全国医院感染监测网2012年综合ICU医院感染现患率调查监测报告

目的了解我国医院综合重症监护室（ICU）医院感染发生率、常见侵入性操作使用率及相关感染率、抗菌药物使用及病原体分布情况。方法对2012年3月15日-12月31日期间上报至全国医院感染监测网医院感染横断面调查资料中综合ICU监测数据进行汇总分析。结果1 313所医院中,621所（47.30%）有综合ICU;共监测患者5 887例,发生医院感染1 634例、1 962例次,医院感染现患率及例次现患率分别为27.76%、33.33%。医院感染部位以下呼吸道（70.39%）居首位,其次为泌尿道（12.79%）、血液（2.86%）。泌尿道插管、动静脉置管及呼吸机使用率分别达53.52%（3 151例）、37.05%（2 181例）、35.62%（2 097例）,其相关泌尿道感染、肺炎、血流感染现患率分别为4.67%、20.41%、0.60%,分别占泌尿道、肺炎、血流现患医院感染的58.57%、30.99%、23.21%,三者合计占医院感染现患率29.97%（588/1 962）。检出医院感染病原体1 795株,居前3位的分别是铜绿假单胞菌（20.78%）、鲍曼不动杆菌(17.99%)和肺炎克雷伯菌(11.64%)。抗菌药物使用率为71.58%（4 214例）,病原学送检率达75.27%（2 553/3 392）。结论综合ICU住院患者医院感染现患率以及抗菌药物使用率高,各种侵入性操作（泌尿道插管率、动静脉置管率和呼吸机使用率）高,30%的医院感染与侵入性操作相关;非发酵菌感染严重,病原学送检率尚可。     

纳米银抗菌敷料治疗78例烧伤患者的疗效及护理体会

目的观察纳米银抗菌辅料对烧伤患者创面的治疗效果。方法对天津市职业病防治院外科收治的78例不同程度烧伤患者,在入院经过清创处理消毒创面后,均选择使用纳米银抗菌敷料进行换药治疗,同时辅以抗感染、抗休克治疗,责任护士严密观察病情和伤口创面变化,同时进行精心的心理和饮食护理。结果78例患者创面均达到I期愈合,未发生并发症,未留有明显瘢痕。结论应用纳米银抗菌敷料治疗烧伤具有减轻疼痛、控制感染、促进愈合、方法简便等优势,临床治疗效果满意。     

壳聚糖宫颈抗菌膜联合多西环素治疗非淋菌性宫颈炎疗效观察

目的 观察壳聚糖宫颈抗菌膜联合多西环素治疗非淋菌性宫颈炎的疗效及安全性.方法 选取非淋菌性宫颈炎患者135例,根据治疗方案的不同分为研究组（90例）与对照组（45例）.研究组给予壳聚糖宫颈抗菌膜联合多西环素进行治疗,对照组仅给予多西环素治疗.观察两组患者的治疗有效率、病原体转阴率及不良反应发生率等.结果 研究组总治疗有效率为88.89％,显著高于对照组的53.33％ （P ＜0.05）;研究组病原体转阴率为77.78％,显著高于对照组额的44.44％ （P ＜0.05）.治疗期间,研究组患者头晕、恶心、食欲不振、上腹部不适等不良反应与对照组相比无显著差异（P＞0.05）.结论 壳聚糖宫颈抗菌膜联合多西环素治疗非淋菌性宫颈炎的临床疗效确切,能够有效提高治疗有效率,提高病原体的转阴率,且不良反应低,值得推广.     

蛋白强化的营养制剂在严重蛇咬伤病人中的应用

目的:评价蛋白强化的营养制剂在严重蛇咬伤病人中的应用效果及临床意义. 方法:将45例上肢毒蛇咬伤需行负压封闭引流术(VSD)治疗的病人随机分为试验组和对照组.试验组病人给予口服蛋白强化的营养制剂,对照组口服普通饮食治疗.比较两组病人的住院时间、VSD治疗5d后伤口新鲜肉芽组织增生满意率和住院总费用.比较两组病人VSD治疗前后血清清蛋白(ALB)、转铁蛋白(TF)、前清蛋白(PA)、纤维连接蛋白(FN)水平的变化.两组病人住院期间死亡、伤口感染、肺部感染和胃肠道不良反应的发生率. 结果:试验组病人住院时间较对照组明显缩短(P＜0.05),VSD治疗5d后伤口新鲜肉芽组织增生满意率明显高于对照组(P＜0.05).对照组病人VSD后的营养学指标水平较前有明显下降(P＜0.05). 结论:对严重毒蛇咬伤病人,给予蛋白强化的营养治疗可通过改善病人营养状况来加快伤口愈合、缩短住院时间、减少伤口和其他部位感染率的发生.     

Microscopic Visualization of Metabotropic Glutamate Receptors on the Surface of Living Cells Using Bifunctional Magnetic Resonance Imaging Probes

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Drastic Therapy for Listerial Brain Abscess Involving Combined Hyperbaric Oxygen Therapy and Antimicrobial Agents

Background

Listeria monocytogenes (L. monocytogenes) is a rare causative pathogen of brain abscess that is often found in immunocompromised patients. Although patients with supratentorial listerial abscesses showed a longer survival with surgical drainage, the standard therapy for patients with subtentorial lesions has not been established.

Case Report

We report herein a patient with supra- and subtentorial brain abscesses caused by L. monocytogenes infection. These abscesses did not respond to antibiotics, and his symptoms gradually worsened. Drainage was not indicated for subtentorial lesions, and the patient was additionally treated with hyperbaric oxygen therapy, which dramatically reduced the volume of abscesses and improved the symptoms.

Conclusions

This is the first report of drastic therapy for a patient with listerial brain abscesses involving combined antibiotics and hyperbaric oxygen therapy. The findings suggest that hyperbaric oxygen therapy is a good option for treating patients with deep-seated listerial abscesses and for who surgical drainage is not indicated.     

抗菌药物在剖宫产围手术期中的应用分析

目的：调查分析剖宫产围手术期患者抗菌药物使用情况,并对用药的合理性进行评价。方法：回顾性分析180例剖宫产围手术期患者的临床资料,对所用抗菌药物采用频度分析法进行分析。结果：所有患者抗菌药物使用率最高的为奥硝唑,消耗量最高的为奥硝唑,销售金额最高的为奥硝唑、头孢替安,用药频度最高的为奥硝唑,使用比较合理的药物为青霉素钾、头孢替安及奥硝唑;使用最不合理的药物中青霉素、头孢唑林的金额排序/DDDs（用药人次数）排序均高于1;头孢美唑的金额排序/DDDs（用药人次数）排序值最低,且低于1。单独用药比例仅为0.56%,联合用药中二联用药所占比例最高,为76.67%。结论：剖宫产患者围手术期所用抗菌药物存在使用时间较长、用法用量不当的问题,应该加强监管力度,提高医院药物的合理使用水平。     

肝脏铁过载的评估及治疗新进展

铁过载为铁在体内过度沉积并导致肝脏、胰腺、心脏、内分泌器官等结构损害和功能障碍的一种病理状态。肝脏为机体储存铁的主要部位,过度铁沉积可诱发肝内炎症及纤维组织增生,后期可发展为肝硬化,甚至肝癌,影响预后。正确的评估及有效的治疗可在一定程度上改善铁过载引起的肝组织损伤,提高患者生存率。     

Direct-acting antiviral agents for hepatitis C virus-mixed cryoglobulinaemia: dissociated virological and haematological responses

The hepatitis C virus-positive (HCV+) mixed cryoglobulinaemia (MC) is associated with haematological alterations such as monoclonal B-cell lymphocytosis or non-Hodgkin lymphomas (NHLs). Antiviral therapy for MC, based on interferon and ribavirin, has been shown to be able to eliminate the viral replication as well as the B-cell monoclonal alterations. Many studies have reported the efficacy of direct-acting antivirals (DAAs) in the treatment of HCV+ MC. However, some authors noticed the persistence of haematological diseases despite HCV eradication. To verify the effects of DAAs on B-cell proliferation, we evaluated 67 patients with HCV+ MC. Six patients had an overt NHL and 30% had monoclonal B-lymphocytosis. In 20% of the patients, the mutation L265P of the myeloid differentiation factor 88 (MYD88) gene was detected in peripheral blood. All patients had negative HCV viraemia at week 12; one had a breakthrough, while two cases relapsed. A complete clinical response of vasculitis was seen in 60% of the patients. Among the six patients with NHL, one showed a complete response, whereas in the others there were no changes in the number and size of the nodes. Among the patients carrying a clonal population in peripheral blood, only 22% became negative. These data indicate that DAAs are not able to eliminate the clonal alterations induced by HCV in a large proportion of cases.     

First-line treatment in older patients with Hodgkin lymphoma: a Surveillance,Epidemiology, and End Results (SEER)-Medicare population-based study

While Hodgkin lymphoma (HL) is highly curable in younger patients, older patients have higher relapse and death rates, which may reflect age-related factors, distinct disease biology and/or treatment decisions. We described the association between patient, disease and geographic factors and first-line treatment in older patients (≥65 years) with incident HL using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1999 to 2014 (n = 2825). First-line treatment initiated at ≤4 months after diagnosis was categorised as: full chemotherapy regimen (n = 699, 24·7%); partial chemotherapy regimen (n = 1016, 36·0%); single chemotherapy agent or radiotherapy (n = 382, 13·5%); and no treatment (n = 728, 25·8%). Among the fully treated, ABVD [doxorubicin (Adriamycin), bleomycin, vinblastine, dacarbazine]/AVD was most common (n = 635, 90·8%). Adjusted multinomial logistic regression identified factors associated with treatment. Older age, Medicaid dual eligibility, not married, frailty, cardiac comorbidity, prior cancer, earlier diagnosis date, histology, advanced disease Stage, B symptoms and South region were independently associated with increased odds of not receiving full chemotherapy regimens. In conclusion, we found variability in first-line HL treatment for older patients. Treatment differences by Medicaid and region may indicate disparities. Even after adjusting for frailty and cardiac comorbidity, age was associated with treatment, suggesting factors such as end-of-life care or shared decision-making may influence treatment in older patients.