A model of infection following trarma was established by introducing B.staphyloecus aureus into the wound.In the exporimental anlmals,the intraoporative high regional concentration of antibiotics was adopted to prevent infection of the distal part of the limb of the rabbits,and those trcated with the conventional method were served as the control.The results showed that in the exporimental animals,not a single limb had developed infection,while in the control group,The tissue culture s...
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.
ObjectiveTo find out the major isolates distribution, drug resistance changes of multidrug-resistant organisms (MDRO) in 2013 for rational use of antibiotics and hospital infection control. MethodsA total of 32 566 cultured bacteria samples from the patients diagnosed between January 1st and December 31st 2013 were collected, using conventional tube biochemical assays and semi-automatic automicrobic (AMS) for bacteria identification; and antimicrobial susceptibility testing, major drug resistance mechanism detection were performed according to CLSI documents. MDRO definition was made according to the 2011 international consensus from European Center for Disease Control and Prevention (CDC), American CDC, Clinical and Laboratory Standards Institute (CLSI), and Food and Drug Administration. The data was analyzed by WHOnet 5.6 software. ResultsWe got 3 684 strains isolates, G- accounted for 76.08%, G+ 16.80%, fungi 7.11%, and fastidious bacteria 17.29%. The top ten isolates in order were:E.coli, A.baumannii, Ps.aeruginosa, H.influenzae, K.pneumoniae, S.aureus, S.pneumoniae, A.fumigatus, M.catarrhalis and C.freundii. From the first quarter 2012 to the fourth quarter 2013, the extended spectrum β lactamases (ESBL)-producing E.coli increased from 40.23% to 53.54%, ESBL-producing K.pneumonia increased from 14.28% to 34.78%, XDR-A.baumannii increased from 62.38% to 99.25%, metalloenzyme-producing Ps.aeruginosa increased from 7.37% to 25.37%, methicillin resistant staphylococcus aureus increased from 23.81% to 58.70%, and VRE increased from 0.00% to 28.12%. ConclusionIn the isolates, the percentage of G- was the highest, and the rate of MDRO are all unremittingly raising, which suggests us should pay more attention to microbiology analysis, rational use of antibiotics, strengthening hospital infection control, reducing the bacterial resistance, and strengthening MDRO surveillance.
ObjectiveTo explore the clinical application and effectiveness of antibiotic-loaded cement spacer combined with free fibular graft in the staged treatment of infectious long bone defect in the lower extremity. MethodsA retrospective analysis was made on the clinical data from 12 patients with infectious long bone defect in the lower extremity between June 2010 and June 2012. Of the 12 cases, there were 9 males and 3 females with an average age of 33 years (range, 19-46 years), including 3 cases of femoral shaft bone defect, 7 cases of tibial shaft bone defect, and 2 cases of metatarsal bone defect. The causes were traffic accident injury in 7 cases, crashing injury in 3 cases, and machine extrusion injury in 2 cases. The length of bone defect ranged from 6 to 14 cm (mean, 8 cm). The soft tissue defect area ranged from 5.0 cm×3.0 cm to 8.0 cm×4.0 cm companied with tibial shaft and metatarsal bone defect in 9 cases. The sinus formed in 3 femoral shaft bone defects. The time between injury and operation was 1-4 months (mean, 2 months). At first stage, antibiotic-loaded cement spacer was placed in the bone defect after debridement and the flaps were used to repair soft tissue defect in 9 cases; at second stage (6 weeks after the first stage), defect was repaired with free fibular graft (7-22 cm in length, 14 cm on average) after antibiotic-loaded cement spacer removal. The area of the cutaneous fibular flap ranged from 6.0 cm×4.0 cm to 10.0 cm×5.0 cm in 10 cases. ResultsAll wounds healed by first intention, and the healing time was 12-18 days, 14 days on average. Twelve cases were followed up 12-36 months (mean, 17 months). Bone healing time ranged from 4 to 6 months (5.5 months on average). The cutaneous fibular flap had good appearance. The function at donor site was satisfactory; no dysfunction of the ankle joint or tibial stress fracture occurred after operation. The mean Enneking score was 25 (range, 20-28) at last follow-up. ConclusionInfection can be well controlled with the antibiotic-loaded cement spacer during first stage operation, and free fibular graft can increase the bone defect healing rate at second stage. Staged treatment is an optimal choice to treat infectious long bone defect in the lower extremity.
ObjectiveTo systematically review the health economic evaluation studies in which externalities of antibacterial drug uses were identified.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect health economic evaluation studies in which externalities of antibacterial drug uses were identified from inception to December 31st, 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Descriptive analysis was then performed.ResultsA total of 14 studies were included. Negative externalities and their impacts on costs and/or effectiveness were examined in 13 literature, and positive externalities in terms of an improvement in disease control were included in only one study. No study was found in which both negative and positive externalities were included. The methods used to quantify negative externalities included: only costs associated with drug resistance per prescription or per unit were calculated; both costs and health impacts associated with the second/third line treatments followed a treatment failure (due to drug resistance) were calculated using a decision tree. In one study in which positive externalities were measured, both health gain and cost reduction from an improvement in disease control (as a benefit of antibacterial drug uses) were calculated by constructing a dynamic model at the population level.ConclusionsWe propose that both the positive and negative externalities should be included in health economic evaluation. This can be achieved by measuring the relevant costs and health impacts in a broader perspective, using a disease-transmission dynamic model. In addition, to achieve an improved health utility measurement, disability-adjusted-life years rather than quality-adjusted-life years should be encouraged for use. Finally, both costs and effectiveness should be discounted.
Objective To evaluate systematically the effect of antibiotic treatment on ventilator-associated tracheobronchitis (VAT). Methods Pubmed,Web of Science,OVID SP (ACP Journal Club,Cochrane Central Register of Contralled Trials,Embase,Medline),as well as China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data were searched for literatures about antibiotic treatment on VAT.The search deadline was March 2016.Meta-analysis was conducted with RevMan 5.3 software. Results A total of 6 studies with 769 patients were included.Among 769 patients,432 patients were treated by antibiotics,and 337 patients in control group were treated without antibiotics.Meta-analysis showed antibiotics treatment significantly reduced incidence of ventilator-associated pneumonia compared with control group [OR=0.27,95%CI (0.17,0.43),P<0.05],and shortened length of ICU stay [MD -1.51,95%CI(-2.04,-0.98),P<0.00001] .There were no significant difference in duration of mechanical ventilation [MD -2.52,95%CI (-6.85,1.81),P=0.25],mortality [OR=0.41,95%CI(0.15,1.14),P=0.09],or drug-resistant bacteria production [OR=0.62,95%CI(0.17,2.19),P>0.05]. Conclusions Antibiotic treatment can reduce incidence of ventilator-associated pneumonia in patients with VAT.Further more high quality randomized controlled trials are needed to assess the effect of antibiotic treatment on VAT.
In order to choose the appropriate antibiotics for treating secondary pancreatic infection, permeability of antibiotics to pancreatic tissue was investigated on experimental dogs with acute hemorrhagic necrotizing pancreatitis. The concentrations of 8 different antibiotics were determined in the blood and the pancreatic tissue using highperformance liquid chromatography. Pancreatic tissue permeability of Cefotaxime, Ofloxacin, Amikacin, Piperacllin, Cefoperazone, Ampicillin, Metronidazole and Ciprofloxacin was 12%, 19%, 20%, 46%, 55%, 63%, 71% and 132% respectively. The study shows that this eight antibiotics have different permeability to the pancreatic tissue. Such observations support the existence of a bloodpancreas barrier, which acts to restrict the permeation of antibiotics into the pancreas. The results suggest that antibiotics with high permeability rate be used to treat the patient with secondary pancreatic infection.
PURPOSE: To investigate the treatment of severe bacterial endophthalmitis. METHODS:The curative effects of vitrectomy after intravitreal antibiotics and steroids (IVAS)for the treatment of 23 patients with bacterial endophthalmitis (group I)and vitrectomy and IVA at the same time for the treatment of 28 patients with bacterial endopbthalmitis (group I)were analyzed retrospectively. RESULTS: The rate of curative effects of two groups were similar,while the marked curative effects in group I (47.8% )was significantly higher than that of the group I (17.9%). The average period of eliminating infiamation of group I was longer than that of group I , and the incidence of postoperative retinal detachment of group Ⅱ was 3 times more than that of group I . CONCLUSION :It was indicated that vitrectomy after IVAS may increase the security of vitrectomy and the curative effects of severe bacterial ndophthalmitis.
Objective To explore the interference of recent use of antibiotics in the sensitivities of different methods for the detection of Helicobacter pylori (Hp) in children. Methods From June 2015 to December 2017, children who were highly suspected of Hp infection and required gastroscopy were divided into the antibiotic group and the control group according to the recent use of antibiotics, with 200 cases in each group. The use of antibiotics of children in the antibiotic group was analyzed. The children in the two groups completed five methods of Hp detection, including rapid urease test (RUT), 13C-urea breath test (13C-UBT), pathological Warthin-Starry staining, colloidal gold method for measuring Hp immunoglobulin M (IgM) antibody, and enzyme linked immunosorbent assay method for measuring Hp stool antigen (HpSA). Comparative analyses of data were done. Results The positive rate of RUT was 36.5% in the antibiotic group and 75.0% in the control group (P<0.05). The positive rate and value of13C-UBT were 59.0% and 13.6±4.7 in the antibiotic group, and 78.0% and 41.7±6.6 in the control group (P<0.05). The positive rate of pathological biopsy was 48.0% in the antibiotic group and 68.0% in the control group (P<0.05), and L-forms were found in 80.9% of the Hp-positive specimens in the antibiotic group. The positive rate of IgM antibody was 54.5% in the antibiotic group and 65.5% in the control group (P<0.05). The positive rate of HpSA was 38.0% in the antibiotic group and 69.0% in the control group (P<0.05). In the antibiotic group, only 12.5% of the children used antibiotics for eradication of Hp and 87.5% for non Hp eradication. Conclusions Under the interference of antibiotics use, the sensitivity of 13C-UBT is the highest among the five methods for Hp detection, and the sensitivities of RUT and HpSA are very low. For children who could not cooperate with 13C-UBT, the sensitivity of IgM detection is relatively high. For children who need gastroscopy, prolonged chromogenic time for RUT and multi-point pathological biopsy can reduce misdiagnosis.
ObjectiveTo analyze the choice of initial antibiotic treatment for health care-associated pneumonia (HCAP). MethodA retrospective study was conducted in patients with HCAP hospitalized in the Emergency Department of West China Hospital from January 1st to December 31st, 2014. A total of 156 HCAP patients were divided into anti-multidrug-resistant treatment group (group A, n=72) and quinolone monotherapy group (group B, n=84). The baseline characteristics, comorbidities, severity, pathogen distribution, antibiotics and clinical outcomes were compared between the two groups. ResultsIn group B, there were 46 males and 38 females with the age of (59.9±10.9) years, and the pneumonia severity index (PSI) score was 89.5±22.7; in group A, there were 44 males and 28 females with the age of (62.2±12.2) years, and the PSI score was 94.4±23.6. The differeces between the two groups were not significant (P>0.05). The duration of using antibiotics in group B was (14.5±3.7) days, which was longer than that in group A[(12.8±3.8) days, P=0.005]. The detection rate of multidrug-resistant bacteria, the proportion of changing antibiotics, the average length of hospitalization, the proportion of using mechanical ventilation, the proportion of patients transferred into Intensive Care Unit and 30 days mortality in group B was 17.9%, 34.5%, (16.9±3.6) days, 11.9%, 9.5%, and 4.8%, respectively; which were similar to those in group A[15.3%, 22.2%, (17.3±3.9) days, 16.8%, 12.5%, and 4.2%, respectively] (P>0.05). ConclusionsIt is unnecessary for all HCAP patients to receive anti-multidrug-resistant treatment. We should regard the risk factors and the popular local features of microbiology to determine the choice of antibiotic treatment.