临床胆汁分离细菌培养与药物敏感试验结果分析

目的分析胆道感染病原菌分布和药敏试验结果,为临床合理用药提供依据。方法 2013年4月至2014年9月厦门大学附属第一医院胆汁标本采用法国生物梅里埃公司BacT/ALERT 3D全自动血培养仪及配套的血培瓶进行增菌培养,全自动微生物鉴定药敏分析仪进行细菌鉴定及药敏试验,运用WHONET 5.6软件进行数据统计分析。结果 217例胆道感染患者有35例(16.1%)分离出2种病原菌,其中肠球菌属与肠杆菌科细菌混合感染(19例,54.3%)最常见;共分离出252株非重复菌株,革兰阳性菌83株(32.9%),革兰阴性菌165株(65.5%),真菌4株(1.6%);分离率居前3位为大肠埃希菌、粪肠球菌和肺炎克雷伯菌;最常见的非发酵菌为铜绿假单胞菌和鲍曼不动杆菌。常见肠杆菌科细菌对氨基糖苷类、4代头孢类、碳青霉烯类和哌拉西林/他唑巴坦耐药率低于40.0%,大肠埃希菌对喹诺酮类的耐药率大于50.0%;粪肠球菌和屎肠球菌对万古霉素、利奈唑胺和替加环素的耐药率极低,对高浓度链霉素和高浓度庆大霉素的耐药率均小于30.0%。结论该地区胆道感染常见病原菌为大肠埃希菌、粪肠球菌和肺炎克雷伯菌,肠球菌属和肠杆菌科细菌混合占2种病原菌混合感染很大比例,病原菌对头孢类和喹诺酮类抗菌药物的耐药性日趋严峻。     

2011年病原菌临床分离株分布及耐药性分析

目的 了解该院病原菌临床分离株的分布及耐药性.方法 回顾性分析2011年病原菌的检出情况及药敏试验结果.结果 2 187份临床标本中分离获得病原菌431株,分离率19.7%;标本病原菌阳性检出率由高到低依次为痰、分泌物、咽拭子、血和尿.检出肠杆菌科细菌202株(占46.8%),非发酵菌73株(占16.9%),革兰阳性球菌123株(占28.5%),真菌28株(占6.5%);大肠埃希菌和肺炎克雷伯菌超广谱β-内酰胺酶阳性率分别为44.4%和48.4%.检出金黄色葡萄球菌45株,其中甲氧西林耐药金黄色葡萄球菌检出率为28.6%,未检出万古霉素耐药葡萄球菌.结论 细菌耐药性监测有助于指导临床合理用药,减少耐药菌株的产生和传播及有效控制院内感染.     

综合ICU血培养阳性标本病原菌的分布及耐药性分析

目的:分析近5年我院综合ICU血培养阳性标本病原菌的分布及耐药性情况。方法:回顾性调查分析2009-01-2013-12住院患者临床血培养阳性标本药敏试验结果。结果:共分离出病原菌208株,其中革兰阳性球菌占61.5%,革兰阴性杆菌占34.6%,真菌占3.9%。凝固酶阴性葡萄球菌(CNS)(39.4%)最多,其余依次为肠杆菌科细菌(27.4%),金黄色葡萄球菌(11.5%)、肠球菌属细菌(8.7%)、非发酵革兰阴性杆菌(6.3%)、真菌。未发现对万古霉素、替考拉宁、利奈唑胺耐药的葡萄球菌。屎肠球菌中检出耐万古霉素和替考拉宁耐药菌1株。肺炎克雷伯菌对碳氢酶烯类耐药率为16.7%,未检出其他耐碳氢酶烯类的肠杆菌科菌株。头孢哌酮-舒巴坦对非发酵革兰阴性杆菌耐药率在20.0%以下。真菌以白色念珠菌为主,对目前主要抗真菌药物敏感率均较高。结论:综合ICU是血流感染的高发区,了解本科室血培养阳性标本病原菌的分布以及进行耐药性监测,对制定经验治疗方案,指导抗生素的临床合理用药具有一定的参考价值。     

2010年临床分离病原菌分布特点及耐药性分析

目的 分析2010年西安交通大学医学院第一附属医院分离的3 476株感染病原菌的分布及抗生素耐药性,为临床合理用药提供参考依据.方法 细菌鉴定方法应用VITEK全自动细菌鉴定分析仪和API鉴定系统鉴定菌株;药敏试验应用K-B纸片扩散法.结果 2010年医院临床标本分离病原菌3 476株,分离率居前10位的细菌分别为大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、屎肠球菌、表皮葡萄球菌、粪肠球菌、嗜麦芽窄食单胞菌、阴沟肠杆菌.其中耐甲氧西林金黄色葡萄球菌(MRSA)分离率达到72.9%,产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌分别为58.7%和63.4%,万古霉素、替考拉宁、利奈唑胺对革兰阳性球菌保持较强的抗菌活性,未发现耐药菌株;肠杆菌科的细菌对碳青霉烯类及头孢哌酮/舒巴坦等抗生素的敏感性较强,非发酵菌中鲍曼不动杆菌和铜绿假单胞菌呈多重耐药性.结论 医院感染病原菌的多重耐药相当严重,检验科加强对病原菌的分布及耐药性监测,对指导临床合理应用抗生素具有重要意义.     

四川省细菌耐药监测网2011年川西地区细菌耐药性监测数据分析

目的总结分析川西地区6个市(州)17家医院2011年度临床分离病原菌的分布及对抗菌药物的耐药性。方法采用K-B法或自动化仪器分析法对临床分离细菌进行药物敏感试验,依据CLSI 2010年标准,采用WHO-NET5.4软件进行统计分析。结果共分离出病原菌株20079株,其中革兰阴性菌14454株,占分离菌的71.99%;革兰阳性菌5625株,占分离菌的28.01%。前10位病原菌依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌、表皮葡萄球菌、阴沟肠杆菌、肺炎链球菌、屎肠球菌、流感嗜血杆菌。肠杆菌科细菌对亚胺培南仍保持较高的敏感率(>93.0%)。未检测到万古霉素及利奈唑胺耐药的葡萄球菌。粪肠球菌对替考拉宁和万古霉素耐药率分别为1.30%和0.70%,屎肠球菌为5.40%和4.00%。结论产超光谱β内酰胺酶的发酵菌及多重耐药的铜绿假单胞菌和鲍曼不动杆菌呈逐年上升趋势。耐甲氧西林葡萄球菌(MRS)和耐糖肽类的肠球菌是抗菌药物治疗中的难点。临床应根据细菌的耐药表型和药敏试验结果合理选用抗菌药物。     

2011年某院临床分离病原菌耐药性分析

目的分析1495株2011年临床分离病原菌的种类及其耐药性。方法用珠海迪尔公司生产的微生物鉴定和药敏板进行细菌鉴定和药敏试验。结果 2011年在4316份临床标本中共分离出病原菌1495株,检出率为34.6%。病原菌以革兰阴性为主,占68.4%。耐甲氧西林金黄色葡萄球菌检出率为65.2%,未发现耐万古霉素的葡萄球菌,万古霉素耐药的粪肠球菌占7.0%。大肠埃希菌和克雷伯菌产超广谱β内酰胺酶(ESBLs)株检出率分别为6.71%和29.2%。各种肠杆菌科菌对亚胺培南的敏感性最高。铜绿假单胞菌、鲍曼不动杆菌对亚胺培南的耐药率分别为6.7%和36.0%。结论临床病原菌的检出率不高,细菌的耐药性日趋严重,应加强药敏监测,促进抗生素的合理应用,有助于临床有效控制和治疗医院感染。     

四川省人民医院老年科病原菌分布及耐药性监测结果分析

目的了解四川省人民医院老年科临床病原菌分布及其耐药性。方法采用VITEK-2 compact全自动微生物分析仪对四川省人民医院老年科住院患者病原菌进行鉴定和药敏试验,按CLSI 2009年版判断结果。结果 2110株细菌中革兰阴性菌占82.7%,革兰阳性菌占17.3%。分离前五位是铜绿假单胞菌、大肠埃希氏菌、肺炎克雷伯氏菌、不动杆菌及肠杆菌属;葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为50.3%和61.5%;发现一株耐万古霉素的屎肠球菌(VRE),同时也对替考拉宁耐药。肠杆菌科细菌对亚胺培南均高度敏感(>98%)。鲍曼不动杆菌对亚胺培南的敏感率为39.6%,对铜绿假单胞菌耐药率最低的是阿米卡星为5.3%;不动杆菌属耐药率均在50.0%以上。大肠埃希菌和肺炎克雷伯菌中产超广谱β-酰胺酶(ESBLs)菌株的阳性率分别为51.0%和34.0%。结论老年患者感染以呼吸道感染为主,耐药状况严重,但肠杆菌科细菌对碳青霉烯类抗菌药物敏感度高。加强细菌耐药性监测,为临床合理应用抗菌药物提供科学依据。     

1938株血流感染病原菌分布与耐药特征分析

目的了解该院血流感染病原菌种类和临床分布特征及药物敏感情况,为临床经验治疗提供依据。方法回顾分析该院2012年1月至2016年8月从血培养中分离到的1 938株病原菌,分析其种类分布、科室分布及药物敏感情况。结果 1 938株病原菌主要由56种细菌和8种真菌构成。革兰阴性菌1 216株,占64.2%,革兰阳性菌677株,占34.9%,真菌45株,占2.4%。分离率前5位的依次是大肠埃希菌628株(32.4%),肺炎克雷伯菌230株(11.9%),沙门氏菌143株(7.4%),表皮葡萄球菌142株(7.3%),人葡萄球菌130株(6.7%)。肠杆菌科细菌共1 098株(58.0%)以大肠埃希菌和肺炎克雷伯菌为主,其中有363(57.8%)株大肠埃希菌和85株(37.0%)肺炎克雷伯菌产超广谱β内酰胺酶(ESBLs)。非发酵菌118株(6.1%),以鲍曼不动杆菌和铜绿假单胞菌为主。金黄色葡萄球菌75株(3.9%),耐甲氧西林金黄色葡萄球菌(MRSA)发生率25.3%,凝固酶阴性葡萄球菌(CoNS)401株(20.7%),耐甲氧西林CoNS(MRCoNS)发生率72.8%。肠球菌85株(4.5%)。阳性率前五位科室为呼吸科、ICU、肝胆科、消化科和血液科,除ICU和儿科外其他科与总体分布一致。鲍曼不动杆菌多数呈多重耐药。未检出耐万古霉素的葡萄球菌和肠球菌,念珠菌对常用抗真菌药保持较好敏感性。结论该院血流感染病原菌分布广泛,常用药物敏感性不同,总体耐药率较高,临床可依据病原菌科室分布及药物敏感特征进行早期用药。     

2013-2019年无菌体液病原菌分布及耐药性分析

目的 了解本院2013年3月至2019年3月临床分离的脑脊液及其他无菌体液病原菌的分布及耐药情况。方法 收集和统计2013年3至2019年3月脑脊液及其他无菌体液标本分离的病原菌分布及耐药性特点,运用WHONET5.6软件进行菌株分布及药敏结果分析。结果 共分离病原菌1 450株,革兰阳性菌806株(55.6%);革兰阴性菌556株(38.3%);真菌88株(6.1%)。常见病原菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌、粪肠球菌。无菌体液标本中耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为35.8%和75.4%,未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。肠球菌属中屎肠球菌对除四环素外的大多数抗菌药物耐药率明显高于粪肠球菌。产超广谱内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的检出率分别为60.6%和65.9%,除肺炎克雷伯菌对亚胺培南耐药率大于10.0%,其他肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感。多重耐药鲍曼不动杆菌和铜绿假单胞菌检出率分别为65.3%和12.7%。结论 应加强常见耐药菌的监测,尤其是耐碳青霉烯类肠杆菌科细菌和多重耐药鲍曼不动杆菌应引起高度关注,根据药敏试验结果合理使用抗菌药物,加强耐药菌感染控制,以减少耐药菌株产生。     

下呼吸道感染病原菌分布及耐药性分析

目的分析下呼吸道感染常见病原菌分布及耐药性变迁情况,为临床合理使用抗菌药物提供依据。方法对临床送检痰标本进行分离培养,应用VITEK-2微生物分析仪进行菌种鉴定和药敏试验,采用WHONET5.4软件对数据进行统计分析。结果共分离病原菌3 050株,其中革兰阴性杆菌2 425株,占79.51%,革兰阳性球菌431株占14.13%,真菌194株占6.36%。革兰阴性杆菌中前4位的细菌分别为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌;其中鲍曼不动杆菌和铜绿假单胞菌对亚胺培南耐药率分别为75.0%和34.8%。大肠埃希菌、肺炎克雷伯菌ESBLs阳性率分别为81.4%、44.6%,且肺炎克雷伯菌对亚胺培南的耐药率达18.9%。革兰阳性球菌主要为金黄色葡萄球菌、肺炎链球菌;其中,耐甲氧西林金黄色葡萄球菌分离率达68.6%,未发现万古霉素耐药。结论本院下呼吸道感染病原菌以革兰阴性杆菌为主。非发酵菌最为常见且耐药问题较为严重。革兰阳性球菌未发现万古霉素耐药菌株。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.