住院患者抗菌药物临床应用横断面调查

目的：了解我院住院患者抗菌类药物临床应用情况,分析存在的问题。方法对我院2012年6月21日000-2400住院患者采用横断面方法调查抗菌药物的使用情况、DDDs值、病原微生物送检率,并对其进行分析。结果住院患者768例中有1274例使用抗菌药物,平均使用率为48.98%;抗细菌药物中,使用频率占前3位的依次为头孢菌素类（57.97%,其中第2、3代头孢菌素占49.64%）、氟喹诺酮类（28.68%）和青霉素类（13.35%）;有401例微生物送检,病原学送检率52.21%。结论我院抗菌药物使用率符合卫生部规定要求,但外科系统使用率较高,预防用药送检率较低,存在盲目用药的现象,需进一步规范抗菌药物的使用规范。     

抗菌药物的肾毒性机制及危险因素研究进展

摘要：随着抗菌药物在临床的广泛使用,其安全性问题也日益凸显,其中以“肾毒性”问题尤为突出,不容忽视。本文归纳了抗菌药物肾毒性的临床表现、毒性机制和危险因素,以期为抗菌药物所致肾毒性的防治提供依据。     

Characterizing the inclusion of pregnant and breastfeeding people in infectious diseases randomized controlled trials: a targeted literature review

ObjectivesSevere complications of infectious diseases can occur during pregnancy. Evidence-based prevention and treatment strategies are critical to improve maternal and neonatal health outcomes. Despite this medical need, pregnant and breastfeeding people have been systematically excluded from biomedical research. The objective of this study was to characterize representation of pregnant and breastfeeding people in randomized controlled trials (RCTs) evaluating a broad range of interventions for infectious diseases.MethodsPregnancy and breastfeeding inclusion criteria were examined in infectious diseases RCTs published between 1 January 2017, and 31 December 2019, in the top five highest impact general medicine and the top three highest impact infectious diseases and HIV journals.ResultsOf 376 RCTs, 5.3% and 1.9% included pregnant and breastfeeding people, respectively. Justification for exclusion was documented in 36/271 (13.3%) studies that explicitly excluded pregnant people. Most studies excluding pregnant people (177/271, 65.3%) required at least one form of contraception, abstinence and/or negative pregnancy test(s) as part of participation. Only 11/271 (4.1%) studies excluding pregnant people allowed participants to continue the intervention if unintended pregnancy occurred during the study. When both pregnant and non-pregnant people were eligible, pregnant people made up <3% of participants. Only 2/48 (4.2%) vaccine studies included pregnant people; 13/234 (5.5%) drug studies included pregnant people. All studies of procedures, devices, behaviour/education and supplements/vitamins explicitly excluded or did not address pregnancy eligibility criteria. Only 2/20 (10.0%) RCTs including pregnant people collected pharmacokinetic data.DiscussionThis study demonstrates widespread exclusion of pregnant and breastfeeding people from infectious disease RCTs.     

Development of novel dental restorative composites with dibasic calcium phosphate loaded chitosan fillers

The incorporation of antimicrobial agents in restorative dental composites has the potential to slow the development of carious lesions.ObjectiveThe objectives of the present study were to develop experimental composite resins with chitosan or chitosan loaded with dibasic calcium phosphate anhydrous (DCPA) particles and to demonstrate their antimicrobial potential without loss of mechanical properties or biocompatibility.MethodsChitosan and chitosan/DCPA particles were synthetized by the electrospray method. Experimental composites were formulated by adding 0, 0.5, or 1.0 wt% particles into a resin matrix along with 60 wt% barium glass. The degree of conversion and mechanical properties were measured after 1 and 90 days of aging in water after photoactivation. Cytotoxicity and genotoxicity were evaluated using fibroblasts from dental pulp in conditioned medium. The antimicrobial activity against Streptococcus mutans was assessed by crystal violet biofilm assay.ResultsThe experimental restorative composites were not found to be cytotoxic or genotoxic, with cell viability of 93.1 ± 8.0% (p = 0.328) and 3.0 ± 0.8% micronucleus per group (p = 0.1078), respectively. The antimicrobial results showed that all composites with approximately 20% less biofilm (p < 0.001) relative to the control. No chitosan release was detected from the composites, suggesting direct contact of the bacteria with exposed chitosan particles on the surface was responsible for the observed antimicrobial effect. The addition of the chitosan and chitosan/DCPA submicrometer (<250 nm average diameter) particles to restorative composites did not change the degree of conversion, flexural strength, elastic modulus and fracture toughness compared to the control group after 90 days aging in water.SignificanceIt can be concluded that the addition of chitosan or chitosan/DCPA particles in the restorative composites induced antimicrobial activity without compromising the mechanical properties or biocompatibility of the composites.     

Oral Mucositis: Time for More Studies

Oral Mucositis (OM) is a frequent cause of severe morbidity in patients receiving chemotherapy and/or radiotherapy. The pathophysiology of OM involves direct cytotoxic effects, local inflammatory responses, and alterations in oral microflora. There are currently no approved agents for the prevention or treatment of OM. In this review we briefly describe current knowledge of the pathophysiology, clinical presentation, and management of OM. We then discuss investigational agents being studied in OM with a particular focus on local antimicrobial agents, hemopoietic growth factors, and cytokines. Measures to reduce the incidence of OM and/or alleviate its clinical sequelae should be incorporated into all chemotherapy or radiotherapy studies.     

基层医院住院儿童抗菌药物应用分析

目的:对邻水县人民医院住院儿童抗菌药物应用情况进行回顾性分析,促进临床合理用药.方法:随机抽取邻水县人民医院2010年1~6月的住院儿童病历367份,对抗菌药物应用情况按使用率、使用种类、联用情况、用药合理性等方面进行统计、分析.结果:使用抗菌药物的病历349份,使用率为95.10%,共使用了5类14种抗菌药物,联用率...     

1014例住院患者抗菌药物应用横断面调查分析

目的:了解抗菌药物使用现状和存在的问题,为临床合理用药提供参考依据。方法:采用横断面调查的方法,对2010年5月18日0时至24时北京友谊医院住院患者抗菌药物的使用种类、使用目的、联合用药情况、病原学检查进行调查分析。结果:1 014例住院患者中479例使用抗菌药物,抗菌药物使用率为47.2%。抗菌药物使用病例中,头孢菌素类占20.9%,其中第3代头孢菌素占头孢菌素类56.10%,氟喹诺酮类占18.5%,β-内酰胺类/β-内酰胺酶抑制剂占15.9%,在Ⅰ类切口手术病例中,术中和术前0.5～2.0 h应用抗菌药物者占47.5%,用药累计时间小于24 h者占16.3%。病原学送检率为47.9%。其中外科系统仅有11.2%。结论:抗菌药物使用率符合卫生部要求,但第3代头孢菌素类使用率高,分级管理需加强,外科系统要重视病原学检测,有针对性地选用抗菌药物,加强对医生合理使用抗菌药物的培训。     

手术科室围术期抗菌药物使用分析

目的调查手术科室围术期抗菌药物预防性使用情况,以加强抗菌药物应用的管理。方法采用回顾性的调查方法,对手术科室350例患者围手术期预防性使用抗菌药物情况进行统计分析。结果 345例患者使用了抗菌药物,其中预防性用药占93.62%,有77.97%于术前30min～2h给药;预防性使用抗菌药物时间≤48h有113例,占预防用药的34.98%,>48h的有210例,占预防用药的65.02%;使用抗菌药物共8类,使用最多的为头孢菌素类,占46.85%,其次是硝基咪唑类,占21.84%;围手术期抗菌药物以一联用药为主。结论该院手术科室在预防性使用抗菌药物中存在不合理现象,必须加强对手术科室医师围术期合理使用抗菌药物的教育和管理。     

Combined effects of NaF and SLS on acid- and polysaccharide-formation of biofilm and planktonic cells

Bacteria grow preferentially attached to surfaces embedded in an exopolysaccharide matrix to form biofilms. In this mode of growth, bacteria often show reduced susceptibility to antimicrobials. The aim of this study was to investigate whether the combination of NaF and the detergent sodium lauryl sulphate (SLS) could result in additive effects on acid formation by planktonic and biofilm cells, as well as on extracellular polysaccharide formation. An additive inhibitory effect on Streptococcus mutans acid formation was observed, both in planktonic and biofilm cells. In dental biofilms, SLS alone and in combination with NaF reduced acid formation. Extracellular polysaccharide formation by S. mutans and saliva was reduced by SLS alone and in combination with NaF. In dentifrices and mouthrinse solutions, NaF and SLS are often present in combination. It remains to be determined whether an additive effect on acid formation may also occur in dental biofilms under different concentrations from those used in the present study, and whether the effects may be selective for certain bacterial species.