ObjectiveTo review the research status of anti-infective graft materials and analyze their application prospects, in order to provide inspiration for the development of anti-infective vascular endograft. MethodThe research on endovascular anti-infective grafts at home and abroad was reviewed. ResultsThe anti-infective capability of endovascular graft could be achieved through main approaches like modification of the bulk material, surface modification, or a combination of both. In terms of bulk material modification, this paper delved into the creation of antibacterial composite materials by incorporating other materials into primary materials like metals (such as Mg, Zn), biologically derived materials (such as chitosan, silk fibroin, bacterial cellulose), and synthetic polymers (such as graphene and its derivatives, polyurethane, polylactic acid). Examples included Mg-Nd-Zn-Zr alloy, bacterial cellulose/chitosan nanocrystal composites, and chitosan/silk fibroin composites. For surface modifications, inorganic coatings (such as silver, copper, and nitrides) and organic coatings (such as antibiotics, antimicrobial peptides, and anti-infection polymers) had shown promising antibacterial effects in experiments. ConclusionsThe future research focus is how to synthesize the composite graft material with the mechanical properties of ordinary graft and the cell, blood compatibility and antibacterial properties through nano technology. At the same time, how to synthesize coatings with stable long-term anti-infection and anti-bacterial biofilm performance is also considered to be an important direction of future research.
ObjectiveTo summarize the related research progress of antibacterial modification of orthopaedic implants surface in recent years. Methods The domestic and foreign related literature in recent years was extensively consulted, the research progress on antibacterial modification of orthopaedic implants surface was discussed from two aspects of characteristics of infection in orthopedic implants and surface anti-infection modification. Results The orthopaedic implants infections are mainly related to aspects of bacterial adhesion, decreased host immunity, and surface biofilm formation. At present, the main antimicrobial coating methods of orthopaedic implants are antibacterial adhesion coating, antibiotic coating, inorganic antimicrobial coating, composite antimicrobial coating, nitric oxide coating, immunomodulation, three-dimensional printing, polymer antimicrobial coating, and “smart” coating. Conclusion The above-mentioned antibacterial coating methods of orthopedic implants can not only inhibit bacterial adhesion, but also solve the problems of low immunity and biofilm formation. However, its mechanism of action and modification are still controversial and require further research.
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.
Bacterial biofilms are associated with at least 80% of human bacterial infections. The clinical treatment of biofilm infection is still arduous, and therefore many new treatment options are under study, such as probiotics and their derivatives, quorum sensing inhibitors, antimicrobial peptides, phage therapy, organic acids, light therapy, and plant extracts. However, most of these schemes are not mature, and it is important to develop new research directions of anti-biofilms.
Titanium and its alloys have become one of the most widely used implant materials in orthopedics because of their excellent mechanical properties and biocompatibility. Implant-associated infection is the main reason of failure of orthopedic implant surgery. The anti-infection modification of implant surface has received more attention in the field of infection prevention and developed rapidly. This article focuses on the current research status of simple anti-infection surface modifications that make titanium implants possess anti-adhesion, bactericidal activity or antibacterial membrane activity, as well as the research progress of composite functional surface modifications that promote bone integration, osteogenesis or immunomodulatory effects on the basis of anti-infection, so as to provide references for the construction of orthopedic implants with composite functions.
Objective To evaluate the effects and safety of procalcitonin(PCT)-guided algorithms of antibiotic therapy in critically ill patients in intensive care unit (ICU). Methods Literatures in English and Chinese concerning randomized controlled trials(RCTs) on PCT-guided algorithms of antibiotic therapy in critically ill patients was retrieved by electronic and manual search. All related data were extracted. Meta-analysis was conducted using the statistical software RevMan 5.3 on the basis of strict quality evaluation. Results Eight RCTs involving 2708 ICU patients were included, with 1360 patients in the PCT-guided group and 1348 patients in the control group. Compared with the control group, PCT-guided algorithms were associated with a significant reduction in the duration of antibiotic therapy (MD -2.44 days, 95%CI -3.25 to -1.62, P < 0.00001), and the occurrence of adverse reaction of antibiotics was also lower (RR=0.74, 95%CI 0.56 to 0.97, P=0.03), however the mortality exhibited no difference between the PCT-guided group and the control group (RR=1.00, 95%CI 0.89 to 1.13, P=0.99). Conclusion PCT-guided algorithms can shorten the duration of antibiotic therapy and reduce the occurrence of adverse reaction in critically ill patients without significant effect on mortality.
Sepsis is not only a common critical disease , but also a common complication and cause of death of patients in intensive care unit. It has the characteristics of dangerous condition, rapid development and high mortality. How to treat sepsis to improve the prognosis and quality of life of patients is very important. Timely and reasonable anti-infection is a vatal part in the treatment of sepsis. This article will review the progress of anti-infective therapy in adult patients with sepsis, starting from empirical anti-infection, procalcitonin-guided anti-infection, bacterial culture combined drug sensitivity test-guided anti-infection and anti-infection with antimicrobial peptides, aiming to provide a certain basis and reference for the anti-infective treatment of adult sepsis.
Objective To investigate the spectrum of diseases and the current situation of antibiotic use in rural hospitals and community health service centers in Chengdu, so as to provide evidence for selecting essential medicines and promoting rational use of antibiotics. Method We selected 7 township/community health institutions, from which we collected inpatient and outpatient information. Information about antibiotic use was also collected, including categories, cost, and dosage. A standard questionnaire was used to investigate physicians’ prescription behavior for principal diseases. Result Urban and rural areas had different spectrums of diseases. The major diseases in urban areas included diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and respiratory tract infection; while those in rural areas were infectious diseases of the respiratory system, digestive system, and urinary system. The physicians’ prescription behavior was mainly based on their personal experience. Antibiotics accounted for 30-50% of the total medicine cost. The top four types of antibiotics with the highest cost were cephalosporins, penicillin, quinolones, and macrolides. Conclusion Based on the different spectrums of diseases, essential drug lists and standard treatment guidelines appropriate for rural health care should be developed to improve the rational use of drugs. Factors such as the average cost of daily dose and the course of treatment should be taken into consideration to reduce the overall cost of medicine. An antimicrobial resistance monitoring system and special training courses on rational use of antibiotics should be utilized in the rural health institutions.