摘要:目的: 探讨我院呼吸内科病房老年肺部疾病患者并发真菌感染发病的相关因素,分析其易患因素、临床特征和治疗。 方法 : 采用回顾性调查方法对2002年1月至2008年6月收住内科的经微生物检查证实49例继发真菌感染的患者进行分析,并与同期无真菌感染的肺部疾病患者(对照组)比较。 结果 : 在呼吸内科病房中,老年患者院内肺部真菌感染发生率为378%,主要感染部位为泌尿系(218%),呼吸道(269%),消化道(409%)。慢性阻塞性肺疾病(498%)是继发院内肺部真菌感染最常见的基础疾病,其感染因素为长期使用广谱抗生素(962%)和糖皮质激素(332%)、营养状况不良(583%)出现低蛋白血症及合并糖尿病、白细胞减少和侵袭性诊疗操作等。肺部真菌感染的临床表现无特异性,确诊需结合痰培养,组织病理学和临床表现来确定,感染菌种以白色念珠菌为主,占626%。氟康唑治疗有效率914%。研究组与同期无真菌感染的肺部疾病患者(对照组)比较:病死率分别为612%和082%,两组治疗无效的病例(恶化和死亡病例)比较差异有显著性。 结论 : 院内真菌是呼吸系统疾病继发感染的重要病原体,而白色假丝酵母菌是院内肺部真菌感染的主要致病菌,宿主免疫状态、感染播散和疾病严重程度是影响预后的因素。该研究认为老年肺部疾病患者并发真菌感染的相关因素和影响预后的因素对其预防、诊断、治疗、改进预后和生存质量有重要的临床意义。除有效的抗真菌治疗外,积极的综合治疗有助于提高真菌感染的治愈率。Abstract: Objective: To study the susceptible factors,clinical features and treatments of nosocomial pulmonary fungal infection in the ward of respiratory department.〖WTHZ〗Methods : The chart files of 49 patients with nosocomial pulmonary fungal infection admitted from January 2002 to June 2008 in the ward of Respiratory Department were reviewed. Results : The incidence rate of nosocomial pulmonary fungal infection was 378%.COPD(498%)was the main predisposing disease,and candidiasis(626%) was the most common pathogen. The main susceptible factors associated with nosocomial pulmonary fungal infection are longterm use of broadspectrum antibiotics(962%),hypoalbuminemia(583%),longterm use of adrenocortical steroid(332%),and diabetes mellitus.There is no specific clinical feature.Fluconazole(914%)is more efficient in the treatment.〖WTHZ〗Conclusion : Nosocomial pulmonary fungis are important pathogenin the secondary infection in respiratory disease.The most common pathogen is candida albicans.Combined therapy as well as treating fungus infection are important measures to increase the cure rate of nosocomial pulmonary fungal infection.
摘要:目的: 探讨在阑尾切除术中应用抗菌薇乔缝线以减少阑尾切口感染的可能性。 方法 : 将我院2007年4月至2009年3月所有阑尾切除术病例1425例随机分为抗菌薇乔缝线组和丝线组,比较其切口感染发生率。 结果 : 统计中按阑尾未穿孔、阑尾穿孔以及总计分别计算切口感染率,在抗菌微乔线组感染率分别为017%、072%、028%,丝线组分别为154%、781%、267%,两组间分别予以X2检验,其〖WTBX〗P 值均小于001,具有显著性差异。 结论 : 缝线是辅助产生切口感染的一个危险因素,在阑尾切除术中使用抗菌薇乔缝线可以显著降低切口感染率。Abstract: Objective: To investigate the application of Coated VICRYL Plus Antibacterial suture in order to reduce the possibility of infection of appendectomy incision. Methods : Hospital from April 2007 to March 2009 appendectomy patients in all 1425 cases were randomly divided into Coated VICRYL Plus Antibacterial suture group and silk group,compared to the incidence of incision infection. Results : The statistics are not in accordance with perforated appendicitis, perforated appendicitis, as well as calculation of the total, respectively, incision infection, the infection rate in the Coated VICRYL Plus Antibacterial suture group were 017%, 072%, 028%, silk group were 154%, 781%, 267% between the two groups separately X2 test, the P value of less than 001, with a significant difference. Conclusion : The suture is to assist the incision produced a risk factor for infection in appendectomy,Coated VICRYL Plus Antibacterial suture can be used in a significant reduction in incision infection rates.
Since the outbreak of coronavirus disease 2019 (COVID-19), health authorities at all levels have issued many prevention and control schemes, guidelines, and notices, and medical institutions have also formulated hospital-level COVID-19 prevention and control measures accordingly. However, the epidemic prevention and control work can only be done well when the prevention and control measures are effectively implemented. West China Hospital of Sichuan University has adopted the two-level (hospital-level and department-level) supervision. By clarifying the content and frequency of two-level supervision and adopting multiple forms of supervision, a complete supervision system covering the whole hospital has been formed. Through supervision, risk points in prevention and control were identified and continuous improvement was carried out to promote the implementation of prevention and control measures. This paper introduces the application of two-level supervision in COVID-19 prevention and control in West China Hospital of Sichuan University, providing a reference for peers.
OBJECTIVE: To investigate the effect of vascular pedicled rib grafting in treatment of the pyogenic infection of the thoracolumbar intervertebral space. METHODS: From November 1993, 7 cases with pyogenic infection of the thoracolumbar intervertebral space were adopted in this study. Among them, there were 5 males and 2 females, aged from 29 to 58 years old. The position of pyogenic infection located at T10 to 11 in 3 cases, at T11 to 12 in 2 cases and at T12 to L1 in 2 cases. During operation, the pyogenic infection was cleared completely and the rib with vascular pedicle was grafted into the intervertebral space. RESULTS: Followed up for 10 to 60 months, the bone graft unioned in 3 months for 5 patients and unioned in 4 months for 2 patients. There was no recurrence and raised kyphosis. CONCLUSION: The technique of vascular pedicled rib graft is simple, it can shorten the bone union time and reconstruct the stability of spine.
Objective To investigate the relations between the human beta defensin-2 (HBD-2) and systemic inflammatory responses in patients with lower respiratory tract infection（LRTI）. Methods Eighty-one patients with confirmed LRTI including community-acquired pneumonia，acute exacerbation of chronic obstructive pulmonary disease or concurrent lung infection，and bronchiectasis concurrent infection were enrolled，and twenty healthy volunteers were included as control. Plasma concentrations of HBD-2，IL-1β，and IL-8 were assayed with ELISA method in all patients and controls. Furthermore the patients were divided into three groups according to the onset of disease:,ie.group A （shorter than 7 days），group B （7 to 14 days），and group C （more than 14 days）. The differences between these groups were compared. Correlation between HBD-2 and IL-1β or IL-8 concentrations was analyzed. Results HBD-2，IL-1β，white blood cell （WBC） of the peripheral blood in the patients with LRTI were all significantly higher than those in the healthy controls. HBD-2 and IL-1β increased in group A and group B，and decreased in group C comparing to the control group （Plt;0.05 respectively）. There was no significant difference of IL-8 in group A，B and C. HBD-2 showed a positive linear correlation with IL-1β （r=0.313，P=0.030） and no correlation with IL-8（Pgt;0.05）. Conclusions The plasma HBD-2 concentration is increased in LRTI patients，which may be a biomarker of systemic inflammation in the early or relative early course of LRTI.
Objective To evaluate the efficacy and safety of genus Phyllanthus for chronic HBV infection. Design a systematic review of randomized clinical trials. Methods Randomized trials comparing genus Phyllanthus versus placebo, no intervention, general non-specific treatment, other herbal medicine, or interferon treatment for chronic HBV infection were identified by electronic and manual searches. Trials of Phyllanthus herb plus interferon versus interferon alone were also included. No blinding and language limitations were applied. The methodological quality of trials was assesses, by the Jadadscale plus allocation concealment. Results Twenty-two randomized trials (n=1 947) were identified. The methodological quality was high in five double blind trials and rest was low. The combined results showed that Phyllanthus species had positive effect on clearance of serum HBsAg (relative risk 5.64, 95%C1 1.85 to 17.21) compared with placebo or no intervention. There was no significant difference on clearance of serum HBsAg, HBeAg and HBV DNA between Phyllanthus and interferon. Phyllanthus species were better than non-specific treatment or other herbal medicines on clearance of serum HBeAg, HBeAg, HBV DNA, and liver enzyme normalization. Analyses showed a better effect of the Phyllanthus plus interferon combination on clearance of serum (1.56, 1.06 to 2.32) and HBV DNA (1.52, 1.05 to 2.21) than interferon alone. No serious adverse events were reported. Conclusions Based on the review Phyllanthus species may have positive effect on antiviral activity and liver biochemistry in chronic HBV infection. However, the evidence is not b due to the general low methodological quality and the variations of the herb. Further large trials are needed.
Objective To improve the success rate of the reverse fascio-cutaneous flap in repairing the infected wound, to observe the effect of surgical delay on the anti-infection abil ity of the reverse fascio-cutaneous flap by establ ishing an oryctolagus cuniculus model of reverse fascio-cutaneous flap based on sural nerve on the lateral side of left later l imb. Methods Sixteen 5-month-old Japanese white rabbits weighing 2.0-2.5 kg (mean, 2.3 kg) were randomly divided into experimental group (n=8) and control group (n=8). The reverse fascio-cutaneous flap of 4 cm × 2 cm was designed, based on 1 cm above the lateral malleolar as pedicle in sural nerve region in the lateral left later l imb. In the experimental group, thefull-thickness of the flap distal end half was harvested according to the design; and after 10 days delay, the full-thickness flap was obtained according to the design, and 0.5 mL staphylococcus aureus solution was implanted at a density of 3.8 × 106 /mL in 2 groups. The general observation was performed postoperatively; the venous blood of the marginal ear vein was collected to observe white blood cell (WBC) count before implantation of staphylococcus aureus solution and after 1, 3, 5, 7, 10, and 14 days of implantation. The flap survival rate and the colony counting of necrosis flap tissue were calculated after 10 days of implantation; the blood vessel cal iber and the peak value of peroneal artery blood flow of flap proximal end were measured after 14 days of implantation. Results All animals survived to the end of the experiment, and all incisions healed primarily. Inflammatory reaction with different degrees was observed after implantation in 2 groups, and it was obvious at 3-5 days. Inflammatory reaction in the experimental group was sl ighter than that in the control group. Except for no significant difference before implantation and after 14 days of implantation between 2 groups (P gt; 0.05), there were significant differences in WBC count at other time points between 2 groups (P lt; 0.05). The flap survival rate of the experimental group (93.20% ± 4.62%) was significant higher than that of the control group (72.65% ± 7.80%) after 10 days of implantation (P lt; 0.05). The colony counting of necrosis flap tissue in the experimental group [(20.63 ± 5.76) × 103 colony/g] was significantly lower than that in the control group [(32.38 ± 6.14) × 103 colony/g] after 10 days of implantation (P lt; 0.05). The blood vessel cal iber of the experimental group and the control group were (1.03 ± 0.10) mm and (0.75 ± 0.09) mm, respectively, and the peak value of peroneal artery blood flow in the experimental group and the control group were (20.73 ± 2.46) cm/s and (13.83 ± 1.51) cm/s, respectively, after 14 days of implantation; showing significant differences between 2 groups (P lt; 0.05). Conclusion Surgical delay has the abil ity of enhancing survival and anti-infection of the rabbit reverse fascio-cutaneous flap.
Objective To analyze the species distribution and resistance of the pathogens isolated fromblood cultures of the patients in intensive care unit ( ICU) , and provide a basis for prevention and control of bloodstream infections in critically ill patients. Methods The data of blood cultures of the patients in ICUduring January 2009 to December 2011 was investigated retrospectively.Results In the last 3 years, positive rate of blood cultures of ICU patients was 15. 4% , 15. 7% , and 17. 6% respectively. Among the isolates, Gram-positive bacteria were predominant ( 52. 3% ) , followed in order by gram-negative bacteria ( 33. 1% ) and fungi ( 14. 7% ) . Aerobe and facultative anaerobe were the predominant bacterial isolates ( 99. 7% ) . Enterococcus faeciumand Staphylococcus spp. were the most common gram-positive bacteria, and 4. 5% of E. faecium isolates were resistant to vancomycin. Rate of methicillin-resistance for S. aureus and S. epidermidis was 73. 5% and 93. 7% respectively. In terms of gram-negative bacteria, Acinetobacter calcoaceticus- A. baumannii complex were the leading species, 96. 9% of the isolates had multi-drug resistance and 14. 1% of the isolates had extra-drug resistance. Klebsiella pneumonia and Escherichia coli isolates were less frequently isolated and those producing extended spectrum beta-lactamases accou ted for 70. 3% and 80. 0% of the isolates respectively. Candida spp. was the most common fungi isolates ( 96. 7% )with an annual change of species distribution and declining susceptibility to azoles.Conclusions Gram-positive bacteria should be the major target for prevention and control of bloodstream infections in critically ill patients. Whereas, more attention should be paid to the infection caused by candida spp. and multidrug resistant gram-negative bacteria.
Objective To observe the clinical manifestations, therapeutic efficacy and results of bacterial culture of seven patients of scleral buckle (SB) infection after scleral bulking surgery. Methods Seven patients (seven eyes) underwent SB removal for SB infections were enrolled in this study. The patients included four males (four eyes) and three females (three eyes). The patients aged from 12 to 69 years, with a mean age of 42.7 years. There were four right eyes and three left eyes. The duration (interval between primary surgery and SB removal) ranged from two weeks to ten years, with a mean of 47.5 months. Six patients were concurrent with systemic disease. All the patients were examined for visual acuity, slit lamp microscope and indirect ophthalmoscope examination. Some patients also received external eye examination and fundus photography. Whether SB exposure or not and the clinical manifestations were observed. SB removal was performed in all the patients and the SB were sent to the laboratory for bacterial culture. The follow-up time ranged from two weeks to eight months, with a mean of 3.2 months. Whether infections recurrence and retinal detachment or not were observed. Results SB exposure was in three eyes. Obvious ocular pain and swelling, conjunctival hyperemia and visible yellow-white discharge in the conjunctival sac were presented in two eyes; irritation and discharge were in one eye. No SB exposure was in four eyes. Ocular pain and swelling, conjunctival hyperemia and visible yellow-white discharge in the conjunctival sac were presented in two eyes. Repeated subconjunctival hemorrhage and diplopia were presented in one eye. Visual acuity decline, conjunctival sac discharge and total retinal detachment were in one eye. All patients had no intraocular inflammation. The infection was controlled after SB removal and the retina was attached during the follow-up. The bacterial culture were all positive, which included Staphylococcus aureus, Staphylcoccus epidermidis and Erysipelothrix rhusiopathiae, Gram positive corynebacterium, Aspergillus flavus, Kocuria roseus, Streptococcus oralis, Maxwell Corynebacterium. Conclusions The clinical manifestations of SB infection and the pathogenic microorganisms are variable. SB removal can control the infection.
Objective To explore the pathogen distribution and the characteristics of antibiotics use of patients with positive bile culture in order to provide evidence for appropriate antibiotic use. Methods Using a patient-based approach, the clinical and laboratory data of patients with positive bile culture between December 1st 2016 and November 30th 2017 were retrospectively analyzed. The pathogen distribution and antibiotics use of patients with bililary duct infections and colonizations were analyzed. Multidrug-resistant organism infections of patients with bililary duct infections were studied. Results There were 299 submitted bililary samples and in which 158 were culture-positive (52.8%). One hundred and ten strains of pathogens were found in 79 patients with positive bile culture, including 66 strains of Gram-negative (G–) organisms (60.0%), 37 strains of Gram-positive (G+) organisms (33.6%), and 7 strains of fungi (6.4%). The top three G– organisms were Escherichia coli (25 strains, 22.7%), Klebsiella pneumoniae (9 strains, 8.2%), and Acinetobacter baumanii (7 strains, 6.4%). The top three G+ organisms were Enterococcus faecium (10 strains, 9.1%), Enterococcus faecalis (6 strains, 5.5%), and coagulase negativeStaphylococcus (6 strains, 5.5%). The number of patients with bililary duct infections and colonizations were 42 and 37, respectively, with pathogens occupied mainly by G– bacteria. Ten strains of multidrug-resistant organisms were isolated from patients with bililary duct infections. Compared to patients with non-multidrug-resistant organism infections, the length of antibiotics use was longer in patients with multidrug- resistant organism infections (t=2.129, P=0.039). The rate of target therapy for antibiotics in patients with bililary duct infections was 76.2%. The rate of proper antibiotics use was 16.2% before positive bile culture and 78.4% after positive bile culture in patients with bililary duct colonizations. Conclusions Pathogens isolated from bile culture of infection and colonization are predominantly G– organisms. The bile culture and blood culture should be done for patients with suspected bililary duct infection. Infection and colonization should be distinguished for positive bile culture and antibiotic should be chosen according to drug susceptibility test results.