ObjectiveTo evaluate the efficacy of aerosolized aminoglycoside antibiotics in patients with ventilator-associated pneumonia (VAP) by meta-analysis.MethodsWe searched PubMed, Embase, China National Knowledge Infrastructure, VIP and Wanfang Data for the Chinese and English literature on aerosolized aminoglycoside antibiotics for VAP until May, 2018. After data extraction and quality evaluation, RevMan 5.2 software was performed for meta-analysis.ResultsA total of 9 randomized controlled trials and a total of 543 patients were included in this study. Compared with patients treated with non-atomized inhaled aminoglycoside antibiotics, meta-analysis showed that aerosol inhalation of amikacin significantly improved the clinical cure rate of patients with VAP ［odds ratio (OR)=2.37, 95% confidence interval (CI) (1.50, 3.75), P=0.000 2］, nebulized tobramycin ［OR=2.30, 95%CI (0.92, 5.78), P=0.08］ and two or more antibiotics ［OR=2.00, 95%CI (0.62, 6.46), P=0.25］ had no significant effect on the clinical cure rate of patients with VAP; aerosolized aminoglycoside antibiotics had no significant effect on mortality of patients ［OR=1.17, 95%CI (0.66, 2.07), P=0.59］ and tracheal spasm rate ［OR=2.39, 95%CI (0.94, 6.11), P=0.07］ and renal dysfunction rate ［OR=0.62, 95%CI (0.32, 1.21), P=0.16］ in patients with VAP.ConclusionInhalation of amikacin can significantly improve the clinical cure rate of patients with VAP, but it can not reduce the mortality rate of patients; the safety of aerosolized aminoglycoside antibiotics is good, and the risk of tracheal spasm and renal function damage in patients with VAP is not increased.
Improving the rate of pathogen examination before antibiotic treatment is of great significance for clarifying pathogen diagnosis and curbing bacterial resistance, and is also one of the important goals for improving national medical quality and safety. In response to the current problem of low pathogen examination rates, Chengdu Women’s and Children’s Central Hospital adopts a FOCUS-PDCA model, has explored measures such as current situation investigation, root cause analysis, intervention plan formulation, countermeasure implementation, and effect evaluation to improve the rate of pathogen examination before antibiotic treatment in inpatients. This article mainly elaborates on the above model, which has practical significance for ensuring the rational use of antibiotics in inpatients.
Objective To study and prepare a new kind of bone graft, which has osteogenesis, local anti-infective function and low immunogenicity. Methods Gentamicin-impregnated bone was prepared bymeans of ultrasonic and vacuum, the release of gentamicin in vivo was measured by inhibition bacteria. Ten healthy male adult sheep were made animal infection models of thigh bone or humerus defect of 6 mm×6 mm×20 mm at size, and the defect was inoculated into 1 ml 5×1010CFU/ml Staphylococcus aureus. The animals were randomly divided into the experimental group (n=5, the bone graft with gentamicin was implanted) and the control group (n=5, the bone graft without gentamincin). Macroscopic, WBC count, radiological, and histological investigations were carried out to evaluate the antiinfective and osteosis capability. Results The concentrations of gentamicin were 46.1 μg/ml in bone allograft and 17.3 μg/ml in muscles after 1 day. The concentrations of gentamicin exceeding the minimum inhibitory concentration lastedfor 14 days in vivo. WBC in the control group was higher than that in the experimental group. In the control group, 1 case died owing to septemia 3 weeks afteroperation. The implanted bones were wrapped in pus 4 and 6 weeks, and the defects were filled with fibre tissue 8 and 10 weeks after operation. In the experimental group, 1 case was infected, the others had a good concrescence. The bone allografts began to integrate with adjacent bone after 4-8 weeks and integrate well after 12 weeks. The X-ray and histological observation showed that new bone formed and took the place of bone allograft. Conclusion The gentamicinimpregnated bone allograft was of a good sustained release feature in vivo, local antiinfection and osteogenesis. It might be an ideal bone grafting material for bone defects with infection.
Objective To analyze the clinical characteristics and risk factors of noninfectious fever after endovascular repair of aortic dilatation diseases, and explore the management strategy. Methods We reviewed 468 patients who received endovascular aortic repair from January 2021 to October 2023. The patients who were selected were classified into a febrile group and an afebrile group according the fever after operation. The fever data were analyzed, and the demographics, operative data were researched to sieve out the correlation factors. Logistic regression analysis was conducted for the risk factors of postoperative fever if the P value≤0.05 in the univariate analysis, and receiver operating characteristic curve (ROC) was used to analyze the predictive indexes of postoperative noninfectious fever. Results75.08% (229/305) patients had noninfectious fever after aortic repair and 98.25% of them had fever within 2 days. There were 229 patients in the febrile group, mean age 65 (53.0,73.0) years (83.4% males , and 76 patients in the afebrile group, mean age 71(65.0,76.7) years(84.2% males). Univariate analysis showed that the number of patients with coronary heart disease, using statins before operation and aortic aneurysm in the febrile group were significantly lower than those in the afebrile group, and patients were younger in the febrile group. The logistic regression showed that age, surgical site, type of disease, preoperative hyperthermia, type of stent were positively correlated with noninfectious fever, while statin use was negatively associated with noninfectious fever. And age, surgical site, preoperative hyperthermia and stent type were analyzed by means of ROC curve (P<0.01). Conclusion Noninfectious fever is very common after aortic repair. The relationship between fever and infection should be comprehensively judged according to the risk factors of noninfectious fever and the disease status to promote rational use of antibiotics.
ObjectiveTo compare the effectiveness of calcium phosphate cement (CPC) loaded with recombinant human bone morphogenetic protein 2 (rhBMP-2) combined with CPC loaded with antibiotic versus CPC loaded with antibiotic alone in one stage for chronic osteomyelitis with bone defect.MethodsA single-blind prospective randomized controlled clinical trial was conducted. Between April 2018 and April 2019, 80 patients of chronic osteomyelitis with bone defect in accordance with the random number table were randomly divided into two groups, 40 in the trial group (CPC loaded with rhBMP-2 combined with CPC loaded with antibiotic) and 40 in the control group (CPC loaded with antibiotic). There was no significant difference in gender, age, disease duration, lesion, and preoperative white blood cells (WBC) count, platelet count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) between the two groups (P>0.05). All patients were implanted the corresponding CPC and external fixator after lesion clearance in the two groups. The postoperative WBC count, platelet count, ESR, CRP, hospital stay, cure rate of osteomyelitis, repaired bone defect volume, the time of external fixator removal, and the time of full weight-bearing of the affected limb were compared between the two groups.ResultsAll patients were followed up 12-24 months, with an average of 18.4 months. There was no significant difference in WBC count, platelet count, ESR, and CRP between the two groups at 4 weeks after operation (P>0.05). There were significant differences in WBC count, platelet count, and CRP in the two groups between 1 week before operation and 4 weeks after operation (P<0.05). And the ESR showed no significant difference between pre- and post-operation in the two groups (P>0.05). In the trial group, the anaphylactic exudate occurred in 1 patient with tibial osteomyelitis and the incision healed after oral administration of loratadine. The incisions of other patients healed by first intention in the two groups. One case of distal tibial osteomyelitis recurred in each group, and 1 case of humeral osteomyelitis recurred in the control group. The cure rates of osteomyelitis were 97.5% (39/40) in the trial group and 95% (38/40) in the control group, showing no significant difference between the two groups (χ2=0.000, P=1.000). There was no significant difference in the repaired bone defect volume and hospital stay between the two groups (P>0.05). X-ray film and CT showed that the bone defects were repaired in the two groups. The time of external fixator removal and the time of full weight-bearing of the affected limb were significantly shorter in the trial group than in the control group (P<0.05).ConclusionApplication of CPC loaded with rhBMP-2 and antibiotic in one stage is effective for the chronic osteomyelitis with bone defect, which can accelerate the bone regeneration in situ to repair bone defect, reduce the trauma, shorten the course of treatment, and obtain good function of the affected limb.
摘要:目的: 金黃色葡萄球菌(金葡菌)的感染近年來已成為醫院內的主要致病菌,而其耐藥性也呈逐漸升高的趨勢,為了解該菌在我院的感染和耐藥情況,為臨床合理使用抗生素提供科學依據。 方法 : 用經典生理生化鑒定方法,對各種臨床標本主要來源于痰液和各種傷口膿液標本分離到的102株金葡菌進行生物學特性及藥敏試驗。 結果 : 從我們醫院2007年5月至2009年8月所分離出來的102株金葡菌中青霉素耐藥性8923%,氨芐青霉素耐藥率為9385%,沒有發現萬古霉素耐藥菌。 結論 : 除萬古霉素外,耐藥率較低的依次是利福平、苯唑青霉素、環丙沙星、呋喃妥因、阿米卡星、磺胺甲基異惡唑、紅霉素,而青霉素G、氨芐青霉素、四環素耐藥性情況非常嚴重,并且多重耐藥,耐藥性強,應引起臨床的高度重視。Abstract: Objective: To analyze the bionomics and antimicrobial susceptibility of staphylococcus aureus, which was the main pathogenic bacterium with high drug tolerance in our hospital, in order to provide the rational use of antibiotics. Methods : Samples of one hundred and two staphylococcus aureus cases from sputamentum and pus were evaluated by classic physiology and biochemistry methods to test the bionomics and antimicrobial susceptibility. Results : The drug resistance rate to penicillin, penbritin and vancomycin was 8923%, 9385% and 0, separately. Conclusion : Besides vancomycin, the drug resistance rate of rifampicin, oxazocilline, ciprofloxacin, furadantin, amikacin, sulfamethoxazole and sulfamethoxazole increased one by one. The resistance to penicillin G, penbritin and tetracycline was serious, including multidrug resistant, which should be paid highly attention.
The treatment of patients with advanced lung cancer has been revolutionized with the advent of immunotherapy. However, not all patients can benefit equally from immunotherapy. In recent years, the relationship between intestinal flora and the efficacy of immunotherapy has gradually attracted scholars' attention. During the treatment of immune checkpoint inhibitors, the use of antibiotics, proton pump inhibitors and other drugs will affect the patient's intestinal flora, thus affecting the efficacy of immune checkpoint inhibitors, leading to poor prognosis of patients. This review will discuss that antibiotics and proton pump inhibitors reduce the efficacy of immunotherapy by affecting the diversity of intestinal flora, in order to facilitate the rational use of related drugs in clinical practice and improve the patient's outcomes.
Objective To investigate the status of nurses’ cognition of skin test for β-lactam antibiotics in tertiary hospitals in China and its influencing factors. Methods The nurses in the eastern and western regions were selected by stratified sampling and convenient sampling between March and May 2023. A multi-center survey was conducted with the help of the questionnaire star platform using the “Questionnaire on the Cognitive Status of β-lactam Antibiotics Skin Test” developed by the “Guidelines for β-lactam Antibiotics Skin Test (2021 Edition)” issued by the National Health Commission of the reference country. Results A total of 89 tertiary hospitals were surveyed. Among them, there were 27 in the eastern regions and 62 in the western regions; There were 64 comprehensive hospitals and 25 specialized hospitals. A total of 4 241 nurses were included. Among them, 4 151 were females and 90 were males. The scores of nurses’ cognition of skin test of β-lactam antibiotics were (61.47±16.27). The survey results showed that the accuracy rate ranges from 15.52% to 88.98%. Only no routine skin test before cephalosporin administration, judgment of skin test results, and infusion device replacement after allergy were greater than 80%. The results of the logistic regression analysis showed that the nurses with professional titles and antimicrobial management training in the past 2 years were independent influencing factors of nurses’ cognition of skin test of β-lactam antibiotics (P<0.001). Conclusions At present, nurses in tertiary hospitals in China still have insufficient knowledge of skin test of β-lactam antibiotics. It is suggested that hospitals should form corresponding hospital skin test of β-lactam antibiotics standards in combination with guidelines and strengthen training for nurses in this regard, so as to improve nurses’ correct cognition and implementation of skin test of β-lactam antibiotics.
Objective To investigate the diagnostic efficacy of 99mTc-MDP three-phase bone scintigraphy (TPBS) combined with C-reactive protein (CRP) for periprosthetic joint infection (PJI). MethodsThe clinical data of 198 patients who underwent revision surgery of artificial joint between January 2017 and January 2024 and received TPBS examination before surgery were retrospectively analyzed. There were 77 males and 121 females with an average age of 63.74 years ranging from 24 to 92 years. There were 90 cases of hip arthroplasty and 108 cases of knee arthroplasty. PJI was diagnosed according to the 2013 American Musculoskeletal Infection Society (MSIS) standard diagnostic criteria. The sensitivity, specificity, accuracy, negative predictive value (NPV), and positive predict value (PPV) were calculated. The receiver operating characteristic (ROC) curve was used to compare the diagnostic performance of the three methods, and the area under curve (AUC) was used to evaluate the diagnostic performance. ResultsAccording to the 2013 MSIS criteria, 116 cases were diagnosed as PJI, and the remaining 82 cases were aseptic loosening. The cases of PJI diagnosed by TPBS, CRP, and TPBS-CRP were 125, 109, and 137 respectively, and the cases of aseptic loosening were 73, 89, and 61 respectively. The sensitivity, accuracy, NPV, and PPV of TPBS-CRP combination in the diagnosis of PJI were higher than those of TPBS and CRP, but the specificity was lower than that of TPBS and CRP. ROC curve analysis further showed that the AUC value of TPBS-CRP combination was better than that of TPBS and CRP. The severity of bone defect and the duration of symptoms in patients with false positive TPBS diagnosis were worse than those in patients with true negative TPBS diagnosis (P<0.05), but there was no significant difference in the survival time of prosthesis between the two groups (P>0.05). Among the patients diagnosed with PJI by TPBS, CRP, and TPBS-CRP, 49, 35, and 54 patients had received antibiotic treatment 2 weeks before diagnosis, respectively. There was no significant difference in the diagnostic accuracy of TPBS and TPBS-CRP before diagnosis between patients treated with and without antibiotics and those not treated (P>0.05). The diagnostic accuracy of antibiotic therapy before CRP diagnosis was significantly lower than that of untreated patients (P<0.05). Conclusion TPBS and CRP have limited specificity in differentiating PJI from aseptic loosening. The TPBS-CRP combination diagnostic method can synergize the local bone metabolic characteristics and systemic inflammatory response to achieve higher diagnostic accuracy, but caution should be exercised in patients with severe bone defects and longer symptom duration.
Objective To perform a systematic review and meta-analysis to evaluate the efficacy and safety of prophylactic use of antibiotics in preventing severe acute pancreatitis. Methods Randomized control trials (RCTs) of prophylactic use of antibiotics were identified from PubMed, EMbase, Cochrane Library, Web of Science, CNKI, Wangfang Database, and handly searched related literatures. The retrieval time was from inception to Dec. 2017. All the data would be analysis with the software RevMan 5.3. Results Eventually 16 RCTs of 999 participants were involved, the patients were divided into two groups: the intervention group (prophylactic use of antibiotics, n=501) and the control group (n=498). The result of meta-analysis showed that, the incidence rate of pancreatitis infectious disease and the incidence rate of peripancreatitis infectious were significant lower in the intervention group than the control group, whose OR were amount to 0.68 ［95% CI was (0.50, 0.93), P=0.02］ and 0.63 ［95% CI was (0.45, 0.88), P=0.007］ respectively. Meanwhile, concerning the rate of surgery intervention ［OR=0.79, 95% CI was (0.57, 1.08), P=0.14］ and in mortality rate ［OR=0.81, 95% CI was (0.56, 1.15), P=0.24］, there was no statistically significant. Conclusion Prophylactic antibiotic treatment can do benefit to reduce the incidence rate of pancreatitis infectious and the rate of peripancreatitis infectious disease, but can not reduce mortality in patients with severe acute pancreatitis and had no significant protective effect in patients in reducing the rate of surgery intervention and mortality rate.