Objective

2

To summarize and analyze the distribution characteristics of traditional Chinese medicine （TCM） syndrome elements in patients with drug-resistant bacteria infection.

Methods

2

Patients admitted to the wards of Beijing Hospital of Traditional Chinese Medicine， Capital Medical University who had any drug sensitivity test results of sputum， urine， blood and secretion culture showing the drug-resistant bacteria was Pseudomonas aeruginosa， Acinetobacter baumannii， Klebsiella pneumoniae or Escherichia coli were included. The general condition of the patient and the information related to the four examinations of TCM were retrospectively collected， including gender， age， case source， diagnosis， infection site， drug-resistant bacteria， drug-resistant degree， symptoms， tongue and pulse manifestation. The distribution of disease nature-related TCM syndrome elements among different drug-resistant bacteria were analyzed， and the category of deficiency and excess was differentiated. Cluster analysis was used to analyze the distribution of different combinations of syndrome elements， and association rules were used to analyze the cluster of core syndrome elements； the complex network of syndrome elements was visualized.

Results

2

A total of 295 patients with drug-resistant bacterial infections were included， most of whom were 75~89 years old （115 cases， 39.0%）， and mainly diagnosed as urinary tract infection （138 cases， 45.2%） and bacterial pneumonia （117 cases， 38.4%）. The drug-resistant bacteria ranked from high to low was Escherichia coli （168 cases， 56.9%）， Klebsiella pneumoniae （58 cases， 19.7%）， Pseudomonas aeruginosa （44 cases， 14.9%） and Acinetobacter baumannii （25 cases， 8.5%）. Multidrug-resistant （MDR） strains accounted for 94.6% of the total patients （279 cases）， while extensively drug-resistant （XDR） strains accounted for 5.4% （16 cases）. A total of 10 syndrome elements were extracted including

qi

deficiency， blood deficiency，

yang

deficiency，

yin

deficiency， cold， heat， dampness， phlegm， rheum， and blood stasis， of which dampness， phlegm and rheum were distributed significantly different in patients with different drug-resistant bacterial infection （

P

＜0.05）. The TCM syndromes could be divided into three types， namely simple excess syndrome， simple deficiency syndrome and deficiency-excess complex syndrome. The number of these three syndromes in patients with MDR bacteria infection was 83 cases， 15 cases and 181 cases， respectively， while that in patients with XDR bacteria infection was 3 cases， 1 case and 12 case， respectively. There was no significant difference in distribution of deficiency syndrome and excess syndrome in different degree of drug-resistant bacteria infection patients （

P

＞0.05）. There were 19 cases with single syndrome element， and the top frequent element was

yang

deficiency （8 times）. The combination of phlegm and heat was mostly frequent （21 times） among the 109 patients who had two syndrome elements. The top frequent combinations of three， four and five syndrome elements were phlegm plus heat plus

qi

deficiency （27 out of 131 cases）， dampness plus heat plus

qi

deficiency plus

yin

deficiency （7 out of 33 cases） and phlegm plus dampness plus heat plus

qi

deficiency plus

yin

deficiency （2 out of 5 cases）， respectively. Four clusters were obtained through clustering analysis， including cold-

yang

deficiency-rheum cluster， dampness-blood stasis cluster， heat-

yin

deficiency cluster， and

qi

deficiency-phlegm-blood deficiency cluster. The association rules and complex network analysis showed that the center elements of patients with drug-resistant bacteria infection were heat and

qi

deficiency， based on which six groups of strong links were formed， including heat-phlegm，

qi

deficiency-heat， heat-dampness，

qi

deficiency-phlegm， heat-

yin

deficiency and

qi

deficiency-dampness.

Conclusion

2

The main TCM syndrome elements of drug-resistant bacteria infection patients were featured by coexistence of deficiency and excess. The deficiency syndrome is mainly

qi

deficiency， while the concurrent excess syndrome is mainly pathogenic heat， phlegm and dampness.