Objective
To investigate the infection rates of toxin-producing Clostridium difficile and Candida albicans in patients with antibiotic-associated diarrhea (AAD) in West China Hospital of Sichuan University, analyze their clinical characteristics and make a survey of the therapy.
Methods
Fecal specimens of AAD patients were collected in West China Hospital of Sichuan University from September 2014 to January 2015. Toxin-producing Clostridium difficile and Candida albicans were identified by polymerase chain reaction and then clinical data of cases was collected and analyzed.
Results
Twenty-eight patients with Clostridium difficile infection were detected from the 126 AAD patients, 20 patients (15.9%) in whom were infected with toxin-producing Clostridium difficile. Type A+B+, type A-B+, and type A+B- accounted for 35.7% (10/28), 35.7% (10/28) and 28.6% (8/28), respectively. Fifty-four patients (42.9%) with yeast infection were detected. The predominant isolate was Candida albicans, accounting for 20.6% (26/126), and the others were Candida glabrata (n=11), Candida tropical (n=10), Candida parapsilosis (n=3), Saccharomyces cerevisiae (n=2), Pichia pastoris (n=1), and Kodamaea ohmeri (n=1). Toxin-producing Clostridium difficile strains and Candida albicans strains were both isolated from 3 patients (2.4%). The main antibiotics used in AAD ppatients were penicillins, carbapenems, third generation cephalosporins, and fluoroquinolones. AAD patients were all with underlying diseases at different degrees. The main treatments were probiotics and montmorillonite powder.
Conclusion
The relatively high infection rates and complicated factors of AAD indicate that much more attention needs to be paid to the diagnosis and therapy of AAD by the clinical doctors.
Clinical practice is very important in clinical pharmacology education. However, there are some deficiencies in this field in China. Clinical trial institutions in China are medical institutions that are qualified to undertake drug clinical trials. There are hardware and software for clinical pharmacology practice, and high-quality teaching personnel with medical, teaching, and scientific research backgrounds in the clinical trial institutions, which can be used as clinical pharmacology teaching practice bases. Therefore, this article discusses the practice of clinical pharmacology teaching reform using clinical trial institutions as a practical platform, and aims to put forward teaching reform ideas that combining students’ clinical pharmacology research practice on the basis of theoretical teaching.
Objective
To explore the expression differences of procalcitonin (PCT) in different infection sites and bacterial strains, and to provide the evidence for early differential diagnosis of infectious diseases with PCT as a biomarker.
Methods
The patients with various kinds of infections diagnosed in West China Hospital of Sichuan University between January 2012 and June 2016 were retrospectively included. The expression differences of PCT in various infection sites and bacterial strains were analyzed.
Results
A total of 1 005 patients were include in this study, including 259 with systemic infection and 746 with local infection. The median PCT level in the systemic infection group was higher than that in the local infection group (8.57 vs. 0.10 ng/mL, P<0.05). In the 779 patients with pulmonary infection, the median PCT level of the patients with sepsis caused by pulmonary infection was higher than that of the ones without sepsis (4.61vs. 0.10 ng/mL, P<0.05), and the median PCT level of the patients with positive sputum culture was higher than that of the ones with negative sputum culture (0.28vs. 0.08 ng/mL, P<0.05). In the 48 patients with urinary tract infection, the median PCT level of the patients with sepsis caused by urinary tract infection was higher than that of the ones without sepsis (12.00vs. 0.42 ng/mL, P<0.05), and the median PCT level of the patients with complicated urinary tract infection was higher than that of the patients with simplex urinary tract infection (19.15vs. 5.02 ng/mL, P<0.05). In the 259 patients with systemic infection, the median PCT level of the patients with infective shock was higher than that of the ones without infective shock (40.26vs. 3.83 ng/mL, P<0.05); the mean PCT level of patients with infection of Gram-negative bacteria, Gram-positive bacteria and fungi was 13.66, 0.99, and 3.30 ng/mL with a significant difference (P<0.05).
Conclusion
The PCT level has unique advantages in identifying different sites of the infection, early diagnosing complicated urinary tract infection, and evaluating the severity of infection, which could provide evidence in early identification for sepsis caused by various kinds of infectious pathogens.
【摘要】 目的 評價高效抗逆轉錄病毒療法（highly active antiretroviral therapy，HAART）對艾滋病患者的療效，并觀察其耐藥情況。 方法 2008年11月，對23例接受免費HAART治療1~3年的艾滋病患者的HIV-RNA病毒載量、HIV-1耐藥、CD4+T淋巴細胞絕對計數、常規生化檢測結果進行分析。 結果 23例艾滋病患者在HAART治療1~3年后有6例（26.1%）患者HIV-RNA載量在水平線以下，17例（73.9%）HIV-RNA載量未達到檢測線以下。5例患者（21.7%）的HIV-1發生了耐藥，服藥依從性良好的患者僅9例（39.1%）。 結論 HAART對艾滋病患者的療效較差、耐藥率高、服藥依從性差。【Abstract】 Objective To evaluate the efficacy of highly active antiretroviral therapy (HAART) in treating HIV, and observe the resistance of HAART in AIDS patients. Methods Twenty-three HIV patients receiving free HAART for one to three years were investigated. The plasma viral load, drug resistance to HIV-1, CD4+ T cell count were tested and routine laboratory examinations were performed in our study. Results After one to fhnee-year HAART treatment, HIV viral load of six patients (26.1%) declined to the undetectable level, while the viral load of 17 patients (73.9%) kept at a high level. Resistance to HIV-1 occurred in five cases (21.7%). Only nine patients (39.1%) had good treatment compliance. Conclusion HAART has a poor therapeutic effect on patients with HIV/AIDS with a high rate of drug resistance and poor treatment compliance.
【摘要】 目的 探討艾滋病患者合并機會性感染的臨床特征并評價其治療效果。 方法 回顧分析2003年-2009年53例確診為艾滋病患者的臨床資料，對患者合并機會性感染的臨床特征，包括發生機會性感染的時間、發生機會性感染時CD4+T細胞計數、起病急緩、嚴重程度等，進行觀察和分析，并給予國家推薦的標準治療方案進行治療，通過臨床癥狀、病毒載量、CD4+T細胞計數、影像學監測進行療效分析，隨訪時間為初治至出院后6年。 結果 53例艾滋病患者均為重癥感染，41例為混合感染，其中2個以上部位感染者為36例（67.9%），2種以上病原體感染者為28例（52.8%），3種以上病原體感染者13例（24.5%）。最常見的機會性感染為結核35.8%（19/53）；其次為卡氏肺孢子菌肺炎30.2%（16/53）；敗血癥20.8%（11/53），此外，尚有隱球菌感染15.1%（8/53）、弓形蟲感染3.8%（2/53）、帶狀皰疹病毒感染7.5%（4/53）、念珠菌感染17.0%（9/53）、巨細胞病毒感染7.5%（4/53）、合并乙肝11.3%（6/53）、丙肝3.8%（2/53）。機會性感染治療有效率為77.4%（41/53），病死率為22.6%（12/53），其中隱球菌腦膜炎或混合感染者病死率最高。 結論 艾滋病患者在CD4+T細胞計數lt;350/mm3時各種機會感染明顯升高，且隨著CD4+T細胞計數的下降呈增高趨勢，艾滋病合并機會性感染最常見的是結核，其次卡氏肺孢子菌肺炎；合并結核的治療效果較好，合并隱球菌腦病的病死率最高。早期啟動高效抗逆轉錄病毒治療效果好。【Abstract】 Objective To investigate the clinical characteristics of acquired immune deficiency syndrome (AIDS) combined with opportunistic infections and its treatment. Methods We retrospectively analyzed the clinical data of 53 patients diagnosed to have AIDS in our hospital between 2003 and 2009. The clinical features (such as time of the onset of opportunistic infections, CD4+ T cells value at the onset, severity of the infection, etc.) of the opportunistic infections (such as tuberculosis, Pneumocystis carinii pneumonia, toxoplasmosis, etc.) were also observed and analyzed. The patients were treated according to the national standards. The clinical outcome was analyzed based on such indicators as clinical symptoms, viral load, CD4+ T cells value at the onset, and the results of various imaging. Follow-up was done for six years. Results All 53 patients had severe AIDS infection. Forty-one of them had combined infections, among whom 36 (67.9%) had infections in two or more parts of the body, 28 (52.8%) were infected by two or more pathogens, and 13 (24.5%) were infected by three or more pathogens. The most common opportunistic infection was tuberculosis (35.8%,19/53) followed by pneumocystis carinii pneumonia (30.2%,16/53) and septicemia (20.8%,11/53). Other infections included cryptococcal infection (15.1%, 8/53), toxoplasma gondii infection (3.8%, 2/53), herpes zoster virus infection (7.5%, 4/53), candidiasis (17.0%, 9/53), cytomegalovirus infection (7.5%, 4/53), combined hepatitis B (11.3%, 6/53), and hepatitis C (3.8%, 2/53). Effective treatment rate for opportunistic infections was 77.4% (41/53) with a mortality of 22.6% (12/53). The highest fatality rate occurred to those patients with cryptococcal meningitis or mixed infections. Conclusions The occurrence of opportunistic infections rises obviously when CD4+ T cells is lower than 350/mm3, and it increases more significantly as the value of CD4+ T cells goes down. The most common opportunistic infection is tuberculosis followed by pneumocystis carinii pneumonia. The clinical outcome for the combined cases of tuberculosis is good, while combined cryptococcal encephalopathy has the highest mortality rate. High active anti-retroviral therapy should be initiated as early as possible.
Zhaojue is a deeply impoverished county located in Liangshan Autonomous Prefecture with high prevalence of human immunodeficiency virus infection. Based on local conditions, West China Hospital of Sichuan University has established a targeted supporting mode called “three-level organization and five-in-one”. This mode integrates administrative support teams, multiple disciplinary technical support teams and on-site expert teams to achieve five goals, including building effective teams, promoting clinical practice, enhancing skill training, focusing on academics and building a systematic platform. This model has improved the ability of treatment on human immunodeficiency virus infection and overall health services in Zhaojue County. It also reflects the responsibility of West China Hospital of Sichuan University in poverty alleviation and public welfare.
