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...
ObjectiveTo investigate the status of antibiotic drug use in the outpatient department based on the special rectification activities of antibiotic drugs, identify the reasons for irrational use of antibiotic agents and propose the solutions. MethodsPrescription of antibiotic drugs were analyzed by a retrospective comparative analysis during April to June 2011, August to October 2011 and August to October 2012. ResultsPrescriptions of antibiotic drugs were 435 (36.25%), 367 (30.58%) and 223 (18.58%) during April to June 2011, August to October 2011 and August to October 2012, respectively, and the unreasonable prescriptions were 35 (2.92%), 27 (2.25%), and 14 (1.25%) respectively. ConclusionThere is a decreased tendency of prescription of antibiotic drugs in the outpatient department of our hospital because of the special rectification activities of antibiotic drugs. It is in accordance with antibiotic use rate of <20% target of "antibiotics in 2012 special rectification program" in hospital outpatient service. But there are some unreasonable phenomena in the use of antibiotics, and to promote the reasonable use of antibiotics, we should strengthen management.
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.
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.
ObjectiveTo understand the characteristics of and risk factors for nosocomial infection in a newly built branch of a university teaching hospital, in order to investigate the control measures for prevention and control of nosocomial infection. MethodsA total of 598 cases of nosocomial infection from April 2012 to June 2014 were enrolled in this study. We analyzed statistically such indexes as nosocomial infection rate, infection site, pathogen detection, and use of antibiotics. Meantime, infection point-prevalence survey was introduced by means of medical record checking and bedside visiting. ResultsAmong all the 44 085 discharged patients between April 2012 and June 2014, there were 598 cases of nosocomial infection with an infection rate of 1.36%. Departments with a high nosocomial infection rate included Intensive Care Unit (ICU) (9.79%), Department of Orthopedics (2.98%), Department of Geriatrics (2.62%), and Department of Hematology (1.64%). The top four nosocomial infection sites were lower respiratory tract (45.32%), urinary tract (13.21%), operative incision (8.86%), and blood stream (8.86%). The samples of 570 nosocomial infections were delivered for examination with a sample-delivering rate of 95.32%. The most common pathogens were acinetobacter Baumanii (17.02%), Klebsiella pneumoniae (14.21%), Escherichia coli (13.68%), Pseudomonas aeruginosa (11.93%), and Staphylococcus aureus (9.12%). And urinary tract intubation (42.81%), admission of ICU (28.60%), and application of corticosteroid and immunosuppressive agents (26.42%) were the top three independent risk factors for nosocomial infection. ConclusionGeneral and comprehensive monitoring is an effective method for the hospital to detect high-risk departments, factors and patients for nosocomial infection, providing a theoretical basis for prevention and control of nosocomial infection.
Objective To evaluate the effects of inhalation combined intravenous antibiotics for the treatment of ventilator-associated pneumonia. Methods A computerized search was performed through Cochrane library, Joanna Briggs Institute Library, PubMed, MEDLINE, CINAHL, CBM, CNKI and Wangfang medical network about inhalation combined intravenous antibiotics therapy in ventilator-associated pneumonia in the literatures. The data extracting and quality assessment were performed by three researchers. The meta-analysis was performed by RevMan 5.3 software. Results Thirteen studies was included for analysis. The results showed that the cure rate was higher in the experimental group compared with the control group with significant difference (RR=1.16, 95%CI 1.07 to 1.56,P=0.000 5). There were no significant differences in the mortality (RR=1.04, 95%CI 0.82 to 1.32,P=0.74) or the incidence of kidney damage (RR=0.79, 95%CI 0.51 to 1.22,P=0.29). The difference in pathogenic bacteria removal was statistically significant (RR=1.38, 95%CI 1.09 to 1.74,P=0.007). The negative conversion rate of respiratory secretions was higher in the experimental group. Conclusion Inhalation combined intravenous antibiotics can improve the cure rate of patients with ventilator-associated pneumonia, clear pathogenic bacteria effectively, and is worthy of recommendation for clinical use.
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 investigate the effects of antimicrobial management program on inpatients outcomes and antimicrobial resistance among clinical isolates in a large-scaled university hospital.MethodsThe antibiotics use density (AUD) and antimicrobial resistance rate of multi-drug resistant bacteria before (from January 2009 to December 2010) and after (from January 2012 to December 2016) the intervention of antimicrobial management program in a large-scaled university hospital (4 300 beds) were calculated and compared, and the correlations of AUD with average length of hospital stay and mortality rate were analyzed.ResultsThe AUD was significantly decreased after intervention (P<0.001). The resistance rate of Staphylococcus aureus to oxacillin decreased (P<0.001). Among Gram-negative bacteria, the resistance rates to carbapenems in Acinetobacter baumannii (P<0.001) and Klebsiella pneumoniae increased (P=0.011). AUD was not correlated with the average length of hospital stay (P=0.644), while positively correlated with the in-hospital mortality rate (r=0.932, P=0.001).ConclusionsThe implementation of antimicrobial management program can significantly reduce the antimicrobial use and do not worsen patient outcomes in the hospital. The impact of the program on resistance varies significantly depending on both the bacterium and the agent, and carbapenem-non-susceptible Gram-negative bacilli emerges as a major threat. It is still necessary to combine other infection control measures.
ObjectiveTo explore the therapeutic effect and its possible mechanisms of somatostatin combined with antibiotics on acute cholecystitis through the detection of serum tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) in rabbits. MethodsForty-five rabbits were randomly averagely classified into three groups following the establishment of acute cholecystitis model: control group, blank group， and experimental group. The rabbits in control group received cefazolin sodium and metronidazoie by intravenous injection twice a day. The rabbits in experimental group got a hypodermic injection of somatostin (20 μg/kg) twice a day besides antibiotics, while these drugs were replaced by equal volume of normal saline for the rabbits in control group. The concentrations of serum TNFα and CRP were detected by enzyme-linked immunosorbent assay and histomorphological and electron microscopic changes of gallbladder in rabbits were observed on 3 d after administer. ResultsThe concentrations of serum TNF-α of rabbits in experimental group 〔(401.6±48.7) pg/ml〕 were significantly lower than those in control group 〔(767.3±67.4) pg/ml〕 and blank group 〔(806.7±61.2) pg/ml〕, P=0.000 and P=0.000, while the difference between the latter two groups was not significant (P=0.196). The concentrations of serum CRP of rabbits in experimental group 〔(16.2±1.1) mg/L〕 were significantly lower than those in control group 〔(55.4±1.2) mg/L〕 and blank group 〔(72.8±8.9) mg/L〕, P=0.000 and P=0.000, and which was higher in blank group compared with control group (P=0.018). The Histopathological results showed that gallbladder wall emerged mulifocality mucosal fluid necrosis, lamina propia hyperemia, bulk neutrophil infiltration and sequent alleviation of reaction in the rabbits of experimental group when compared with the rabbits of blank group and control group. Electron microscopic results demonstrated that the intercellular junction of gallbladder kept relative integrity and the swelling and vacuolar degeneration of mitochondria and endoplasmic reticulum obviously relieved. ConclusionsSomatostatin can significantly reduce the concentrations of serum TNF-α and CRP in the model of rabbits acute cholecystitis, which may protect the mucous membrane of gallbladder from the inflammation reaction.
ObjectiveTo investigate the current problems and corresponding solutions regarding the use of antibiotic-impregnated cement spacer for the treatment of periprosthetic joint infection (PJI). MethodsA retrospective analysis was made on the clinical data of 27 patients with PJI who underwent two-stage revision with antibiotic-impregnated cement spacer between January 2001 and January 2013. There were 12 males and 15 females, with an average age of 62.7 years (range, 25-81 years). All arthroplasties were unilateral, including 19 hip PJI and 8 knee PJI. The mean duration from primary arthroplasty to PJI was 25 months (range, 3-252 months). After infection was controlled with the antibiotic-impregnated cement spacer combined with systematic antibiotics treatment, two-stage revision was performed. The effectiveness was evaluated. ResultsOne patient died of myocardial infarction at 2 days after surgery. Infection was controlled, and two-stage revision was successfully performed in 19 patients; deep venous thrombosis occurred in 1 of 3 patients who experienced hip spacer fractures, which was cured after conservative management. The spacers were removed and bacteria-sensitive antibiotics was used because of recurrent infections after the first-stage surgery in 7 patients; 3 patients gave up treatment because infection was not controlled, 4 patients received revision after infection was controlled. Twenty-three patients were followed up 1-5 years (mean, 2.3 years). The average Harris hip score and KSS score at 1 years after revision were significantly improved when compared with preoperative ones (P<0.05). In the 8 patients with gram-negative or fungus infection, 7 were found to have recurrent infection after the first-stage surgery; in the 12 patients with gram-positive infection, no recurrent infection was found. Failed treatment was observed in 1 patient with gram-positive and gram-negative infections and 2 with fungus infection, respectively. ConclusionAntibiotic-impregnated cement spacer has a satisfactory effectiveness for PJI. However, complication of spacer fracture should be noted, especially hip spacers. If the pathogen is gram-negative bacteria or fungus, the implanted spacer may increase the possibility of recurrent infection.