摘要:目的: 金黄色葡萄球菌(金葡菌)的感染近年来已成为医院内的主要致病菌,而其耐药性也呈逐渐升高的趋势,为了解该菌在我院的感染和耐药情况,为临床合理使用抗生素提供科学依据。 方法 : 用经典生理生化鉴定方法,对各种临床标本主要来源于痰液和各种伤口脓液标本分离到的102株金葡菌进行生物学特性及药敏试验。 结果 : 从我们医院2007年5月至2009年8月所分离出来的102株金葡菌中青霉素耐药性8923%,氨苄青霉素耐药率为9385%,没有发现万古霉素耐药菌。 结论 : 除万古霉素外,耐药率较低的依次是利福平、苯唑青霉素、环丙沙星、呋喃妥因、阿米卡星、磺胺甲基异恶唑、红霉素,而青霉素G、氨苄青霉素、四环素耐药性情况非常严重,并且多重耐药,耐药性强,应引起临床的高度重视。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.
Objective To study and prepare a new kind of bone graft, which has osteogenesis, local anti-infective function and low immunogenicity. Methods Gentamicin-impregnated bone was prepared bymeans of ultrasonic and vacuum, the release of gentamicin in vivo was measured by inhibition bacteria. Ten healthy male adult sheep were made animal infection models of thigh bone or humerus defect of 6 mm×6 mm×20 mm at size, and the defect was inoculated into 1 ml 5×1010CFU/ml Staphylococcus aureus. The animals were randomly divided into the experimental group (n=5, the bone graft with gentamicin was implanted) and the control group (n=5, the bone graft without gentamincin). Macroscopic, WBC count, radiological, and histological investigations were carried out to evaluate the antiinfective and osteosis capability. Results The concentrations of gentamicin were 46.1 μg/ml in bone allograft and 17.3 μg/ml in muscles after 1 day. The concentrations of gentamicin exceeding the minimum inhibitory concentration lastedfor 14 days in vivo. WBC in the control group was higher than that in the experimental group. In the control group, 1 case died owing to septemia 3 weeks afteroperation. The implanted bones were wrapped in pus 4 and 6 weeks, and the defects were filled with fibre tissue 8 and 10 weeks after operation. In the experimental group, 1 case was infected, the others had a good concrescence. The bone allografts began to integrate with adjacent bone after 4-8 weeks and integrate well after 12 weeks. The X-ray and histological observation showed that new bone formed and took the place of bone allograft. Conclusion The gentamicinimpregnated bone allograft was of a good sustained release feature in vivo, local antiinfection and osteogenesis. It might be an ideal bone grafting material for bone defects with infection.
ObjectiveTo understand the clinical distribution and drug resistance of Klebsiella pneumoniae in Yibin during 2011 to 2014 so as to provide evidence for clinical rational use of antimicrobial drugs. MethodsKlebsiella pneumoniae isolated from all types of clinical specimens were collected from the First People's Hospital and the Second People's Hospital of Yibin during 2011 to 2014. VITEK2 Compact and its supporting identification card GP and drug sensitivity test card AST-GP67 were used for detection, and the results were analyzed and summarized. ResultsMost Klebsiella pneumoniae were detected from the Department of Respiratory Medicine, the proportion for each year was 48.15%, 46.24%, 45.44%, and 44.97% during 2011 to 2014. Klebsiella pneumoniae isolated were mainly from sputum samples, the proportion for each year was 81.01%, 89.18%, 87.80%, and 83.52% between 2011 and 2014. Imipenem and piperacillin/tazobactam resistance rates were lower, but the overall trend was rising. Ampicillin/sulbactam, and sulfamethoxazole resistance rates were higher. Levofloxacin, ciprofloxacin increased year by year. Aztreonam, cefepime, and amikacin rate declined. ConclusionKlebsiella pneumoniae is one of the main infection pathogen in the Department of Respiratory Medicine. Klebsiella pneumoniae resistance rates are higher. Klebsiella pneumoniae were sensitive to enzyme inhibitors β-lactam antimicrobial agents and carbapenem antibiotics.
Objective To investigate the status of nurses’ cognition of skin test for β-lactam antibiotics in tertiary hospitals in China and its influencing factors. Methods The nurses in the eastern and western regions were selected by stratified sampling and convenient sampling between March and May 2023. A multi-center survey was conducted with the help of the questionnaire star platform using the “Questionnaire on the Cognitive Status of β-lactam Antibiotics Skin Test” developed by the “Guidelines for β-lactam Antibiotics Skin Test (2021 Edition)” issued by the National Health Commission of the reference country. Results A total of 89 tertiary hospitals were surveyed. Among them, there were 27 in the eastern regions and 62 in the western regions; There were 64 comprehensive hospitals and 25 specialized hospitals. A total of 4 241 nurses were included. Among them, 4 151 were females and 90 were males. The scores of nurses’ cognition of skin test of β-lactam antibiotics were (61.47±16.27). The survey results showed that the accuracy rate ranges from 15.52% to 88.98%. Only no routine skin test before cephalosporin administration, judgment of skin test results, and infusion device replacement after allergy were greater than 80%. The results of the logistic regression analysis showed that the nurses with professional titles and antimicrobial management training in the past 2 years were independent influencing factors of nurses’ cognition of skin test of β-lactam antibiotics (P<0.001). Conclusions At present, nurses in tertiary hospitals in China still have insufficient knowledge of skin test of β-lactam antibiotics. It is suggested that hospitals should form corresponding hospital skin test of β-lactam antibiotics standards in combination with guidelines and strengthen training for nurses in this regard, so as to improve nurses’ correct cognition and implementation of skin test of β-lactam antibiotics.
ObjectiveTo investigate the effectiveness of debridement-vacuum sealing drainage (VSD)-modified external fixation antibiotic-impregnated cement semi-open technique in treatment of chronic ulcer wounds. MethodsClinical data of 43 patients with chronic ulcer wounds who met the selection criteria and admitted between January 2019 and June 2023 were retrospectively analyzed. Among them, 23 cases were treated with debridement-VSD-modified external fixation antibiotic-impregnated cement semi-open technique (improved group), and 20 cases were treated with debridement-VSD-traditional antibiotic-impregnated cement technique (control group). There was no significant difference in gender, age, constituent ratio of patients with type 2 diabetes mellitus, constituent ratio of patients with smoking history, body mass index, wound site, and other baseline data between the two groups (P>0.05). The healing quality and healing time, the positive rate of bacterial culture after bone cement coating, the loosening rate of bone cement, the number of operations, the number of hospitalizations, the length of hospitalization, and the cost of hospitalization were recorded and compared between the two groups. Results Compared with the control group, the positive rate of bacterial culture after bone cement coating and the loosening rate of bone cement in the improved group was significantly lower, as well as the number of operations, the number of hospitalizations, the length of hospitalization, and hospitalization cost significantly reduced (P<0.05). Wound repair was completed in both groups without amputation. The wound healing quality of the improved group was better than that of the control group and the wound healing time was shorter, the differences were significant (P<0.05). All patients were followed up 1-5 years (mean 3.4 years), and no ulcers recurred during follow-up. ConclusionDebridement-VSD-modified external fixation antibiotic-impregnated cement semi-open technique in the treatment of chronic ulcer wounds can effectively reduce the loosening rate of bone cement, facilitate the induced membrane formation and wound healing, and significantly reduce the number of operations and shorten the length of hospital stay.
The treatment of patients with advanced lung cancer has been revolutionized with the advent of immunotherapy. However, not all patients can benefit equally from immunotherapy. In recent years, the relationship between intestinal flora and the efficacy of immunotherapy has gradually attracted scholars' attention. During the treatment of immune checkpoint inhibitors, the use of antibiotics, proton pump inhibitors and other drugs will affect the patient's intestinal flora, thus affecting the efficacy of immune checkpoint inhibitors, leading to poor prognosis of patients. This review will discuss that antibiotics and proton pump inhibitors reduce the efficacy of immunotherapy by affecting the diversity of intestinal flora, in order to facilitate the rational use of related drugs in clinical practice and improve the patient's outcomes.
Objective To systematically assess the efficacy and clinical significance of antibiotic prophylaxis in severe acute pancreatitis (SAP), so as to provide references for its rational clinical application. Methods For collecting the randomized controlled trials (RCTs) about antibiotic prophylaxis in SAP, a search was conducted in MEDLINE, EMbase, Cochrane Central Register of Controlled Trials, CBM and CNKI from the date of their establishment to August, 2010. After the clinical studies meeting the inclusive criteria were extracted and their quality was assessed. Meta-analysis was conduced by using RevMan 5.0 software. Results Twelve RCTs were included with a total of 777 patients. The results of Meta-analysis showed compared with the control group, the antibiotic prophylaxis group was not associated with a statistically significant reduction in mortality (RR=0.75, 95%CI 0.50 to 1.12), in the incidence of infected pancreatic necrosis (RR 0.82, 95%CI 0.63 to 1.09), in surgical interventions (RR=0.97, 95%CI 0.74 to 1.26), and in the incidence of nonpancreatic infections (RR=0.73, 95%CI 0.48 to 1.10). Conclusion Antibiotic prophylaxis for SAP does not reduce mortality, infected necrosis, or surgical intervention.
细菌耐药是一个全球性的难题，而滥用抗生素是导致细菌耐药的重要原因。合理使用抗生素的核心包括以下三点：①选择合适的抗生素（有效、经济、毒副作用小和使用方便）；②采取合适的给药方法（给药剂量、间期和途径）；③采取合适的疗程。其中抗生素的疗程究竟多长最合适是目前研究最薄弱的环节，同时也是当前和今后抗感染领域研究的热点[1]。
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.
Objective To analyze the clinical characteristics and risk factors of noninfectious fever after endovascular repair of aortic dilatation diseases, and explore the management strategy. Methods We reviewed 468 patients who received endovascular aortic repair from January 2021 to October 2023. The patients who were selected were classified into a febrile group and an afebrile group according the fever after operation. The fever data were analyzed, and the demographics, operative data were researched to sieve out the correlation factors. Logistic regression analysis was conducted for the risk factors of postoperative fever if the P value≤0.05 in the univariate analysis, and receiver operating characteristic curve (ROC) was used to analyze the predictive indexes of postoperative noninfectious fever. Results75.08% (229/305) patients had noninfectious fever after aortic repair and 98.25% of them had fever within 2 days. There were 229 patients in the febrile group, mean age 65 (53.0,73.0) years (83.4% males , and 76 patients in the afebrile group, mean age 71(65.0,76.7) years(84.2% males). Univariate analysis showed that the number of patients with coronary heart disease, using statins before operation and aortic aneurysm in the febrile group were significantly lower than those in the afebrile group, and patients were younger in the febrile group. The logistic regression showed that age, surgical site, type of disease, preoperative hyperthermia, type of stent were positively correlated with noninfectious fever, while statin use was negatively associated with noninfectious fever. And age, surgical site, preoperative hyperthermia and stent type were analyzed by means of ROC curve (P<0.01). Conclusion Noninfectious fever is very common after aortic repair. The relationship between fever and infection should be comprehensively judged according to the risk factors of noninfectious fever and the disease status to promote rational use of antibiotics.