ObjectivesTo systematically review the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy.MethodsPubMed, EMbase, The Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect clinical studies on the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy from January 1990 to September 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software and Stata 15.0 software.ResultsA total of 8 retrospective cohort studies and 1 randomized controlled trial involving 60 136 subjects were included. The results of the meta-analysis showed that: there was no difference in the post-operational infection rate among patients with and without antimicrobial prophylaxis for arthroscopies (OR=0.51, 95%CI 0.25 to 1.04, P=0.06). For knee arthroscopies, the post-operational infection rate had no difference between patients with and without antimicrobial prophylaxis (OR=0.89, 95% CI 0.65 to 1.23, P=0.48). However, for shoulder arthroscopies, the post-operational infection rate in the antimicrobial prophylaxis group was significantly lower than that in the group without the antimicrobial prophylaxis(OR=0.18, 95%CI 0.08 to 0.37, P<0.000 01).ConclusionsCurrent evidence shows that there is no association between preoperative antimicrobial prophylaxis and a decreased infection rate for knee arthroscopies. Antimicrobial prophylaxis appears to lead to fewer infections after shoulder arthroscopies. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Cardiac implantable electronic device (CIED) is commonly used to treat arrhythmias. The amount of CIED implantation has increased year by year since its first application in 1958. At the same time, the CIED infection rate also increases significantly. Although the infection rate is very low for the primary implantation, the consequences of CIED infection are serious, and it is often necessary to remove the equipment for treatment. The mortality rate in patients with CIED infections is high, and the economic burden is huge. In this paper, the epidemiology, pathogenesis and pathogen, manifestations and diagnosis, risk factors, treatment and preventive measures of CIED infection were systematically described based on the recently published guidelines and international consensus literature, so as to provide theoretical guidance for the prevention of CIED infections.
ObjectiveTo investigate the effect of multidrug resistant (MDR) bacterial infection in clinical course of acute pancreatitis.
MethodsThe medical records of 134 patients with a diagnosis of infected pancreatic necrosis in West China Hospital from Jan. 2003 to Jun. 2010 were reviewed.
ResultsMDR microorganisms were found in 78 of the 134 patients. MDR group had higher rate of transferred patients than non-MDR group (38.5% vs. 10.7%, P=0.002). The intensive care unit admission rate was significantly higher in patients with MDR bacterial infections (48.7% vs. 26.8%, P=0.01). The mean intensive care unit stay was significantly longer in patients with MDR bacterial infections (20 days vs. 3 days, P<0.001). Mortality and total hospital stay was not significantly different in the patients with MDR infections vs. those without it (20.5% vs. 14.3%, P>0.05; 78 d vs. 55 d, P>0.05).
ConclusionClinicians should be aware of the high incidence and impact of MDR infections in patients with acute necrotizing pancreatitis, especially in transferred patients.
ObjectiveTo summarize the clinical characteristics and treatment of acute cellulitis of shank after total knee arthroplasty.
MethodsWe retrospectively analyzed the clinical data of five patients with delayed acute cellulitis of shank after total knee arthroplasty treated in our hospital between January 2008 and January 2013. The clinical characteristics, treatment and prognosis of the disease were then summarized and analyzed.
ResultsThe delayed acute cellulitis of shank after total knee arthroplasty was mainly caused by tinea pedis, which resulted in skin damage and bacteria diffusion. The main clinical manifestations were pain and swelling around the knee joint and shank. The laboratory test found the increasing of C-reactive protein, erythrocyte sedimentation rate, white blood cell and neutrophils. Two cases were caused by hemolytic streptococcus according to blood culture. All patients were discharged after treatment without periprosthetic infection.
ConclusionAccording to the typical clinical manifestations and laboratory test, the diagnosis of delayed acute cellulitis of shank is not difficult. Timely and comprehensive treatment should be emphasized to seek and eradicate the primary lesions, such as tinea pedis, subcutaneous ulcer and carbuncle.
The limitation of resource of blood and risk of transfusion-transmitted infections contribute to development and generalization of restrictive transfusion strategy. However, advanced evidences of clinical trials indicated a restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs. It is time to optimize patient blood management but not free-transfusion and increase of risk of patients. The duration of red-cell storage was not associated with significant differences in the mortality and morbidity of patients. Three new pathogen-reduction technologies and pharmaceutical intervenes may provide safe of transfusion and improvement of outcomes.
Objective To evaluate the relationship between the severity of neonatal infection and the activity change of cardiac enzyme. Methods A total of 102 infectious neonates in NICU were evaluated with neonatal serious illness scoring system and then divided into non-critical, critical, and extremely-critical groups. The activity of such serum myocardial enzymes as AST, ALT, LDH, CK, and CKMB was tested in the first 24 hours on admission. Comparison between groups and analyses were conducted. Resultes Myocardial enzyme of the critical and extremely-critical groups was obviously higher than that of the non-critical group (Plt;0.01). Conclusion The serious illness score of infectious neonates is closely associated with the activity change of myocardial enzyme and the level of serum myocardial enzymes has certain advantages in judging the myocardial injury and the disease severity of neonatal infection.
Objective To explore the early prevention measures of severe acute pancreatitis （SAP） complicated with infection. Methods The foreign and native related literatures of SAP complicated with infection in recent 10 yearswere retrieved， and the effect of sooner measures for SAP complicated with infection were discussed. Results It was beneficial to reduce the incidence of infection and improve the outcome in SAP by using antibiotics of apt through the blood-pancreatic barrier， using proton pump inhibitor properly， and using enteral nutrition， hemofiltration， and hyperbaric oxygen as soon as possible， and then combined with traditional Chinese medicine. Conclusions SAP complicated with infection is the one of the main reasons of death. It is a must to take effective and comprehensive measures in the early stage in order to reduce the rate of infection. However， there are several unclear problems to probe in the future on this issue.
OBJECTIVE: To explore the possibility of repair long segmental bone defects and preventing infection with cefazolin loaded bone matrix gelatin (C-BMG). METHODS: C-BMG was made from putting cefazolin into BMG by vacuum adsorption and freeze-drying techniques. The sustaining period of effective drug concentration in vitro and in vivo was detected by inhabition bacteria, and the drug concentration in local tissues (bone and muscle) and plasma after implantation of C-BMG was examined by high performance liquid chromatography(HPLC). RESULTS: The effective inhibition time to staphylococcus aureus of C-BMG was 22 days in vitro, while 14 days in vivo. The drug concentration in local tissues(bone and muscle) were higher than that of plasma, and the drug concentration in local tissues was higher in early stage, later it kept stable low drug release. It suggested that C-BMG had excellent ability to repair segmental long bone defects. CONCLUSION: C-BMG can gradually release cefazolin with effective drug concentration and has excellent ability to repair segmental long bone defects. It may be a novel method to repair segmental long bone defects and prevent infection after the operation.
Objective To study the effect of vancomycin-loaded polymethylmethacrylate (VCMPMMA) in the treatment of an experimental hemiprosthetic hip infectionof rabbits. Methods The infected hemiprosthetic hip joints of the rabbits underwent debridement and one-stage revision arthroplasty. Requested by the “fixed” method, 24 rabbits were equally divided into 2 groups: the control group and theexperimental group. The prostheses were fixed with PMMA in the control group, but with VCM-PMMA in the experimental group. X-ray films were taken immediately after operation, and then 4, 8, and 12 weeks after operation. The C reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were measured before operation, then measured 1, 3, and 7 days after operation, and then 2, 4, 8, and 12 weeks after operation, i.e., they were measured at the above 8 time points. All the rabbits were sacrificed 12 weeks later. The cure rate of the infection was determined by the blood culture for the corresponding bacteria and the Rhodamine-labeled anti-Staphylococcus epidermidisimmune serum staining. Results The X-ray films revealed that6 hemiprosthetic hip joints were dislocated in the control group, but 3 in the experimental group; 58.3% and 16.7% of the hemiprosthetic hip joints were reinfected in the control group and the experimental group, respectively. At 8 weeks in the control group, the serum CRP level decreased to a greater extent than that measured at the time of debridement, but in the experimental group just at 2 weeks （Plt;0.01）. ESR remained elevated in the control group, but at 4 weeks ESR were significantly lowered compared with that measured at the time of debridement（Plt;0.01）. The test results for the pathogenic organisms revealed that the re-infection incidences were respectively 58.3% (7/12) and 16.7% (2/12) in the control group and the experimental group, with the successful revision rates of 41.7% and 83.3% respectively in the above 2 groups. The light microscopy revealed that therewas a heavy infiltration by the inflammatory cells in the reinfected tissues, but there was a proliferation of the fibrocytes in the tissues of the cured patients. Conclusion Onestage revision arthroplasty can significantly promote the control of the hemiprosthetic hip joint infection in rabbits by the use of VCM-PMMA.
Objective To review the association between chlamydia pneumoniae (CP) infection and cerebral infarction. Methods We electronically searched MEDLINE, BIOSIS, VIP database, and China Full Text Journal Database from Jan. 1990 through Dec. 2007 to identify case-control studies about the association of CP and cerebral infarction. The quality of the included studies was assessed and the RevMan 4.2 software was used for meta-analyses. Results A total of 22 studies were included. The results of meta-analyses showed: ① When the microimmunofluorescence (MIF) method was used to examine CP antibody in serum, the positive rate of the cerebral infarction group was higher than that of the control group when the positive infection was defined by IgA≥1?16 [n=8, OR=2.18, 95%CI (1.49 to 3.49), Plt;0.0001]; but when positive infection was defined by IgA≥1?32 (n=3), IgG≥1?32 (n=6), or IgG≥1?64 (n=5), there were no significant differences in the positive rate between the two groups [OR (95%CI) were 1.47 (0.97 to 2.24), 1.24 (0.82 to 1.86), and 1.23 (0.98 to 1.55), respectively]; ② When the ELISA method was used to examine CP-IgG antibody in serum, the positive rate of the cerebral infarction group was higher than that of the controlled group [n=8, OR=2.40, 95%CI (1.42 to 4.06), P=0.000 2]. ③ The acute and chronic CP infections were associated with the incidence of cerebral infarction [n=4, OR=7.22, 95%CI (2.68 to 19.49); n=4, OR=4.30, 95%CI (3.40 to 7.40)]. Conclusion ① The association between CP infection and cerebral infarction is determined by the positive criterion. IgA antibody is more sensitive than the IgG antibody. When the positive infection is determined by IgA≥1?16, CP infection is associated with cerebral infarction. ② The results of ELISA for examining CP-IgG support the association between CP infection and cerebral infarction. ③ Both acute and chronic CP infections are associated with cerebral infarction, but these associations needed to be proven by more scientific studies.
