重症监护病房婴幼儿多重耐药菌主动筛查及感染特征分析

目的分析婴幼儿多重耐药菌（MDRO）的感染特征,为制定医院感染预防控制措施提供科学依据。方法运用快速显色培养基对入院48小时内的危重转运患儿的鼻咽拭子、肛拭子标本进行甲氧西林耐药金黄色葡萄球菌（MRSA）和产超广谱β-内酰胺酶（ESBL）的肠杆菌的主动筛查,分析比较不同性别、年龄、是否接受侵入性操作、早产儿及住院时间长短的研究对象MRSA、产ESBLs杆菌检测阳性率,描述婴幼儿多重耐药菌的感染特征。结果本研究对1 013例患儿进行MRSA、ESBLs的主动筛查,阳性率分别为6.5%、43.3%,男、女之间阳性率差异无统计学意义（p〉0.05）。年龄1～2个月及6个月以上患儿的ESBLs检出阳性率（≥60.0%）较高（p=0.001）,2～6个月的患儿MRSA的筛查阳性率（20.6%）高于其他年龄组的患儿（p=0.032）。早产儿、接受侵入性操作及住院时间越长的患儿的多重耐药菌的定植率越高（p〉0.05）。结论婴幼儿多重耐药菌的定植或感染可能受年龄、侵袭性操作、早产儿、住院时间影响,而与性别无关,早期发现可避免多重耐药菌的扩散传播。     

The combination of intravenous bevacizumab and metronomic oral cyclophosphamide is an effective regimen for platinum-resistant recurrent ovarian cancer

Objective

To determine the efficacy, progression-free survival (PFS) and overall survival (OS) for the combination of intravenous bevacizumab and oral cyclophosphamide in heavily pretreated patients with recurrent ovarian carcinoma.

Methods

A retrospective review was performed for all patients with recurrent ovarian carcinoma treated with intravenous bevacizumab 10 mg/kg every 14 days and oral cyclophosphamide 50 mg daily between January 2006 and December 2010. Response to treatment was determined by Response Evaluation Criteria in Solid Tumors criteria and/or CA-125 levels.

Results

Sixty-six eligible patients were identified. Median age was 53 years. Fifty-five patients (83%) had undergone optimal cytoreduction. All patients were primarily or secondarily platinum resistant at the time of administration of bevacizumab and cyclophosphamide. The median number of prior chemotherapy treatments was 6.5 (range, 3 to 16). Eight patients (12.1%) had side effects which required discontinuation of bevacizumab and cyclophosphamide. There was one bowel perforation (1.5%). Overall response rate was 42.4%, including, complete response in 7 patients (10.6%), and partial response in 21 patients (31.8%), while 15 patients (22.7%) had stable disease and 23 patients (34.8%) had disease progression. Median PFS for responders was 5 months (range, 2 to 14 months). Median OS from initiation of bevacizumab and cyclophosphamide was 20 months (range, 2 to 56 months) for responders and 9 months (range, 2 to 51 months) for non-responders (p=0.004).

Conclusion

Bevacizumab and cyclophosphamide is an effective, well-tolerated chemotherapy regimen in heavily pretreated patients with recurrent ovarian carcinoma. This combination significantly improved PFS and OS in responders. Response rates were similar and favorable to the rates reported for similar patients receiving other commonly used second-line chemotherapeutic agents.     

Identifying crop variants with high resistant starch content to maintain healthy glucose homeostasis

Identifying dietary tools that prevent disordered insulin secretion from pancreatic β‐cells is an attractive strategy to combat the increasing prevalence of type 2 diabetes. Dietary resistant starch has been linked to improvements in the function of β‐cells, possibly via increased colonic fermentation and production of short‐chain fatty acids (SCFAs). Increasing the resistant starch content of commonly consumed foods could therefore maintain glucose homeostasis at the population level. As part of Biotechnology and Biological Sciences Research Council (BBSRC) Diet and Health Research Industry Club (DRINC) initiative, variants of Pisum sativum L. (pea) are being investigated to identify the features of pea starch that make it resistant to digestion and available for colonic fermentation and SCFA production. Parallel in vitro and in vivo studies are being conducted using both whole pea seeds and pea flour to facilitate a better understanding of how cells in the pea cotyledons are affected by processing and, in turn, how this influences starch digestibility. Trials in human volunteers are being used to monitor a full spectrum of short‐ and long‐term physiological responses relevant to pancreatic β‐cell function and glucose homeostasis. This project is providing new insights into variants of crops that are associated with the specific types of resistant starch that provide the best protection against defects in insulin secretion and function.     

综合ICU多重耐药菌医院感染的风险模型构建

目的构建重症监护病房（ICU）多重耐药菌医院感染的风险模型。方法对2012年10月—2015年9月入住ICU＞48 h的836例患者进行回顾性分析,构建医院感染logistic回归模型,对模型进行拟和优度检验、ROC曲线下面积（AUC）分析。结果3年入住ICU＞48 h的患者共836例,多重耐药菌医院感染发病率为14.23%(119例)。15个单因素分析有意义的自变量纳入logistic多因素分析,结果显示,ICU住院时间（OR=2.493;95%CI：1.816～3.494）、基础疾病种类(OR=1.536; 95%CI：1.243～1.898)、低蛋白血症(OR=87.211;95%CI：36.165～210.304)、呼吸机插管日数(OR=1.723;95%CI=1.399～2.121)、发热（OR=20.639;95%CI：3.462～123.043）、原发肺部感染(OR=0.295;95%CI：0.133～0.664)变量进入logistic回归方程。评价模型效果：灵敏度95%,特异度87.9%,模型ROC的AUC为0.973。结论logistic回归模型对ICU患者医院感染预测风险拟合度较好。     

重症监护病房医务人员鼻腔带菌及其耐药性

目的探讨重症监护病房（ICU）医务人员鼻腔带菌及其耐药情况,为制订医院感染防控措施提供依据。方法采用棉拭子采样法,对某院2014年4月-2015年3月ICU医务人员鼻腔黏膜进行采样,检测其携带病原菌及其耐药情况。结果共采集450份鼻腔标本,分离病原菌137株,检出率为30.44%。不同性别、年龄、工作岗位、工龄、文化程度的医务人员鼻腔带菌检出率比较,差异均无统计学意义（P＞0.05）;医务人员不同季节鼻腔带菌检出率比较,差异具有统计学意义（P＜0.05）。其中革兰阴性菌82株（占59.85%）,以肺炎克雷伯菌（21.16%）、产气肠杆菌（18.98%）为主;革兰阳性菌55株（占40.15%）,以金黄色葡萄球菌（18.98%）、表皮葡萄球菌（15.33%）为主。检出38株（27.74%）多重耐药菌。耐甲氧西林金黄色葡萄球菌占7.69%（2/26）,耐亚胺培南肺炎克雷伯菌占3.45%（1/29）,耐亚胺培南产气肠杆菌占3.85%（1/26）。结论ICU医务人员鼻腔病原菌携带率较高,多重耐药菌检出率高。     

综合干预措施对ICU患者呼吸道多重耐药菌感染/定植的防控效果

目的探讨综合干预措施对重症监护病房（ICU）患者呼吸道多重耐药菌（MDRO）感染/定植的防控效果。方法对每例监测对象于入院第1、4、8天及之后每间隔7天采集咽拭子和人工气道吸痰标本,并送细菌培养及药敏试验。2013年6—12月为干预前组,2014年1月开始实施综合干预措施,2014年6—12月为干预后组,统计MDRO检出情况。结果共检出253株MDRO,干预前后分别为164、89株,其中检出耐碳青霉烯类鲍曼不动杆菌（CRAB）191株（占75.49%）,干预前后分别为119、72株。患者呼吸道MDRO感染发病率干预前组为52.94%,干预后组为30.43%,差异有统计学意义（χ2=5.02,P=0.03）。患者平均住院时间干预前组为（8.07±2.52）d,干预后组为（6.89±1.71）d,差异有统计学意义（t=5.40,P＜0.01）。结论MDRO为ICU医院感染重要病原菌,采取有效综合干预措施可减少患者医院感染的发生。     

小青龙汤加减治疗脑病合并多重耐药菌肺炎30例

目的:观察小青龙汤加治疗脑病合并多重耐药菌肺炎的临床疗效。方法:选取西安中医脑病医院2013年5月—2015年4月住院的60例多重耐药菌肺炎患者,随机分为治疗组和对照组,每组各30例。对照组给予常规西医治疗,治疗组在对照组的基础上给予小青龙汤加减。观察两组患者的临床疗效。结果:治疗组有效率为86.67%,对照组有效率为66.67%,两组有效率比较,差异具有统计学意义(P0.05)。两组患者治疗后临床肺部感染(CPIS)评分较治疗前降低,且治疗组优于对照组,差异具有统计学意义(P0.05)。结论:小青龙汤加减治疗比单纯西医基础治疗脑病合并多重耐药菌肺炎临床疗效显著。     

In vitro synergistic effect of Hibiscus sabdariffa aqueous extract in combination with standard antibiotics against Helicobacter pylori clinical isolates

Context The increasing problem of drug-resistant strains has led to the failure of current treatment regimens of Helicobacter pylori (HP) infection. Recently, a new treatment strategy has been developed to overcome the problem by using natural products in combination with antibiotics to enhance the treatment efficacy.

Objective The antimicrobial combinatory effect of the aqueous extract of Hibiscus sabdariffa L. (Malvaceae) (AEHS) with antibiotics (clarithromycin, CLA; amoxicillin, AMX; metronidazole, MTZ) has been evaluated in vitro against HP strains.

Materials and methods Hibiscus calyces (35?g) were brewed in 250?mL of boiled water for 30?min, and minimum inhibitory concentrations (MICs) were determined by agar dilution method. The checkerboard assay was used to evaluate the antimicrobial combinatory effect according to the sum of fractional inhibitory concentration (∑FIC) indices.

Results In this study, AEHS exerted remarkable bacteriostatic effect against all HP strains tested with MICs values ranging from 9.18 to 16.68?μg/mL. Synergy effect of AEHS with CLA or MTZ was obtained against four of seven HP strains tested with ∑FIC ranging from 0.21 to 0.39. The additive effect of AEHS with AMX was obtained against five of seven HP strains tested with ∑FIC ranging from 0.61 to 0.91.

Conclusion This study presents AEHS as a potent therapeutic candidate alone, or in combination with antibiotics for the treatment of HP infection.