Clinical audit of gentamicin use by Bayesian pharmacokinetic approach in critically ill children

IntroductionCritically ill children tend to have altered gentamicin pharmacokinetics (PK); and so we carried out an audit of gentamicin use using the estimated peak concentrations (C_max), trough concentrations (C_min) and area-under-the-concentration-time curve (AUCs) by Bayesian approach.MethodsCritically ill children with at least one serum gentamicin concentrations available were recruited. We used multiple models Bayesian adaptive control to estimate C_max, and AUC_0-t following each dose. Pediatric risk, injury, failure, loss, end stage renal disease (pRIFLE) criteria was used to identify the incidence of acute kidney injury (AKI).ResultsSeventy-three children (961 doses and 143 concentrations) were analysed. AUC_0-24 was observed to be higher in earlier age groups with a steady decline in older children. Similar changes were observed in C_max, C_min and AUC_0-24 at steady state. Significantly higher proportions of children in the other age groups were estimated to have C_max between 5 and 10 mg/L compared to neonates. Neonates had a higher risk of C_max above 10 mg/L. Patients with augmented renal clearance exhibited lower AUC_0-24 and reduced proportion achieving the target AUC_0-24 levels. Nearly one-third of children were observed to meet the pRIFLE criteria for AKI.ConclusionWe observed higher initial doses and peak concentrations of gentamicin in neonates and infants compared to older age groups in critically ill children. Uniformity in the paediatric-specific standard treatment guidelines for gentamicin is the need of the hour.     

A national evaluation of the management practices of acute diverticulitis

Introduction

Diverticulitis is a common surgical admission that presents with a wide range of symptoms and severity. Overall there has been a shift to conservative management practices, including the consideration of non-antibiotic treatment approaches in select cases.

某三甲医院血流感染肠杆菌科细菌的临床分布及耐药性分析

目的 了解某三甲医院血流感染肠杆菌科细菌临床分布特点及耐药性,为指导临床合理抗感染治疗提供依据.方法 应用BD BACTEC FX-400全自动血液培养系统对临床血标本进行上机培养检测,应用VITEK-2全自动微生物鉴定仪对菌株进行上机鉴定及药敏试验,用WHONET5.6软件整理分析相关数据.结果 2011-2015年某三甲医院血流感染患者共分离出肠杆菌科细菌1 892株,主要分布在危重症监护室、血液内科,分别占15.5％、11.8％;分离的病原菌主要为大肠埃希菌、肺炎克雷伯菌,分别占49.4％、29.1％;大肠埃希菌、肺炎克雷伯菌中,产ESBLs菌株的分离率分别为55.6％、39.7％;肠杆菌科细菌对碳青霉烯类、阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率较低,对氨苄西林的耐药率较高;产ESBLs菌株对除碳青霉烯类外抗菌药物的耐药率均高于不产酶菌株.结论 医院血流感染肠杆菌科细菌中,主要病原菌为大肠埃希菌、肺炎克雷伯菌.临床应重视血流感染病原菌的分布特点及耐药性监测,从而合理、正确选择抗菌药物.     

卒中相关性肺炎病原菌分布及耐药性分析

目的 探讨卒中相关性肺炎患者的病原菌分布及其耐药情况,为临床合理选用抗菌药物提供依据.方法 运用回顾性研究的方法对188例卒中相关性肺炎患者的病原菌分布及药敏试验结果进行分析.结果 119例患者检出致病菌,阳性检出率为63.3％(119/188);共分离出病原菌143株,以革兰阴性菌为主,占74.1％;混合感染24例,占20.2％(24/119);前五位的病原菌依次为:肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌及金黄色葡萄球菌;革兰阴性菌对常用的抗菌药物表现出很高的耐药性.结论 革兰阴性菌是卒中相关性肺炎的主要致病菌,临床医生应根据病原菌及药敏试验选择安全、有效的抗菌药物,以减少耐药菌的产生.     

Anti-diabetics and antimicrobials: Harmony of mutual interplay

Diabetes is one of the four major non-communicable diseases, and appointed by the world health organization as the seventh leading cause of death worldwide. The scientists have turned over every rock in the corners of medical sciences in order to come up with better understanding and hence more effective treatments of diabetes. The continuous research on the subject has elucidated the role of immune disorders and inflammation as definitive factors in the trajectory of diabetes, assuring that blood glucose adjustments would result in a relief in the systemic stress leading to minimizing inflammation. On a parallel basis, microbial infections usually take advantage of immunity disorders and propagate creating a pro-inflammatory environment, all of which can be reversed by antimicrobial treatment. Standing at the crossroads between diabetes, immunity and infection, we aim in this review at projecting the interplay between immunity and diabetes, shedding the light on the overlapping playgrounds for the activity of some antimicrobial and anti-diabetic agents. Furthermore, we focused on the anti-diabetic drugs that can confer antimicrobial or anti-virulence activities.     

医院感染专职人员在抗菌药物使用管理中的作用

目的探讨医院感染专职人员在抗菌药物使用管理中的作用。方法围绕医院感染管理办法及相关的抗菌药物使用管理内容,提出法律赋予感染专职人员在抗菌药物使用管理中的责任和义务;专职人员应在抗菌药物使用管理过程的中发挥作用。结果坚持医院感染预防和控制措施的落实,充分发挥非抗菌药物干预的作用及多学科的合作,提高了抗菌药物使用管理的效率和质量。结论抗菌药物的使用管理必须结合医院感染控制措施,才能形成一个完整的使用管理体系。