospital and ICU ward were mainly Staphylococcus aureus.A total of 1570drug-resistant strains were isolated from the second affiliated Hospital of Liaoning University of traditional Chinese Medicine in recent 3 years,including 842 males(53.63%)and 728 females(46.37),with a male to female ratio of 1.16 ≤ 1.The age distribution of the patients was between 50 and 89 years old,accounting for 93.06%of the patients aged 30-49 years and over 90 years of age.Sputum,urine and blood could be detected in the first three specimens,and a variety of drug-resistant strains could be detected in the same sample.More than two kinds of drug-resistant bacteria were detected in the same sample of ICU patients,accounting for 28.43% of the total hospital,and 3,4 and more drug-resistant bacteria were detected in the same sample,accounting for 41.86,42.86 and 40% of the total hospital,which indicated that ICU patients were more likely to be infected with multiple drug-resistant bacteria than those in general ward.For the treatment of common Gram-negative bacteria,the optional antibiotics are carbapenem(meropenem,imipenem),piperacillin /tazobactam,amikacin.There is no Gram-positive strain resistant to vancomycin,so vancomycin is still the first choice for the treatment of MRSA,but it should be used carefully in clinic.In the process of statistics and analysis of clinical drug-resistant bacteria,drug-resistant bacteria were collected and subcultured in order to prepare for in vitro bacteriostatic test and serum pharmacological experiment.2.Through meta analysis of the clinical efficacy of combined use of traditional Chinese medicine for clearing away heat and detoxification and antibiotics in the treatment of drug-resistant bacteria infection,the total effective rate and healing rate of the treatment outcome in the included study were systematically evaluated.The total effective rate and healing effective rate of the combined traditional Chinese medicine for clearing away heat and detoxification were obviously better than those in the simple western medicine treatment group.3.The preparation has a definite inhibitory effect on four kinds of drug-resistant bacteria(CR-PA,CR-AB and MRSA),and its bacteriostatic effect is positively correlated with the drug administration concentration.The results of serum pharmacological experiment showed that the high concentration of drug-containing serum could inhibit the growth of drug-resistant bacteria,and the combination of low-concentration drug-containing serum and the antibiotic piperacillin sodium tazobactam sodium could inhibit the growth of drug-resistant bacteria,and achieved good bacteriostatic effect.Conclusion:1.The infection of drug-resistant bacteria in our hospital was mainly Gram-negative bacteria,followed by Escherichia coli,Pseudomonas aeruginosa,Acinetobacter baumannii complex,Klebsiella pneumoniae and subspecies,and ICU resistant bacteria were also mainly Gram-negative bacteria,followed by Acinetobacter baumannii complex,Pseudomonas aeruginosa and Klebsiella pneumoniae.Staphylococcus aureus was the main infection of Gram-positive cocci(including ICU)in our hospital.Sputum,urine and blood were the main infection specimens,respiratory tract was the main infection site,but there was no significant correlation between the infection rate and the type of bacteria.The infection rate of drug-resistant bacteria was positively correlated with the increase of age.The proportion of drug-resistant bacteria in men was higher than that in women.Drug-resistant bacteria infection is universal,no single drug can fully cover drug-resistant bacteria,the use of western drugs alone in the treatment of drug-resistant bacteria infection will accelerate the emergence of bacterial drug resistance,we should seek the method of integrated traditional Chinese and western medicine to treat drug-resistant bacteria infection.2.The effect of clearing away heat and detoxifying traditional Chinese medicine combined with conventional western medicine is significantly higher than that of simple western medicine antibiotics,which can effectively improve the clinical symptoms.Although the credibility of the results is reduced due to the small number of literature included and the low quality of the literature,according to the existing evidence analysis,integrated traditional Chinese and western medicine is a safe and efficient treatment for drug-resistant bacterial infection,which is worth popularizing and applying.3.The preparation has bacteriostatic effect,and the combination of drug-containing serum and piperacillin sodium tazobactam sodium has good bacteriostatic activity and synergistic effect.The drug resistance of bacteria can be reversed,the bacteriostatic effect of antibiotics can be improved,and the dosage of antibiotics can be reduced.