Materials Express 2158-5849/2020/10/756/006 Copyright © 2020 by American Scientific Publishers All rights reserved. doi:10.1166/mex.2020.1693 Printed in the United States of America www.aspbs.com/mex Clinical efficacy and safety of silver nanoparticle- based disinfectant combined with piperacillin sodium and sulbactam sodium in the treatment of lower respiratory tract infection Xiaofei Li, Lina Sheng, Juncai Tu, and Lianqing Lou∗ Department of Infectious Diseases, Yiwu Central Hospita, Yiwu 322000, Zhejiang, PR China ABSTRACT This study evaluated the clinical efficacy and safety of piperacillin sulbactam in the treatment of lower res- piratory tract infections, asIP: well 192.168.39.211 as the efficacy On: of Wed,silver 29 nanoparticle-basedSep 2021 02:32:18 disinfectant in equipment dis- infection to reduce exogenous infection.Copyright: From American May Scientific 2018 to Publishers November 2018, 100 patients that had been Delivered by Ingenta diagnosed with a lower respiratory tract infection and hospitalized were divided into an experimental group and a control group. The experimental group was given piperacillin/sulbactam, and the control group was given mezlocillin/sulbactam, where 5.0 g was added to 100 mL of normal saline and administered via intravenous Article drip twice a day over a treatment course of 14 days. The cure rate of the experimental and control groups were 65.22% and 56.52% respectively. The efficacy rate was 91.30% and 91.30% respectively, with no significant difference between the two groups (P>0.05). The results indicated that piperacillin/sulbactam is a safe, effec- tive treatment for lower respiratory tract infections in elderly patients, the equipment was sterilized with silver nanoparticle-based disinfectant to reduce the incidence of adverse reactions and exogenous infections. Keywords: Piperacillin/Sulbactam, Mezlocillin/Sulbactam, Lower Respiratory Tract Infection, Elderly Patients, Silver Material. 1. INTRODUCTION Lower respiratory tract infections (LRTIs) are signifi- Cefoperazone/sulbactam is a type of compound prepara- cant contributors to death of the elderly due to low immune tion. The third generation of cefoperazone can effectively function [1–3]. With the extensive application of anti- block the synthesis of bacterial cell walls and has signif- microbial drugs, the selective pressure on microorganisms icant antibacterial effects. Sulbactam, another component has increased, and the number of drug-resistant strains of the drug, is a -lactamase inhibitor that can irreversibly is increasing. This brings challenges to the treatment bind a variety of -lactamases produced by drug-resistant of pulmonary infection, particularly in elderly patients. strains and has significant bactericidal effects. In addi- Piperacillin is a broad-spectrum semi-synthetic acrylamide tion, it can prevent cefoperazone from being hydrolyzed penicillin, which has a wide antibacterial spectrum and by -lactamase. The combination of sulbactam and cef- strong antibacterial effects [4–7]. It has good antibacterial operazone can enhance the degradation ability of the drug effects on most Gram-negative and positive bacteria, but against a variety of -lactamases, and the combination of drug resistance is increasing. Sulbactam is a strong broad- the two has a clear synergistic effect. spectrum -lactamase inhibitor, and can protect antibi- otics from -lactamase damage. Piperacillin/sulbactam ∗Author to whom correspondence should be addressed. is a compound preparation of piperacillin sodium and 756 Mater. Express, Vol. 10, No. 5, 2020 Clinical efficacy and safety of silver nanoparticle-based disinfectant Materials Express Li et al. sulbactam sodium [8–10], and it is hoped that the com- experimental group, piperacillin/sulbactam produced by bined preparation can protect against piperacillin sodium Shenyang Huatai Pharmaceutical Research Co., Ltd. was -lactamase damage and enhance the anti-enzyme and used. The batch number of the control drug was 030730, bactericidal ability of piperacillin sodium [11–13]. and was produced by Hainan General Sanyang Pharma- At present, intravenous piperacillin sodium/sulbactam ceutical Co., Ltd. and the batch number was 030306. For sodium is commonly used to treat patients with LRTIs. participants that had a negative skin test, the usage was Removal of intravenous drips, dosing, and contact with 5.0 g added to 100–250 mL of physiological salt water patients and nurses often introduce exogenous viruses, pre- given by intravenous drip twice a day. The course of treat- senting challenges to the disinfection of intravenous drip ment was 5–14 d, and both treatments were the same. The equipment. Common disinfection methods can only inac- observation indexes, including the rate of hypothermia, the tivate bacteria or viruses attached to the surface of the improvement of symptoms (sputum volume, color, cough device and the human body, but lack long-lasting antibac- frequency), the disappearance time of signs (lung moist terial properties. By interfering with the formation of the rale, dry rale), the length of use of antibiotics, a labora- cell wall, the silver nanoparticle material can damage the tory examination (blood routine, liver and kidney function, cell membrane and inhibit the formation of protein and chest X-ray film, sputum bacteriology culture, drug sensi- nucleic acid. The material also has good functionality with tivity test), and the evaluation standard of the pulmonary biological metabolism and very low biological toxicity, infection score (CPIS) 2, are shown in Table I. The highest therefore it is harmless and quickly metabolized out of score was 12 points. When a score drops below six points, the body. Moreover, the silver nanoparticle material can antibiotics can be stopped. be applied to the surface of equipment to achieve long- term and sustained antibacterial and sterilization effects. 2.3. Assessment of Therapeutic Effects At present, silver nanoparticle material is often used for According to the Guidance Standard for Clinical Research clinical disinfection in hospitals because of its excellent of Scandium Bacteria issued by the Ministry of Health antibacterial and adhesion properties. in 1993, the criteria for efficacy evaluation are divided Article The purpose of this study was to evaluate the clini- into four levels: recovery, significant effect, progress, and cal efficacy and safety of intravenous piperacillin sodium/ IP: 192.168.39.211 On: Wed, ineffectiveness.29 Sep 2021 02:32:18 Recovery indicates that after treatment, sulbactam sodium injection in the treatment of LRTIs Copyright: American Scientificsymptoms, Publishers signs, laboratory tests, and etiology tests were in elderly Chinese patients after silver materialDelivered disinfec- by Ingenta tion, and to provide evidence that it overcomes clinical completely restored to normal. Significant effect indicates resistance and is a reasonable and effective disinfection that after treatment, the above four items were significantly procedure. improved, but one of them was not completely restored to normal. Progress indicates that after treatment, the four items were improved, but did not reach the significant 2. MATERIALS AND METHODS effect standard. Ineffectiveness indicates that after 72 hours 2.1. General Data of treatment, the symptoms were not improved or were Patients in our hospital from May to November 2018 aggravated. The effective rate is calculated according to with LRTIs were selected in accordance with diagnosis the combination of cure and significant effect [14–16]. standards from 2004 internal medicine and 2004 practical geriatrics. The inclusion criteria required a minimum age 2.4. Adverse Reaction Observation 60 years old, an unlimited number of men and women, The relationship between adverse reactions and drugs no serious liver or kidney dysfunction, and no history of can be divided into five grades: positively related, likely drug allergies. The exclusion criteria excluded those who related, possibly related, positively unrelated, and difficult were expected to fail to complete the course of treatment to judge. The first three are considered adverse reactions, due to various reasons, had a history of central nervous and the incidence of adverse reactions is counted. diseases or epilepsy, or refused to participate in the trial. A total of 44 cases were included, including seven cases of acute attack of chronic obstructive pulmonary disease Table I. Clinical pulmonary infection score. (AECOPD) and 27 cases of pneumonia. Project 0 point 1 point 2 point Body temperature 36–38 38–39 >39 or <36 2.2. Trial Design (12 hour average) Clinical control trials (CCT) were used in the study Leukocyte count 4–11 11–17 <4or>17 design. The selected 44 patients with LRTIs were divided (109/L) into two groups: the piperacillin/sulbactam experimen- Secretion No sputum Medium sputum Lots of sputum > < tal group (n = 24), and the mezlocillin/sulbactam control Oxygenation index 23 23 n = X-ray infiltrating No Plaque like Fusion sheet group ( 20). The experimental group was treated with shadow an intravenous drip device sterilized with silver. In the Mater. Express, Vol. 10, 2020 757 Materials Express Clinical efficacy and safety of silver nanoparticle-based disinfectant Li et al. 2.5. Statistical Analysis The Statistical Package for the Social Sciences (SPSS) software was used for the statistical analysis. The Group t test was used for the measurement data, the test was used for the counting data, and the exact probability method was used for