摘要:目的: 金黃色葡萄球菌(金葡菌)的感染近年來已成為醫院內的主要致病菌,而其耐藥性也呈逐漸升高的趨勢,為了解該菌在我院的感染和耐藥情況,為臨床合理使用抗生素提供科學依據。 方法 : 用經典生理生化鑒定方法,對各種臨床標本主要來源于痰液和各種傷口膿液標本分離到的102株金葡菌進行生物學特性及藥敏試驗。 結果 : 從我們醫院2007年5月至2009年8月所分離出來的102株金葡菌中青霉素耐藥性8923%,氨芐青霉素耐藥率為9385%,沒有發現萬古霉素耐藥菌。 結論 : 除萬古霉素外,耐藥率較低的依次是利福平、苯唑青霉素、環丙沙星、呋喃妥因、阿米卡星、磺胺甲基異惡唑、紅霉素,而青霉素G、氨芐青霉素、四環素耐藥性情況非常嚴重,并且多重耐藥,耐藥性強,應引起臨床的高度重視。Abstract: Objective: To analyze the bionomics and antimicrobial susceptibility of staphylococcus aureus, which was the main pathogenic bacterium with high drug tolerance in our hospital, in order to provide the rational use of antibiotics. Methods : Samples of one hundred and two staphylococcus aureus cases from sputamentum and pus were evaluated by classic physiology and biochemistry methods to test the bionomics and antimicrobial susceptibility. Results : The drug resistance rate to penicillin, penbritin and vancomycin was 8923%, 9385% and 0, separately. Conclusion : Besides vancomycin, the drug resistance rate of rifampicin, oxazocilline, ciprofloxacin, furadantin, amikacin, sulfamethoxazole and sulfamethoxazole increased one by one. The resistance to penicillin G, penbritin and tetracycline was serious, including multidrug resistant, which should be paid highly attention.
摘要:目的：評價圍手術期預防性應用抗菌藥物現狀及合理性。方法：采用回顧性調查的方法，隨機抽查2009年度Ⅰ類切口手術圍手術期病案500份，設計外科圍手術期預防性應用抗生素調查表，對預防用藥的適應證、用藥種類、聯合用藥、給藥時機及持續時間進行統計分析。結果：未使用抗生素5例，預防性使用抗生素495例，其中不合理80例（16.00％）。預防性使用抗生素總品規數為540，其中頭孢菌素類453例（83.89%），青霉素類（包括加酶抑制劑）26例（4.81%），喹諾酮類44例（8.15%）。選用頭孢唑啉鈉178例（32.96%）居第一位，頭孢替唑鈉第二，151例（2796%）。結論：Ⅰ類切口手術患者圍手術期預防性使用抗菌藥物較為合理，但仍存在用藥指征把握不嚴，抗菌藥物的選擇、抗菌藥物使用時間較長等問題，有待進一步規范化管理。Abstract: Objective: To understand the current application of perioperative preventive antibiotics, and their rationality. Methods: Five hundred perioperative records of patients with incision Ⅰ were randomly chosen and surveyed in 2009. A questionnaire for prophylactic use of antimicrobial was designed. The indication of antimicrobial use, the species, combination, timing and drug duration were analyzed. Results: Our of 500, 495 used antimicrobial and 80 were unreasonable; 540 kinds of antimicrobial were used, included cephalosporin 453 cases (83.89%), penicillin class (including plus enzyme inhibitors) in 26 cases (4.81%), quinolone 44 cases (8.15%). Cefazolin sodium (178 patients, 32.96%) ranked first, second was cefazolin sodium (151, 27.96%). Conclusion: Perioperative use of antimicrobial prophylaxis in patients with incision Ⅰ is reasonable, but standardization management should be strengthened in the indication, species, and duration.
Objective To evaluate the value of serumprocalcitonin( PCT) guided antibiotic strategy in the treatment of acute exacerbation of chronic obstructive pulmonary disease( AECOPD) .Methods From August 2011 to June 2012, a total of 96 patients hospitalized for AECOPD were randomly assigned into a PCT-guided group( n = 48) and an empirical therapy group( n = 48) . The PCT levels of PCT-guided group were measured by immunochemiluminometric assays before and 5,7, 10 days after treatment. The PCT-guided group was treated with antibiotics according to serum PCT levels, ie. antibiotic treatment was applied when PCT level ≥ 0. 25 μg/L and was discouraged when PCT level lt; 0. 25 μg/L. The empirical therapy group received antibiotics according to physician’s decision. The antibiotics usage rate, length of antibiotic exposure, length of hospitalization, clinical efficacy, hospital mortality, rate of invasive mechanical ventilation and costs of hospitalization were recorded. Results The antibiotics usage rate, length of antibiotic exposure, length of hospitalization, and costs of hospitalization in the PCT-guided group were all lower than those of the empirical therapy group( P lt;0.05) while clinical efficacy, hospital mortality and rate of invasive mechanical ventilation were similar in two groups(Pgt;0.05) . Conclusion PCT guided antibiotic strategy can be used in the treatment of AECOPD, which may reduce the dose of antibiotic drugs to avoid bacterial resistance and lower costs of hospitalization.
Objective To investigate the diagnostic efficacy of 99mTc-MDP three-phase bone scintigraphy (TPBS) combined with C-reactive protein (CRP) for periprosthetic joint infection (PJI). MethodsThe clinical data of 198 patients who underwent revision surgery of artificial joint between January 2017 and January 2024 and received TPBS examination before surgery were retrospectively analyzed. There were 77 males and 121 females with an average age of 63.74 years ranging from 24 to 92 years. There were 90 cases of hip arthroplasty and 108 cases of knee arthroplasty. PJI was diagnosed according to the 2013 American Musculoskeletal Infection Society (MSIS) standard diagnostic criteria. The sensitivity, specificity, accuracy, negative predictive value (NPV), and positive predict value (PPV) were calculated. The receiver operating characteristic (ROC) curve was used to compare the diagnostic performance of the three methods, and the area under curve (AUC) was used to evaluate the diagnostic performance. ResultsAccording to the 2013 MSIS criteria, 116 cases were diagnosed as PJI, and the remaining 82 cases were aseptic loosening. The cases of PJI diagnosed by TPBS, CRP, and TPBS-CRP were 125, 109, and 137 respectively, and the cases of aseptic loosening were 73, 89, and 61 respectively. The sensitivity, accuracy, NPV, and PPV of TPBS-CRP combination in the diagnosis of PJI were higher than those of TPBS and CRP, but the specificity was lower than that of TPBS and CRP. ROC curve analysis further showed that the AUC value of TPBS-CRP combination was better than that of TPBS and CRP. The severity of bone defect and the duration of symptoms in patients with false positive TPBS diagnosis were worse than those in patients with true negative TPBS diagnosis (P<0.05), but there was no significant difference in the survival time of prosthesis between the two groups (P>0.05). Among the patients diagnosed with PJI by TPBS, CRP, and TPBS-CRP, 49, 35, and 54 patients had received antibiotic treatment 2 weeks before diagnosis, respectively. There was no significant difference in the diagnostic accuracy of TPBS and TPBS-CRP before diagnosis between patients treated with and without antibiotics and those not treated (P>0.05). The diagnostic accuracy of antibiotic therapy before CRP diagnosis was significantly lower than that of untreated patients (P<0.05). Conclusion TPBS and CRP have limited specificity in differentiating PJI from aseptic loosening. The TPBS-CRP combination diagnostic method can synergize the local bone metabolic characteristics and systemic inflammatory response to achieve higher diagnostic accuracy, but caution should be exercised in patients with severe bone defects and longer symptom duration.
【Abstract】ObjectiveTo study the relationship between the bacterial spectrum difference of gallbladder mucosa and choledochus bile and clinical prognosis of gallstone pancreatitis. MethodsA synchronic bacterial culture and drug sensitivity test were carried out on 48 patients with gallstone pancreatitis. ResultsThe cases of positive gallbladder mucosa and choledochus bile were 13 (27.1%) and 31 (64.6%) respectively. The cases of double positivity were 12 (25.0%). The cultural strains of gallbladder mucosa and choledochus bile were significantly different. Some strains were only found in choledochus bile，whereas in gallbladder mucosa L-form bacteria predominated.ConclusionThe most common causative strain of gallstone pancreatitis is Bacterium coli. The drug-resistant strain emerges maybe due to bacterium immigration and delitescence in gallbladder mucosa. L-form bacteria should be considered when using antibiotics, because L-form bacteria have close relationship with the prognosis of gallstone pancreatitis.
【摘要】 目的 了解在圍手術期術前30 min應用抗生素的情況。 方法 根據2004年衛生部、國家中醫藥管理局、總后勤部發布的《抗菌藥物臨床應用指導原則》中圍手術期抗生素的使用原則，對四川大學華西醫院2010年4-6月500臺手術圍手術期抗生素的使用情況進行分析。 結果 抗生素在麻醉前輸：0臺；抗生素末在術前30 min輸2臺，占0.4%；抗生素末即用即配：0臺；抗生素與麻藥及其他禁忌藥混合輸:0臺；手術3 h后末及時追加抗生素：0臺；特殊患者使用抗生素的注意事項不清楚2臺，占0.4%。 結論 該院99.6%的手術實行在手術室術前30 min輸入抗生素，確保抗生素達到有效濃度，有效控制感染，保證手術的成功，保障患者安全。【Abstract】 Objective To investigate the application of perioperative antibiotics half an hour before operation in West China Hospital of Sichuan University. Methods According to Clinical Guidance of Antibiotics published by Ministry of Health, State Administration of Traditional Chinese Medicine and General Logistics Department in 2004, we investigated the application of perioperative antibiotics in 500 operations between April to June 2010 in our hospital. Results There was no operation with infusion of antibiotics before anesthesia, 2 operations without infusion of antibiotics half an hour before operation (0.4%), no operation without immediate infusion after preparation, no operation with mixed infusion of antibiotics and anesthesia and other contraindicated drugs, no operation without infusion of antibiotics 3 hours after operation, and 2 operations in which cautious items about the children, pregnancy and old patients were unclear (0.4%). Conclusion About 99.6% operations in our hospital have the infusion of antibiotics 30 minutes before the operation, which is the guarantee of antibiotics with effective concentration, inhibition of infection, success of the operation and safety of the patients.
Objective
To evaluate the effects of inhalation combined intravenous antibiotics for the treatment of ventilator-associated pneumonia.
Methods
A computerized search was performed through Cochrane library, Joanna Briggs Institute Library, PubMed, MEDLINE, CINAHL, CBM, CNKI and Wangfang medical network about inhalation combined intravenous antibiotics therapy in ventilator-associated pneumonia in the literatures. The data extracting and quality assessment were performed by three researchers. The meta-analysis was performed by RevMan 5.3 software.
Results
Thirteen studies was included for analysis. The results showed that the cure rate was higher in the experimental group compared with the control group with significant difference (RR=1.16, 95%CI 1.07 to 1.56,P=0.000 5). There were no significant differences in the mortality (RR=1.04, 95%CI 0.82 to 1.32,P=0.74) or the incidence of kidney damage (RR=0.79, 95%CI 0.51 to 1.22,P=0.29). The difference in pathogenic bacteria removal was statistically significant (RR=1.38, 95%CI 1.09 to 1.74,P=0.007). The negative conversion rate of respiratory secretions was higher in the experimental group.
Conclusion
Inhalation combined intravenous antibiotics can improve the cure rate of patients with ventilator-associated pneumonia, clear pathogenic bacteria effectively, and is worthy of recommendation for clinical use.
