ObjectiveTo systematically review the efficacy of antibiotics on the outcomes of patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors. MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect cohort studies on efficacy of antibiotics on the outcomes of patients with NSCLC treated with immune checkpoint inhibitors from inception to August 1st, 2021. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 27 cohort studies involving 7 087 patients were included. The results of meta-analysis showed that antibiotic use was associated with poor overall survival (OS) (HR=2.04, 95%CI 1.68 to 2.49, P<0.000 01) and progression free survival (PFS) (HR=1.63, 95%CI 1.35 to 1.99, P<0.000 01). ConclusionCurrent evidence shows that antibiotic use is associated with poor OS and PFS. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
手術野感染（surgical site infection, SSI）是外科手術的并發癥之一。為預防和減少SSI，采用了不少措施： 提高空氣的潔凈度，良好的患者皮膚準備和腸道準備，治療已存在的感染灶，提高術中防護，減少術中污染。預防性抗生素的使用是重要措施之一。多年實踐證明，預防性抗生素使用，可以減低SSI發生率。近來預防性抗生素使用已近乎成為常規了，抗生素用量迅速增長。但如何使用預防性抗生素在臨床上缺乏統一的認識與規范。
目的 分析下肢慢性創傷性骨髓炎患者創面細菌培養分布情況，為臨床用藥提供依據。 方法 對2006年1月－2010年12月收治的91例慢性骨髓炎患者創面分泌物細菌培養標本結果進行回顧性調查分析。其中男78例，女13例；年齡5～78歲，平均41.3歲。病程47 d～7個月，平均68.6 d。使用抗生素總療程均＞7 d。 結果 65例創面細菌培養陽性患者共分離出113株病原菌，其中G?菌72株，占63.71%；G+菌41株，占36.28%。藥敏結果顯示，G+菌對常規青霉素類基本耐藥，碳青霉烯類耐藥菌株少見，對萬古霉素耐藥菌株尚未出現。G?菌對青霉素類及頭孢菌素類耐藥較高，對頭孢哌酮－舒巴坦無耐藥。 結論 加強對慢性創傷性骨髓炎患者創面病原菌監測極為必要,對臨床抗生素的合理使用具有一定的指導意義。Objective To analyze the distribution of cultured bacteria from chronic osteomyelitis patients, and provide a basis for clinical medicine. Methods We retrospectively analyzed the bacterial culture results of the secretions from 91 patients with chronic osteomyelitis treated in our hospital from January 2006 to December 2010. Among them, there were 78 males and 13 females aged from 5 to 78 years averaging at (41.3 ± 8.35) years. The duration of the disease ranged from 47 days to more than 7 months, averaging (68.6 ± 14.57) days. The total course of antibiotic-taking was longer than 7 days for all the patients. Results A total of 113 pathogen strains were isolated from 65 secretion samples, including 72 Gram-negative bacteria accounting for 63.71% and 41 gram-positive bacteria accounting for 36.28%. Drug susceptibility results showed basic resistance of Gram-positive bacteria to conventional penicillin, rare resistance to carbapenem, and no resistance to vancomycin. Gram-negative bacteria were basically resistant to penicillin and cephalosporins, but not resistant to cefoperazone-sulbactam. Conclusion Enhancing the monitoring of pathogens for patients with chronic osteomyelitis is extremely necessary for the rational clinical use of antibiotics.
目的 了解單純膽囊切除術圍手術期應用預防性抗生素的作用。方法 對我院普外一科1998年1月至1999年12月2年間所施行的642例擇期單純膽囊切除術圍手術期抗生素的使用、細菌培養結果和切口感染情況進行回顧性分析。結果 642例根據其抗生素應用情況分為未用抗生素組(n＝220)、術前30分鐘一次性給藥組(n＝200)和術后3天持續用藥組(n＝222) 3組，3組患者之性別、年齡構成情況、全身狀況及發生術后切口感染情況間的差異均無顯著性意義(Ｐ＞0.05)； 對642例中隨機選擇52例行術中膽囊膽汁培養，結果47例無細菌生長。結論 對單純膽囊切除術患者術前無感染前提下，不用或僅術前30分鐘一次性使用抗生素是安全可行的，這對縮短患者住院日，減少其醫療費用具有積極的意義。
Objective To investigate the feasibility and effectiveness of antibiotic bone cement directly inducing skin regeneration technology in the repairing of wound in the lateral toe flap donor area. MethodsBetween June 2020 and February 2023, antibiotic bone cement directly inducing skin regeneration technology was used to repair lateral toe flap donor area in 10 patients with a total of 11 wounds, including 7 males and 3 females. The patients’ age ranged from 21 to 63 years, with an average of 40.6 years. There were 3 cases of the distal segment of the thumb, 2 cases of the distal segment of the index finger, 1 case of the middle segment of the index and middle fingers, 1 case of the distal segment of the middle finger, and 3 cases of the distal segment of the ring finger. The size of the skin defect of the hand ranged from 2.4 cm×1.8 cm to 4.3 cm×3.4 cm. The disease duration ranged from 1 to 15 days, with an average of 6.9 days. The flap donor sites were located at fibular side of the great toe in 5 sites, tibial side of the second toe in 5 sites, and tibial side of the third toe in 1 site. The skin flap donor site wounds could not be directly sutured, with 2 cases having exposed tendons, all of which were covered with antibiotic bone cement. ResultsAll patients were followed up 6 months to 2 years, with an average of 14.7 months. All the 11 flaps survived and had good appearance. The wound healing time was 40-72 days, with an average of 51.7 days. There was no hypertrophic scar in the donor site, which was similar to the color of the surrounding normal skin; the appearance of the foot was good, and wearing shoes and walking of the donor foot were not affected. ConclusionIt is a feasible method to repair the wound in the lateral foot flap donor area with the antibiotic bone cement directly inducing skin regeneration technology. The wound heals spontaneously, the operation is simple, and there is no second donor site injury.
ObjectiveTo evaluate the value of serum procalcitonin (PCT) level after conventional intravenous antibiotic treatment to predict the risk of re-exacerbation, and vertify the feasiblity of an additional course of oral antibiotics after discharge to reduce the risk of re-exacerbation. MethodsThe patients who hospitalized in West China Hospital from October 2012 to October 2013 because of infectious acute exacerbation of chronic obstructive pulmonary disease (AECOPD) were recruited. The concentrations of PCT and C-reactive protein (CRP), the number of white blood cell (WBC) and neutrophil percentage at the end of intravenous antibiotic therapy were recorded. The information about additional course of antibiotics was collected according to the medical instruction and visit. The subjects were followed up for 1 year.The time to the first re-exacerbation and frequencies of exacerbations were recorded. The Cox regression model was used to estimate the hazard rations (HR). ResultsOne hundred and thirty-eight eligible patients were included totally. The HRs in PCT≥0.11μg/L and neutrophil percentage≥70% were 1.462 (P=0.035) and 1.673 (P=0.005) respectively, suggesting higher risk of re-exacerbation. There was no relationship of CRP (P=0.330) or WBC (P=0.432) with the risk of re-exacerbation. Generally an additional course of antibiotics had no effects on re-exacerbation (P=0.231) but this therapy could reduce the risk of re-exacerbation in high PCT level group (HR=2.29, P=0.004). ConclusionsSerum PCT concentrations and neutrophil percentage after conventional intravenous antibiotic treatment can predict the risk of re-exacerbations in the future. An additional course of antibiotics in the patients with high PCT level can reduce the risk of re-exacerbation.