8种寄生虫病例分析

本文报道并分析8例寄生虫病例,其中包括脑裂头蚴病、眼部裂头蚴病、肺吸虫幼虫移行症、肺吸虫病、钩虫病、肝吸虫病、包虫病和广州管圆线虫病各1例。8例寄生虫病均有不同程度的误诊,其中6例在寄生虫抗体筛查检测阳性后得以确诊。因此,寄生虫病应引起临床医生的重视,抗体筛查有助于发现寄生虫病例。     

肿瘤合并感染新冠肺炎患者临床分析及疫情期间肿瘤患者的管理建议

目的:探讨分析肿瘤合并新冠病毒感染患者情况并提出自己的思考与建议。方法:通过统计2020年1月至2020年3月期间纳入的313名本院肿瘤科在新冠疫情期间肿瘤合并感染新冠肺炎患者情况，汇总临床资料，分析患者肺部影像学特点，总结肿瘤合并新冠肺炎病毒感染患者临床特征、预后及转归等，并提出自己建议。结果:科室总共313名患者住院，5名新冠感染患者，新冠病毒肺炎发生率为1.6%，这比之前所报道的武汉市新冠病毒普通人群发生率0.37%要高接近3倍，肿瘤合并新冠患者死亡率接近20%。结论:对于疫情结束初期病房应尽量减少患者非必要往返医院次数，实行肿瘤患者分层管理，加强轻症患者随访，线上管理等；而对于住院患者，则采取缓冲分诊模式，做好病房消毒隔离以及管理，避免感染，减少肿瘤病房新型冠状病毒爆发概率。     

敷料更换的不同次数对穿刺引流术后穿刺口感染的影响

目的 研究敷料更换的不同次数对穿刺引流术后穿刺口感染的影响.方法 随机将该院2013年6月—2014年7月收治的100位进行穿刺引流术的患者分为两组,50例为A组,50例为B组. 为A组患者1周更换1次敷料,B组患者1周更换2次敷料. 对两组患者穿刺口感染的情况进行分析比较. 结果 A组患者穿刺口感染的几率显著低于B组(P<0.05),A组患者的病原菌定植率显著低于B组(P<0.05),两组患者导管相关性血流感染率差异无统计学意义(P>0.05). 结论 穿刺引流术后的患者1周更换1次敷料比较合理,既能降低患者术后穿刺口感染的几率,又能降低医护人员的工作量,但要注意在敷料发生松动或者潮湿时也要及时进行更换.     

Stage 1 acute kidney injury is independently associated with infection following cardiac surgery

ObjectivesSevere acute kidney injury (AKI) is a known risk factor for infection and mortality. However, whether stage 1 AKI is a risk factor for infection has not been evaluated in adults. We hypothesized that stage 1 AKI following cardiac surgery would independently associate with infection and mortality.MethodsIn this retrospective propensity score–matched study, we evaluated 1620 adult patients who underwent nonemergent cardiac surgery at the University of Colorado Hospital from 2011 to 2017. Patients who developed stage 1 AKI by Kidney Disease Improving Global Outcomes creatinine criteria within 72 hours of surgery were matched to patients who did not develop AKI. The primary outcome was an infection, defined as a new surgical-site infection, positive blood or urine culture, or development of pneumonia. Secondary outcomes included in-hospital mortality, stroke, and intensive care unit (ICU) and hospital length of stay (LOS).ResultsStage 1 AKI occurred in 293 patients (18.3%). Infection occurred in 20.9% of patients with stage 1 AKI compared with 8.1% in the no-AKI group (P < .001). In propensity-score matched analysis, stage 1 AKI independently associated with increased infection (odds ratio [OR]; 2.24, 95% confidence interval [CI], 1.37-3.17), ICU LOS (OR, 2.38; 95% CI, 1.71–3.31), and hospital LOS (OR, 1.30; 95% CI, 1.17-1.45).ConclusionsStage 1 AKI is independently associated with postoperative infection, ICU LOS, and hospital LOS. Treatment strategies focused on prevention, early recognition, and optimal medical management of AKI may decrease significant postoperative morbidity.     

Gendered dimensions of population mobility associated with HIV across three epidemics in rural Eastern Africa

Mobility in sub-Saharan Africa links geographically-separate HIV epidemics, intensifies transmission by enabling higher-risk sexual behavior, and disrupts care. This population-based observational cohort study measured complex dimensions of mobility in rural Uganda and Kenya. Survey data were collected every 6 months beginning in 2016 from a random sample of 2308 adults in 12 communities across three regions, stratified by intervention arm, baseline residential stability and HIV status. Analyses were survey-weighted and stratified by sex, region, and HIV status. In this study, there were large differences in the forms and magnitude of mobility across regions, between men and women, and by HIV status.We found that adult migration varied widely by region, higher proportions of men than women migrated within the past one and five years, and men predominated across all but the most localized scales of migration: a higher proportion of women than men migrated within county of origin. Labor-related mobility was more common among men than women, while women were more likely to travel for non-labor reasons. Labor-related mobility was associated with HIV positive status for both men and women, adjusting for age and region, but the association was especially pronounced in women. The forms, drivers, and correlates of mobility in eastern Africa are complex and highly gendered. An in-depth understanding of mobility may help improve implementation and address gaps in the HIV prevention and care continua.     

手术室细节护理管理在医院感染控制中的应用评价

目的探讨手术室细节护理管理在医院感染控制中的应用效果。方法选定2017年1月-2018年3月该院收诊的160例手术室患者,按照管理方法的不同分为观察组(细节护理管理)80例与对照组(传统护理管理)80例,比较两组手术室患者的护理质量、并发症发生率、感染发生率、护理满意度、收缩压。结果观察组护理管理后的护理安全(82.23±6.14)分、体征监测(93.46±6.23)分、体位协助(87.32±4.65)分、器械准备(91.57±6.21)分、文书记录(90.24±4.92)分、护理满意率(98.75%)均高于对照组(P<0.05);观察组护理管理后的并发症发生率(2.50%)、感染发生率(1.25%)、收缩压(121.37±6.26)mmHg均低于对照组(P<0.05)。结论细节护理管理方法可有效提高手术室患者的护理满意度,减少其感染情况,值得推广使用。     

84例产褥感染的临床特点及常见致病微生物耐药性分析

目的 研究产褥感染的危险因素及常见致病微生物耐药情况，为临床治疗提供参考。方法 回顾性分析我院2017 年1 月～2019 年12 月发生的84 例产褥感染病例的临床资料，与同时期未发生产褥感染的200 例产妇进行对照研究，分析产褥感染的影响因素，并对分离获得的致病微生物进行耐药性分析。结果 感染组妊娠糖尿病、产钳助产、宫口开全后中转剖宫产患者的分布率高于对照组，差异有统计学意义（P＜0.05）；经多因素Logistic 回归分析，妊娠糖尿病是产褥感染的独立影响因素（P＜0.05）。本研究中共检出致病微生物40 株，其中革兰阴性菌13 株（占32.50%），革兰阳性菌10 株（占25.00%），支原体16 株（占40.00%），衣原体1 株（占2.50%），革兰阴性菌中以大肠埃希菌最常见，对二代头孢菌素类抗生素耐药率20%。革兰阳性菌以金黄色葡萄球菌最常见，对青霉素及头孢菌素耐药率高，未发现对亚胺培南及万古霉素耐药。结论 产钳助产、妊娠糖尿病、宫口开全后中转剖宫产是产褥感染可能的危险因素，其中，妊娠糖尿病是产褥感染的独立危险因素。目前临床常见致病微生物谱及耐药率未发生明显变化。     

Therapeutics and delivery vehicles for local treatment of osteomyelitis

Osteomyelitis, or the infection of the bone, presents a major complication in orthopedics and may lead to prolonged hospital visits, implant failure, and in more extreme cases, amputation of affected limbs. Typical treatment for this disease involves surgical debridement followed by long-term, systemic antibiotic administration, which contributes to the development of antibiotic-resistant bacteria and has limited ability to eradicate challenging biofilm-forming pathogens including Staphylococcus aureus—the most common cause of osteomyelitis. Local delivery of high doses of antibiotics via traditional bone cement can reduce systemic side effects of an antibiotic. Nonetheless, growing concerns over burst release (then subtherapeutic dose) of antibiotics, along with microbial colonization of the nondegradable cement biomaterial, further exacerbate antibiotic resistance and highlight the need to engineer alternative antimicrobial therapeutics and local delivery vehicles with increased efficacy against, in particular, biofilm-forming, antibiotic-resistant bacteria. Furthermore, limited guidance exists regarding both standardized formulation protocols and validated assays to predict efficacy of a therapeutic against multiple strains of bacteria. Ideally, antimicrobial strategies would be highly specific while exhibiting a broad spectrum of bactericidal activity. With a focus on S. aureus infection, this review addresses the efficacy of novel therapeutics and local delivery vehicles, as alternatives to the traditional antibiotic regimens. The aim of this review is to discuss these components with regards to long bone osteomyelitis and to encourage positive directions for future research efforts.     

铜绿假单胞菌噬菌体PaP3生物学特性的研究

目的测定铜绿假单胞菌噬菌体PaP3的最佳感染复数、一步生长曲线和吸附K值及交叉吸附K值等基本生物学特性。方法按照感染复数（MOI）分别为0．0001、0．001、0．01、0．1、1和10加入噬菌体纯培养液和宿主菌，充分裂解细菌后，测定噬菌体滴度；以MOI=10的比例加入噬菌体及宿主菌，进行一步生长实验；纯化PaP3颗粒，免疫家兔，获得抗血清，通过中和反应实验测定PaP3和其抗血清之间的吸附反应常数K值。同时，利用抗血清交叉中和试验确定本室分离的三株噬菌体之间的血清学关系。结果当MOI=0．001时PaP3感染其宿主菌产生的子代噬菌体滴度最高；根据一步生长实验结果绘制一步生长曲线；通过血清交叉中和反应得出不同的吸附常数。结论PaP3最佳感染复数为0．001，感染宿主菌的潜伏期是20min，爆发期是60min，平均爆发量约为31，其抗血清反应的吸附常数K值为262。